Processed and ultra-processed foods are associated with lower-quality nutrient profiles in children from Colombia

Association between consumption of nonessential energy-dense food and body mass index among Mexican school-aged children: a prospective cohort study

BACKGROUND/OBJECTIVES

Obesity prevalence in Mexican children has increased rapidly and is among the highest in the world. We aimed to estimate the longitudinal association between nonessential energy-dense food (NEDF) consumption and body mass index (BMI) in school-aged children 5 to 11 years, using a cohort study with 6 years of follow-up.

SUBJECTS/METHODS

We studied the offspring of women in the Prenatal omega-3 fatty acid supplementation, child growth, and development (POSGRAD) cohort study. NEDF was classified into four main groups: chips and popcorn, sweet bakery products, non-cereal based sweets, and ready-to-eat cereals. We fitted fixed effects models to assess the association between change in NEDF consumption and changes in BMI.

RESULTS

Between 5 and 11 years, children increased their consumption of NEDF by 225 kJ/day (53.9 kcal/day). In fully adjusted models, we found that change in total NEDF was not associated with change in children's BMI (0.033 kg/m2, [p = 0.246]). However, BMI increased 0.078 kg/m2 for every 418.6 kJ/day (100 kcal/day) of sweet bakery products (p = 0.035) in fully adjusted models. For chips and popcorn, BMI increased 0.208 kg/m2 (p = 0.035), yet, the association was attenuated after adjustment (p = 0.303).

CONCLUSIONS

Changes in total NEDF consumption were not associated with changes in BMI in children. However, increases in the consumption of sweet bakery products were associated with BMI gain. NEDF are widely recognized as providing poor nutrition yet, their impact in Mexican children BMI seems to be heterogeneous.

Knowledge, Attitudes, and Practices Associated with the Selection of Sweetened Ultra-Processed Foods and Their Importance in Oral Health

BACKGROUND

Reading nutritional labelling helps consumers select healthier food, thereby benefitting their oral health. The purpose of this study was to describe the knowledge, attitudes, and practices (KAPs) of parents and carers of children and preteens, associated with reading nutritional labelling, selecting sweetened ultra-processed foods, and their impact on oral health.

MATERIALS AND METHODS

This was a descriptive cross-sectional study in which a validated questionnaire was administered to 298 parents and caregivers of children aged 1-12 years from different districts in Villavicencio, Colombia. Participants' scores, based on the number of correct answers, were used to classify their level of KAP as low, medium, or high. In addition, the frequency of responses, the KAP levels, and the median scores were analysed. Finally, associations were determined using the chi-square test.

RESULTS

Most participants reached a medium level in terms of knowledge (41.6%) and attitudes (49.3%) and a low level in terms of practices (43.3%). An association was found between participants' level of KAPs and their socioeconomic and educational level (p < 0.05).

CONCLUSIONS

The study findings reveal inadequate KAPs associated with nutritional labelling, adequate food selection, and the importance of oral health.

How and why ultra-processed foods harm human health

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

Is food produced by farmers healthier, more natural, and gaining more popularity? Research on the influencing mechanism of food producer labels on consumers' food choices

Introduction

Extant studies have demonstrated the relationship between naturalness and healthiness, and the effectiveness of various food labels in influencing consumers' perception of food and subsequent food choices. However, little attention has been given to food producer labels.

Methods

Drawing on Stimulation-Organism-Response theory, the current study explored the causal relationship between food producer labels and consumers' food choices. Three studies (562 participants) were employed to test the main effect, the mediating effect, and the moderating effect.

Results

The results showed that: (1) food producer label could influence consumers' food choice, that is, produced-by-farmer label (vs. produced-by-enterprise label vs. control group) could significantly increase consumers' food choices, while there is no significant difference between produced-by-enterprise label and control group. (2) Perceived naturalness and standardization perception mediate the effects on consumers' food choices of food producer labels. (3) Food processing level moderates the effect of food producer label on consumers' food choices.

Discussion

The current study enriches the research of food label and food choice, expands the application of Stimulation-Organism-Response theory in consumer behavior, and provides some practical suggestions for consumers, enterprise and policy-maker. Various kinds of experiments (online and offline) enhanced the conclusions' ecological validity. Finally, the limitations and future research are discussed.

Ultra-processed food consumption is associated with variations in daily routines in elementary schoolchildren during the COVID-19 pandemic in Chile

OBJECTIVE

To assess the association between child ultra-processed food (UPF) consumption and home-school learning environment characteristics during school closures due to the COVID-19 pandemic in schoolchildren with low- and middle income in Chile.

DESIGN

Cross-sectional. UPF consumption was collected using the Nova screener. We apply the structured days hypothesis (SDH) to assess home-school learning environment characteristics with three constructs that summarised school preparedness for online teaching and learning, school closure difficulties for caregivers and child routine. We explored associations between child UPF consumption and home-school environment characteristics using multivariate linear regression analyses after controlling for child demographic and school characteristics.

SETTING

Low- and middle-income neighbourhoods in southeastern Santiago, Chile.

PARTICIPANTS

Children from the Food Environment Chilean Cohort (n 428, 8-10 years old).

RESULTS

Based on the Nova score, child mean consumption of UPF was 4·3 (sd 1·9) groups. We found a statistically significant negative association between child routine for eating, play and study and child UPF consumption when we adjusted for child sociodemographic (model 1: β = -0·19, (95 % CI -0·40, 0·02)) and school characteristics (model 2: β = -0·20, (95 % CI -0·41, 0·00)). Associations between school preparedness for online teaching or school closure difficulties and UPF were not statistically significant.

CONCLUSIONS

Variations in child routines during the COVID-19 pandemic were negatively associated with UPF intake in schoolchildren with low- and middle income. Our findings are consistent with the SDH, suggesting the school environment helps regulate eating behaviours. Future research should evaluate what happens when children return to in-person classes at school.

Consumption of ultra-processed foods and associated factors in children from Barbacena (MG), Brazil

OBJECTIVE

To evaluate the prevalence of ultra-processed food consumption and associated factors among children enrolled in the public school system of the city of Barbacena, Minas Gerais, Brazil.

METHODS

This is a cross-sectional study conducted with schoolchildren aged 7-9 years, of both sexes, enrolled in state public schools. Food intake was assessed using the Previous Day Food Questionnaire and the level of physical activity by the Previous Day Physical Activity Questionnaire. The listed foods were classified according to the extent and purpose of industrial processing, using the NOVA classification. Pearson's χ2 test, Fisher's exact test, χ2 with Yates correction, and Poisson regression were used in the statistical analysis, estimating the crude and adjusted prevalence ratio, with 95% confidence intervals.

RESULTS

The prevalence of daily ultra-processed food consumption was 69.6%. After adjusted analyses, the consumption of ultra-processed food was associated with the omission of breakfast, mid-afternoon snack, supper, low physical activity, and consumption of risk foods. On the other hand, consumption of in natura or minimally processed foods was associated with older age, the consumption of lunch, mid-afternoon snack, dinner, and protective foods.

CONCLUSIONS

There is a high prevalence of ultra-processed foods consumption, associated with unhealthy dietary habits among schoolchildren. This highlights the need for nutritional counseling and educational actions, favoring healthy eating in childhood.

Association between consumption of nonessential energy-dense food and body mass index among Mexican school-aged children: A prospective cohort study

BACKGROUND/OBJECTIVES

Obesity prevalence in Mexican children has increased rapidly and is among the highest in the world. We aimed to estimate the longitudinal association between nonessential energy-dense food (NEDF) consumption and body mass index (BMI) in school-aged children 5 to 11 years, using a cohort study with 6 years of follow-up.

SUBJECTS/METHODS

We studied the offspring of women in the Prenatal omega-3 fatty acid supplementation, child growth, and development (POSGRAD) cohort study. NEDF were classified into four main groups: chips and popcorn, sweet bakery products, non-cereal based sweets, and ready-to-eat cereals. We fitted fixed effects models to assess the association between change in 418.6 kJ (100 kcal) of NEDF consumption and changes in BMI.

RESULTS

Between 5 and 11 years, children increased their consumption of NEDF by 225 kJ/day (53.9 kcal/day). In fully adjusted models, we found that change in total NEDF was not associated with change in children's BMI (0.033 kg/m2, [p=0.246]). However, BMI increased 0.078 kg/m2 for every 418.6 kJ/day (100 kcal/day) of sweet bakery products (p=0.035) in fully adjusted models. For chips and popcorn, BMI increased 0.208 kg/m2 (p=0.035), yet, the association was attenuated after adjustment (p=0.303).

CONCLUSIONS

Changes in total NEDF consumption were not associated with changes in BMI in children. However, increases in the consumption of sweet bakery products were associated with BMI gain. NEDF are widely recognized as providing poor nutrition yet, their impact in Mexican children BMI seems to be heterogeneous.

Ultra-processed food consumption deteriorates the profile of micronutrients consumed by Portuguese adults and elderly: the UPPER project

PURPOSE

This study aims to describe micronutrient intake according to food processing degree and to investigate the association between the dietary share of ultra-processed foods and micronutrient inadequacies in a representative sample of Portuguese adult and elderly individuals.

METHODS

Cross-sectional data from the National Food, Nutrition and Physical Activity Survey (2015/2016) were used. Food consumption data were collected through two 24-h food recalls, and food items were classified according to the NOVA system. Linear regression models were used to assess the association between the micronutrient density and the quintiles of ultra-processed food consumption-crude and adjusted. Negative Binomial regressions were performed to measure the prevalence ratio of micronutrient inadequacy according to ultra-processed food quintiles.

RESULTS

For adults, all evaluated vitamins had significantly lower content in the fraction of ultra-processed foods compared to unprocessed or minimally processed foods, except vitamin B2. For the elderly, out of ten evaluated vitamins, seven presented significantly less content in ultra-processed foods compared to non-processed ones. The higher energy contribution of ultra-processed foods in adults was associated with a lower density of vitamins and minerals. This association was not observed in the elderly. For adults, compared with the first quintile of ultra-processed food consumption, the fifth quintile was positively associated with inadequate intakes of vitamin B6 (PR 1.51), vitamin C (PR 1.32), folate (PR 1.14), magnesium (PR 1.21), zinc (PR 1.33), and potassium (PR 1.19).

CONCLUSION

Our results corroborate the importance of public health actions that promote a reduction in the consumption of ultra-processed foods.

Sex modifies the renal consequences of high fructose consumption introduced after weaning

After lactation, many children consume fructose-rich processed foods. However, overconsumption of these foods can predispose individuals to non-communicable chronic diseases, which can have different repercussions depending on the sex. Thus, we evaluated the effects of fructose overload introduced after weaning on the renal function of young rats of both sexes.

Methods: After weaning, male and female offspring of Wistar rats were assigned to drink water (the male/water and female/water groups) or 20% D-fructose solution (male/fructose and female/fructose groups). Food and water or fructose solution was offered ad libitum. Rats were evaluated at 4 months. Parameters analyzed: blood pressure, body weight, triglyceride levels, glomerular filtration rate, sodium, potassium, calcium, and magnesium excretion, macrophage infiltration, and eNOS and 8OHdG expression in renal tissue. CEUA-UNIFESP: 2757270117.

Results: Fructose intake affected the blood pressure, body weight, and plasma triglyceride in all rats. Glomerular filtration rate was significantly reduced in males that received fructose when compared to that of the control group. Sodium and potassium excretion decreased in all fructose-treated rats; however, the excreted load of these ions was significantly higher in females than in males. In the female control group, calcium excretion was higher than that of the male control group. Fructose overload increased magnesium excretion in females, and also increased macrophage infiltration and reduced eNOS expression in both males and females.

Conclusion: Fructose overload introduced after weaning caused metabolic and renal changes in rats. Renal function was more affected in males; however, several significant alterations were also observed in the female-fructose group.

Characteristics associated with dietary patterns in Brazilian children under two years of age

OBJECTIVE

To analyze the dietary patterns of Brazilian children under two years of age and assess their association with sociodemographic characteristics and health service use.

METHODS

This is a cross-sectional study with data from the 2013 National Health Survey (PNS). Patterns were found for two age groups by principal component analysis and their correlation with characteristics of interest was tested by linear regression models.

RESULTS

We found two dietary patterns for our groups. The first consisted of the consumption of fresh or minimally processed foods and the second, of ultra-processed foods. The greater adherence of children between six and 11 months to the first pattern was associated with higher per capita family income and urban residences in the most developed regions of Brazil. At 12 months or more, adherence related to white race/color, higher per capita family incomes, residence in more developed regions, and visits to private childcare. Adherence to the second pattern among children under one year of age was inversely associated with Yellow or Indigenous race/color, residence in the Brazilian Northeast, and childcare in specialized public or private services. At 12 months or more, greater adherence was directly associated with Black or Brown children who resided in more developed regions, and inversely associated with those living in the Brazilian Northeast.

CONCLUSION

We found two opposite dietary patterns in Brazilian children under two years of age and that several social determinants modify their chance of adhering to these patterns.

Llamado a la implementación de la Ley 2120 de 2021 contra la comida chatarra en los tiempos del COVID-19 en Colombia

Durante dos años y medio, tanto en Colombia como en el resto del mundo, hemos enfrentado la pandemia generada por el SARS-CoV-2, agudizando los múltiples problemasde salud pública que venían cursando a manera de sindemias. Tal es el caso de las enfermedades crónicas no transmisibles asociadas, entre otros factores, a los malos hábitos alimenticios, especialmente por el gran consumo de alimentos ultraprocesados y bebidas azucaradas. En julio del 2021, se aprobó la Ley 2120, por medio de la cual se adoptaron medidas para fomentar entornos alimentarios saludables.Entre estas medidas, también se promueve que los alimentos empacados, procesados y que afectan negativamente la salud humana, tengan un sello que identifique sus componentes y valor nutricional para informar a los consumidores sobre el producto que están comprando o consumiendo.Entre las enfermedades más prevalentes en Colombia que afectan la salud bucal, se encuentran las caries y las periodontitis, ambas con factores de riesgo comunes con las enfermedades crónicas no transmisibles. Dados sus costos y prevalencia, dichas enfermedades crónicas no transmisibles resultan primordiales desde un enfoque de gestión del riesgo en salud pública, siendo, quizá, su gravedad mayor durante la pandemia generada por el SARS CoV-2.Asimismo, se especula que la población confinada pudo llegar a consumir más comida chatarra durante la pandemia del COVID-19 en comparación con otros períodos, además,porque en aquellos con enfermedades crónicas no transmisibles, el confinamiento obligado se asocia con mayor sedentarismo y con un menor número de controles médicos regulares, asuntos que se han reportado previamente.La promulgación de la ley de comida chatarra no va a cambiar los hábitos de alimentación de los colombianos “de la noche a la mañana” y, por esto, se necesita con urgencia implementar procesos de educación y sensibilización frente a los efectos adversos de los alimentos procesados y ultraprocesados en la salud.

Evolution of infant feeding practices in children from 9 to 24 months, considering complementary feeding indicators and food processing: Results from the Brazilian cohort of the MAL‐ED study

Infant feeding practices impact children's nutritional and health status, influencing growth and development. This study aimed to analyse the evolution of infant feeding practices from 9 to 24 months of age, considering infant and young child feeding (IYCF) indicators and food processing. The infant feeding practices in children from the Brazilian site of the MAL‐ED study were evaluated at 9 (n = 193), 15 (n = 182) and 24 months (n = 164) using 24‐h dietary recalls. IYCF indicators were evaluated, and the extent of food processing was evaluated, using the NOVA classification. Breastfeeding declined significantly over time, from 77.6% at 9 months to 45.1% at 24 months. Although dietary diversity did not significantly change during the study period (80.5% at 24 months), the minimum acceptable diet significantly increased from 67.9% to 76.1% at 24 months (p < 0.0005). All the studied children consumed sweetened beverages from 9 months. Unhealthy food consumption and zero vegetable or fruit consumption significantly increased over time (p < 0.0005). Unprocessed food consumption decreased from 9 to 24 months of age (p < 0.0005), while ultra‐processed food consumption increased (p < 0.0005) during the study period. Logistic regressions showed that, at 9 months, breastfed children presented a lower risk for ultra‐processed food consumption (odds ratio [OR] = 0.31; 95% confidence interval [CI] = 0.13–0.77); and children reaching the minimum acceptable diet presented more risk for ultra‐processed food consumption (OR = 2.31; 95% CI = 1.01–5.27). In conclusion, data showed a reduction in the quality of infant feeding practices over the first 2 years of life, with a decrease in breastfeeding and an increase in the consumption of unhealthy and ultra‐processed foods.

Data showed a reduction in the quality of infant feeding practices over the first 2 years of life.

Breastfeeding decreased over the studied period. There was an increase in the consumption of ultra‐processed and unhealthy foods, which occurred concomitantly to the increase of no consumption of fruits/vegetables.

Breastfeeding was an important protective factor against a greater consumption of ultra‐processed food.

National nutrition policy should consider promoting breastfeeding and increasing fresh and minimally processed food consumption in children under 2 years.

Ultra-processed Foods, Weight Gain, and Co-morbidity Risk

PURPOSE OF REVIEW

The purpose of this review is to provide an update on the available data regarding the associations of Ultra-processed food (UPF) consumption with food intake and possible underlying mechanisms relating UPF consumption to weight gain and co-morbidities.

RECENT FINDINGS

In primarily observational studies, UPF consumption is consistently associated with an increased risk for weight gain among adults and children and increased risk for adiposity-related co-morbidities in adults. In a single mechanistic study, consumption of UPFs led to increased energy intake and weight gain relative to whole foods. UPFs tend to be more energy-dense than nutrient-dense, and UPF consumption is associated with increased adiposity and co-morbidity risk. These data suggest that recommendations to limit UPF consumption may be beneficial to health - though further mechanistic studies are needed.

Geographical and Temporal Variability of Ultra-Processed Food Consumption in the Spanish Population: Findings from the DRECE Study

The consumption of ultra-processed foods (UPFs) has increased in recent decades, worldwide. Evidence on the negative impacts of food processing on health outcomes has also been steadily increasing. The aim of this study is to describe changes in consumption patterns of ultra-processed foods in the Spanish population over time and their geographical variability. Data from four representative cohorts of the Spanish population were used (1991−1996−2004−2008). Dietary information was collected using a validated frequency questionnaire and categorized using the NOVA classification. A total increase of 10.8% in UPF consumption between 1991 and 2008 was found in Spain (p-value < 0.001). The products contributing most to UPF consumption were sugar-sweetened beverages, processed meats, dairy products, and sweets. Those who consumed more ultra-processed foods were younger (p-value < 0.001) and female (p-value = 0.01). Significant differences between the different geographical areas of Spain were found. The eastern part of Spain was the area with the lowest UPF consumption, whereas the north-western part was the area with the highest increase in UPF consumption. Given the negative effect that the consumption of ultra-processed foods has on health, it is necessary to implement public health policies to curb this increase in UPF consumption.

Ultra-processed food intake is associated with children and adolescents with congenital heart disease clustered by high cardiovascular risk factors

The excessive intake of ultra-processed foods (UPF) is associated with an increase in cardiovascular risk. However, the effect of UPF intake on cardiovascular health in children and adolescents with congenital heart disease (CHD) is unknown. The aim of the present study was to describe UPF intake and evaluate associations with isolated cardiovascular risk factors and children and adolescents with CHD clustered by cardiovascular risk factors. A cross-sectional study was conducted involving 232 children and adolescents with CHD. Dietary intake was assessed using three 24-hour recalls. UPFs were categorized using the NOVA classification. The cardiovascular risk factors evaluated were central adiposity, elevated high-sensitivity C-reactive protein (hs-CRP) and subclinical atherosclerosis. The clustering of cardiovascular risk factors (waist circumference, hs-CRP and carotid intima-media thickness) was performed, allocating the participants to two groups (high versus low cardiovascular risk). UPFs contributed 40.69% (SD 6.21) to total energy intake. The main UPF groups were ready-to-eat and take-away/fast foods (22.2% energy from UPFs). The multivariable logistic regression revealed that an absolute increase of 10% in UPF intake (OR=1.90; 95% CI: 1.01;3.58) was associated with central adiposity. An absolute increase of 10% in UPF intake (OR=3.77; 95% CI: 1.80;7.87) was also associated with children and adolescents with CHD clustered by high cardiovascular risk after adjusting for confounding factors. Our findings demonstrate that UPF intake should be considered a modifiable risk factor for obesity and its cardiovascular consequences in children and adolescents with CHD.

Ultraprocessed Products as Food Fortification Alternatives: A Critical Appraisal from Latin America

Ultraprocessed products (UPPs), associated with obesity and non-communicable diseases (NCDs), are becoming predominant on the global market and a target for market-driven fortification initiatives. The aim of this article is to describe the implications of adding micronutrients to UPPs with excessive amounts of critical nutrients associated with NCDs and provide recommendations for legislation and policies. UPPs with added micronutrients such as breakfast cereals, sugar-sweetened beverages, powder beverages, fruit juices, sauces, and bouillon cubes, among others, are commonly available and heavily promoted in Latin American countries. Misleading advertising of UPPs with added micronutrients and with excessive content of sugar, fat, and salt might increase the consumption of such products, giving them a “health halo effect” that leads consumers to overestimate their nutritional quality and healthfulness. Although international collections of standards such as the Codex Alimentarius provide some guidelines on this matter, countries need to implement national legislations, through a food systems approach, to regulate the marketing and labeling of UPPs. Lastly, there is still the need to foster research to close knowledge gaps and help countries to guide the process of food fortification strategies from a regulatory standpoint.

Access to Healthy Wheat and Maize Processed Foods in Mexico City: Comparisons across Socioeconomic Areas and Store Types

The contributions of processed foods to the overweight and obesity problem in Latin America are well known. Engagement with the private and public sectors on possible solutions requires deeper insights into where and how these products are sold and the related implications for diet quality. This article characterizes the diversity of wheat and maize processed foods (WMPFs) available to consumers in Mexico City. Data were gathered across nine product categories at different points of sale (supermarkets, small grocery stores, convenience stores) in high and low socioeconomic (SE) areas. We assessed WMPFs based on Nutri-Score profile, price, and health and nutrition claims. Roughly 17.4% of the WMPFs were considered healthy, of which 62.2% were pastas and breads. Availability of healthy WMPFs was scarce in most stores, particularly in convenience stores Compared to supermarkets in the low SE area, those in the high SE area exhibited greater variety in access to healthy WMPFs across all product categories. In the low SE area, healthy WMPFs were priced 16-69% lower than unhealthy WMPFs across product categories. The extensive variety of unhealthy WMPFs, the limited stock of healthy WMPFs in most retail outlets, and the confusing health and nutrition claims on packaging make it difficult for urban consumers to find and choose healthy WMPFs.

Effect of a dietary intervention including minimal and unprocessed foods, high in natural saturated fats, on the lipid profile of children, pooled evidence from randomized controlled trials and a cohort study

Aim

To study the possible effects of a dietary intervention with minimal and unprocessed foods, high in natural saturated fats on the lipid profile and body mass index of children.

Method

This study combines three intervention studies; one non-randomized retrospective cohort study and two randomized controlled trials, to a pooled analysis. The intervention group received a dietary intervention of minimal and unprocessed foods for three to six months, consisting of five times per week green vegetables, three times per week beef, daily 200–300 mL whole cow’s milk (3.4% fat) and whole dairy butter (80% fat) on each slice of bread. The control group continued their usual dietary habits. Raw data of the three intervention studies where combined into one single dataset for data analysis, using mixed effects analysis of covariance to test the effects of the dietary advice on the main study outcomes, which are measurements of the lipid profile.

Results

In total, 267 children aged 1 to 16 years were followed. 135 children were included in the intervention group and 139 children in the control group. Characteristics (age, gender and follow-up period) were equally distributed between the groups at baseline. In the intervention group HDL-cholesterol increased significantly from 1.22 mmol/L, 95% confidence interval (CI) 1.14–1.32 to 1.42 mmol/L 95% CI 1.30–1.65 (p = 0.007). The increase over time in HDL cholesterol in the intervention group was significantly different compared to the increase in the control group (from 1.26 mmol/L, 95% CI 1.19–1.35, to 1.30 mmol/L, 95% CI 1.26–1.37) (p = 0.04). Due to the increased HDL concentration in the intervention group, the total cholesterol/HDL cholesterol ratio decreased significantly from 3.70 mmol/L, 95% CI 3.38–3.87, to 3.25 mmol/L, 95% CI 2.96–3.31 (p = 0.05).

Conclusion

Consumption of minimal and unprocessed foods (high in natural saturated fats) has favourable effects on HDL cholesterol in children. Therefore, this dietary advice can safely be recommended to children.

Food insecurity, type 2 diabetes, and hyperglycaemia: A systematic review and meta-analysis

AIMS

Food insecurity (FIS) is a major public health issue with possible implications for type 2 diabetes mellitus (T2DM) risk. We conducted a systematic review and meta-analysis to explore the association between FIS and T2DM.

METHODS

We performed a systematic search in PubMed, Embase, Scopus, and Web of Science. All cross-sectional, peer-reviewed studies investigating the link between FIS and T2DM were included. Population characteristics, study sizes, covariates, T2DM diagnoses, and diabetes-related clinical measures such as fasting blood glucose (FBG) and HbA1c were extracted from each study. Outcomes were compared between food insecure and food secure individuals. Effect sizes were combined across studies using the random effect model.

RESULTS

Forty-nine peer-reviewed studies investigating the link between FIS and T2DM were identified (n = 258,250). Results of meta-analyses showed no association between FIS and clinically determined T2DM either through FBG or HbA1c: OR = 1.22 [95%CI: 0.96, 1.55], Q(df = 5) = 12.5, I2  = 60% and OR = 1.21 [95%CI: 0.95, 1.54], Q(df = 5) = 14; I2  = 71% respectively. Standardized mean difference (SMD) meta-analyses yielded no association between FIS and FBG or HbA1c: g = 0.06 [95%CI: -0.06, 0.17], Q(df = 5) = 15.8, I2  = 68%; g = 0.11 [95% CI: -0.02, 0.25], Q(df = 7) = 26.8, I2  = 74% respectively. For children, no association was found between FIS and HbA1c: g = 0.06 [95%CI: 0.00, 0.17], Q(df = 2) = 5.7, I2  = 65%.

CONCLUSIONS

Despite multiple proposed mechanisms linking FIS to T2DM, integration of the available literature suggests FIS is not associated with clinically determined T2DM or increases in FBG or HbA1c among adult patients.

Social inequalities shape diet composition among urban Colombians: The Colombian Nutritional Profiles cross-sectional study

OBJECTIVE

To explore the influence of socioeconomic position on habitual dietary intake in Colombian cities.

DESIGN

We conducted a cross-sectional, population-based study in five Colombian cities. Dietary intake was assessed with a 157-item semi-quantitative food frequency questionnaire previously developed for the Colombian population. Nutrient analysis was performed using national and international food composition tables. Socioeconomic position was assessed with two indicators: a government-defined, asset-based, household-level index called socioeconomic stratum (SES) and, among adults, highest educational level attained.

SETTING

The five main urban centers of Colombia: Bogotá, Medellin, Barranquilla, Cali and Bucaramanga.

PARTICIPANTS

Probabilistic, multistage sample of 1865 participants (n=1491 for analyses on education).

RESULTS

For both sexes, increasing SES was associated with a lower consumption of energy (p-trend <0.001 in both sexes), carbohydrates (p-trend ˂0.001 in both sexes), sodium (p-trend=0.005 in males, <0.001 in females), saturated fatty acids (p-trend <0.001 in both sexes) and among females, cholesterol (p-trend=0.002). More educated men consumed significantly less energy and carbohydrates (p-trend=0.036 and ˂0.001, respectively). Among men, intake of trans fats increased monotonically with educational level, being 21% higher among college graduates relative to those with only elementary education (p-trend=0.023). Among women, higher educational level was associated with higher MUFA intake (p-trend=0.027).

CONCLUSIONS

SES and educational level are strong correlates of the usual diet of urban Colombians. Economically deprived and less educated segments of society display dietary habits that make them vulnerable to chronic diseases and should be the primary target of public health nutrition policies.

Association Between Family Physical Violence Victimization and Food Consumption Among Brazilian Adolescents

Few studies have evaluated the relationship between stressful events, such as child abuse and food consumption. Thus, the objective of this study is to assess whether family physical violence victimization is associated with food consumption in adolescents. We used data from the Brazilian National Adolescent School-based Health Survey, carried out in 2015, in a representative sample of 102,072 students attending ninth grade from public and private schools. We used Venn diagrams and logistic regression analysis to, respectively, graphically represent and evaluate the association between the consumption of ultra-processed food (soft drinks, sweets/candies, and salty biscuits, packaged snacks, or processed meat) and in natura food (beans, fruits and vegetables) with victimization from family physical violence. We found a lower consumption of in natura and higher consumption of ultra-processed foods among adolescent victims when compared with nonvictims of family physical violence. The probability of consuming 4 or more times a week increased by 44% for salty biscuits, packaged snacks, or processed meats; 38% for soft drinks; and 22% for sweets among adolescents who reported violence. On the contrary, the probability of consuming 4 or more times a week decreased by 25% for beans, 19% for vegetables, and 13% for fruits among adolescent victims of family physical violence. We conclude that family physical violence victimization is associated with high consumption of ultra-processed food and low consumption of in natura food among Brazilian adolescents. Therefore, issues related to violence in childhood and adolescence should be addressed in interventions aimed at altering food consumption and consequent prevention, control, and treatment of nutrition-related outcomes to increase their effectiveness.

Reverse thinking: taking a healthy diet perspective towards food systems transformations

Food systems that deliver healthy diets without exceeding the planet’s resources are essential to achieve the worlds’ ambitious development goals. Healthy diets need to be safe, accessible, and affordable for all, including for disadvantaged and nutritionally vulnerable groups such as of smallholder producers, traders, and consumers in low- and middle-income countries. Globally, food systems are experiencing rapid and drastic changes and are failing to fulfil these multiple duties simultaneously. The international community therefore calls for rigorous food systems transformations and policy solutions to support the achievement of healthy diets for all. Most strategies, however, are essentially supply- and market-oriented. Incorporation of a healthy diet perspective in food system transformation is essential to enable food systems to deliver not only on supplying nutritious foods but also on ensuring that consumers have access can afford and desire healthy, sustainable, and culturally acceptable diets. This paper argues that this should be guided by information on diets, dietary trends, consumer motives, and food environment characteristics. Transformational approaches and policies should also take into account the stage of food system development requiring different strategies to ensure healthier diets for consumers. We review current knowledge on drivers of consumer choices at the individual and food environment level with special emphasis on low- and middle income countries, discuss the converging and conflicting objectives that exist among multiple food-system actors, and argue that failure to strengthen synergies and resolve trade-offs may lead to missed opportunities and benefits, or negative unintended consequences in food system outcomes. The paper proposes a menu of promising consumer- and food-environment- oriented policy options to include in the food systems transformation agenda in order to shift LMIC consumer demand towards healthier diets in low- and middle income countries.

Packaged Foods Labeled as Organic Have a More Healthful Profile Than Their Conventional Counterparts, According to Analysis of Products Sold in the U.S. in 2019-2020

The organic food market's recent rapid global growth reflects the public's interest in buying certified organic foods, including packaged products. Our analysis shows that packaged foods containing fewer ingredients associated with negative public health outcomes are more likely to be labeled organic. Previous studies comparing organic and conventional foods focused primarily on nutrient composition. We expanded this research by additionally examining ingredient characteristics, including processing and functional use. Our dataset included nutrition and ingredient data for 8240 organic and 72,205 conventional food products sold in the U.S. from 2019 to 2020. Compared to conventional foods, organic foods in this dataset had lower total sugar, added sugar, saturated fat and sodium content. Using a mixed effects logistic regression, we found that likelihood of classification as organic increased as sodium content, added sugar content and the number of ultra-processed ingredients and cosmetic additives on the product label decreased. Products containing no trans-fat ingredients were more likely to be labeled organic. A product was more likely to be classified "organic" the more potassium it contained. These features of organic foods sold in the U.S. are significant because lower dietary ingestion of ultra-processed foods, added sugar, sodium and trans-fats is associated with improved public health outcomes.

Use of Different Food Classification Systems to Assess the Association between Ultra-Processed Food Consumption and Cardiometabolic Health in an Elderly Population with Metabolic Syndrome (PREDIMED-Plus Cohort)

The association between ultra-processed food (UPF) and risk of cardiometabolic disorders is an ongoing concern. Different food processing-based classification systems have originated discrepancies in the conclusions among studies. To test whether the association between UPF consumption and cardiometabolic markers changes with the classification system, we used baseline data from 5636 participants (48.5% female and 51.5% male, mean age 65.1 ± 4.9) of the PREDIMED-Plus (“PREvention with MEDiterranean DIet”) trial. Subjects presented with overweight or obesity and met at least three metabolic syndrome (MetS) criteria. Food consumption was classified using a 143-item food frequency questionnaire according to four food processing-based classifications: NOVA, International Agency for Research on Cancer (IARC), International Food Information Council (IFIC) and University of North Carolina (UNC). Mean changes in nutritional and cardiometabolic markers were assessed according to quintiles of UPF consumption for each system. The association between UPF consumption and cardiometabolic markers was assessed using linear regression analysis. The concordance of the different classifications was assessed with intra-class correlation coefficients (ICC3, overall = 0.51). The highest UPF consumption was obtained with the IARC classification (45.9%) and the lowest with NOVA (7.9%). Subjects with high UPF consumption showed a poor dietary profile. We detected a direct association between UPF consumption and BMI (p = 0.001) when using the NOVA system, and with systolic (p = 0.018) and diastolic (p = 0.042) blood pressure when using the UNC system. Food classification methodologies markedly influenced the association between UPF consumption and cardiometabolic risk markers.

Is Food Addictive? A Review of the Science

As ultraprocessed foods (i.e., foods composed of mostly cheap industrial sources of dietary energy and nutrients plus additives) have become more abundant in our food supply, rates of obesity and diet-related disease have increased simultaneously. Food addiction has emerged as a phenotype of significant empirical interest within the past decade, conceptualized most commonly as a substance-based addiction to ultraprocessed foods. We detail (a) how approaches used to understand substance-use disorders may be applicable for operationalizing food addiction, (b) evidence for the reinforcing potential of ingredients in ultraprocessed foods that may drive compulsive consumptions, (c) the utility of conceptualizing food addiction as a substance-use disorder versus a behavioral addiction, and (d) clinical and policy implications that may follow if ultraprocessed foods exhibit an addictive potential. Broadly, the existing literature suggests biological and behavioral parallels between food addiction and substance addictions, with ultraprocessed foods high in both added fat and refined carbohydrates being most implicated in addictive-like eating. Future research priorities are also discussed, including the need for longitudinal studies and the potential negative impact of addictive ultraprocessed foods on children. Expected final online publication date for the Annual Review of Nutrition, Volume 41 is September 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Food environment solutions for childhood obesity in Latin America and among Latinos living in the United States

The food environment is a major contributor to unhealthy diets in children and, therefore, to the increasing rates of obesity. Acclaimed by scholars across the world, Latin American countries have been leaders in implementing policies that target different aspects of the food environment. Evidence on the nature and to what extent children are exposed and respond to unhealthy food environments in the region and among Latinos in the United States is, however, deficient. The objective of this review is to use the integrated International Network for Food and Obesity/noncommunicable diseases (NCDs) Research, Monitoring and Action Support (INFORMAS) framework to create healthy food environment to (i) compare the key elements of childhood obesity-related food environments in Latin America and for Latinos living in the United States; (ii) describe the evidence on solutions to improve childhood obesity-related food environments; and (iii) identify research priorities to inform solutions to fight childhood obesity in these populations. We found that an integrated body of evidence is needed to inform an optimal package of policies to improve food environments to which children in Latin America and Latino children in the United States are exposed and more efficiently translate policy solutions to help curb growing childhood obesity levels across borders.

Ultra-Processed Food Consumption Among Chilean Preschoolers Is Associated With Diets Promoting Non-communicable Diseases

Introduction: In adults, intake of ultra-processed foods (UPF) has been linked with poor diets and adverse health outcomes. In young children, evidence is scarcer but suggests a higher dietary share of UPF.

Objective: To quantify the intake of UPF and its association with the nutrient composition of the diet in a sample of preschoolers in Santiago, Chile.

Methods: Cross-sectional analysis of dietary data (24-h recall survey) from 960 preschoolers. Foods were categorized according to the extent and purpose of processing (NOVA classification) and participants were classified in quintiles of UPF intake. We explored the associations between UPF intake (% of the total energy) and intake of nutrients of concern for non-communicable disease development (carbohydrates, total sugars, fats, and sodium), and nutrients for promotion (proteins, polyunsaturated fats, iron, calcium, zinc, vitamins A, D, C, and B₁₂, folate, and fiber) using multivariate regression after controlling for covariates.

Results: UPF constituted 49% of the total energy intake. Preschoolers with higher intake consumed more energy, saturated and monounsaturated fats, carbohydrates, total sugars, and vitamin D, compared to preschoolers in the lowest quintile of UPF intake. In contrast, UPF intake was negatively associated with the consumption of proteins, polyunsaturated fats, fiber, zinc, vitamin A, and sodium (p < 0.05).

Conclusion: In Chilean preschoolers, UPF was the primary source of energy intake. The dietary share of UPF was associated with the nutrient composition of the diet. Improving children's diet should consider not only promoting healthy food consumption but also limiting UPF consumption.

Review: The Consumption of Ultra-Processed Foods and Non-communicable Diseases in Latin America

The objective of this article is to assess current trends in Latin America with respect to the consumption of ultra-processed foods and non-communicable diseases. This review addresses the rapid growth of the ultra-processed foods market in Latin America which, along with other social and environmental factors, has been shown to be highly influential in the prevalence of non-communicable diseases such as obesity, type 2 diabetes, hypertension and cardiovascular disease, cancer, and all-cause mortality. Ultra-processed foods represent a health concern for a number of reasons. They are generally calorically dense and high in sodium, sugar, and saturated and trans fats, and low in fiber and protein. Additionally, they may contain additives and neoformed compounds that affect health in ways that have not been adequately researched. Furthermore, the packaging of ultra-processed foods may contain hormone disruptors whose effects on humans are not entirely clear. Associations between ultra-processed foods and cardio-metabolic dysfunction, as well as several plausible mechanisms, will be evaluated.

[Food consumption according to the level of processing among adolescents from the rural area of a municipality in the south of Brazil]

The scope of the study was to assess food consumption according to the level of processing and the ingestion of nutrients among adolescents in the rural areas of Pelotas-RS. It involved a cross-sectional census-type study with 462 students in grades 6 through 9 of elementary school from 21 municipal schools in the rural area. Food consumption was evaluated by 24-hour dietary recall (24HR), with food products being classified into four groups according to the level of processing in line with the NOVA classification. The average daily energy intake was 1,921 calories, namely 48.2% from in natura or minimally processed food and 31.9% from ultra-processed food. The products that contributed most to the total daily calory intake were rice, meat, legumes, sugar, homemade bread, cookies, candies, soda, and artificial juices. A higher proportion of macro and micronutrients was observed from ingestion of in natura or minimally processed food, although carbohydrates, fat and iron contents derived from ultra-processed food was also high. The results of the study indicate that adolescents in rural areas have a higher energy intake from fresh or minimally processed food, however, it is observed that ultra-processed food is also part of their diet, thereby revealing the nutritional transition.

Nutritional Components in Western Diet Versus Mediterranean Diet at the Gut Microbiota-Immune System Interplay. Implications for Health and Disease

The most prevalent diseases of our time, non-communicable diseases (NCDs) (including obesity, type 2 diabetes, cardiovascular diseases and some types of cancer) are rising worldwide. All of them share the condition of an "inflammatory disorder", with impaired immune functions frequently caused or accompanied by alterations in gut microbiota. These multifactorial maladies also have in common malnutrition related to physiopathology. In this context, diet is the greatest modulator of immune system-microbiota crosstalk, and much interest, and new challenges, are arising in the area of precision nutrition as a way towards treatment and prevention. It is a fact that the westernized diet (WD) is partly responsible for the increased prevalence of NCDs, negatively affecting both gut microbiota and the immune system. Conversely, other nutritional approaches, such as Mediterranean diet (MD), positively influence immune system and gut microbiota, and is proposed not only as a potential tool in the clinical management of different disease conditions, but also for prevention and health promotion globally. Thus, the purpose of this review is to determine the regulatory role of nutritional components of WD and MD in the gut microbiota and immune system interplay, in order to understand, and create awareness of, the influence of diet over both key components.

Atualização dos parâmetros de aquisição do Programa Nacional de Alimentação Escolar com base no Guia Alimentar para a População Brasileira

O Guia Alimentar para a População Brasileira é reconhecido como um potente indutor de políticas públicas de alimentação e nutrição. Nessa perspectiva, este artigo apresenta o percurso metodológico e as evidências que subsidiaram a elaboração dos novos parâmetros de aquisição de alimentos do Programa Nacional de Alimentação Escolar (PNAE). Tal elaboração envolveu as análises de: (1) participação dos recursos federais utilizados para compra de alimentos, agrupados segundo a classificação NOVA, empregada no Guia Alimentar para a População Brasileira, pelo conjunto de municípios brasileiros e segundo classificação da execução (positiva ou negativa); (2) cardápios mensais de referência que foram elaborados seguindo recomendações do Guia Alimentar para a População Brasileira; (3) aquisição de alimentos por amostra de 525 municípios, envolvendo a participação relativa dos grupos de alimentos (segundo a NOVA) no total de gastos e de energia e a qualidade nutricional dos alimentos adquiridos; e (4) alimentos ultraprocessados que não devem ser ofertados no ambiente escolar. Foi proposta a adoção dos seguintes parâmetros para participação dos grupos de alimentos em relação ao total de recursos federais empregados na compra de alimentos: ≥ 75% de recursos para alimentos in natura ou minimamente processados; < 20% para alimentos processados ou ultraprocessados e < 5% para ingredientes culinários processados e a ampliação da lista de alimentos cuja aquisição com recursos federais do PNAE é proibida. Esse processo subsidiou a elaboração da Resolução CD/FNDE nº 6, de 8 de maio de 2020, que dispõe sobre o atendimento da alimentação escolar aos alunos da educação básica no âmbito do PNAE.

Family influence on the nutritional status and eating habits of six to nine year-old children

ABSTRACT Objective To investigate whether caregivers’ attitudes, beliefs, practices, alimentary habits, and nutritional status influence the alimentary habits and nutritional status of children aged six to nine years. Methods This cross-sectional study included 164 children and a family member (caregiver) each (n=164), carried out in the family health units of the municipality of Ribeirão Preto (SP), Brazil. Weight and height measurements were performed; each child was then evaluated by the application of both the Child Feeding Questionnaire and 24h recall (for calculating the Healthy Eating Index Revised), in addition to the assessment of adherence to healthy eating steps of the Ministry of Health, through a questionnaire. Results The results showed that the prevalence of being overweight was 18.3% in children and 32.9% in caregivers, and the prevalence of obesity was 15.9% and 37.9%, respectively. Most of the 56 children categorized as overweight also had overweight caregivers (82.1%; n=46). Concerns regarding children’s weight control were higher among caregivers responsible for overweight children (3.6±1.29). In contrast, caregivers responsible for children below or at normal weight demonstrated a greater tendency toward getting children to eat (3.3±0.97 and 3.9±0.99, respectively). The average score; of the children’s Brazilian Healthy Eating Index Revised (50.0±13.6) was similar to that of their caregivers (56.5±12.1). Conclusions Caregivers have a direct influence on the nutritional status and eating habits of children; therefore, they should be targeted in the processes of nutritional intervention for the prevention and treatment of childhood obesity.

Extent and nutritional quality of foods and beverages to which children are exposed in Colombian TV food advertising

OBJECTIVE

To examine children's exposure to food and beverage advertising across a year of Colombian television based on whether products exceed Pan-American Health Organization (PAHO)-defined nutrient thresholds.

DESIGN

Nutritional information was obtained for all foods and beverages advertised and used to categorise each product according to the product category (e.g. beverage, snack food) and nutritional quality based on the PAHO model for identifying products in excess of free sugars, Na or saturated fat or containing non-caloric sweeteners or trans-fat. Television audience ratings data were used to derive the average child audience (unique child viewers) per ad and the number of times ads were seen by children in a single week (weekly impressions) based on product category and nutritional quality.

SETTING

All food and beverage ads on cable and over-the-air TV in Colombia in 2017.

PARTICIPANTS

N/A.

RESULTS

Of all instances of TV ads, 89·3 % were of unhealthy products. A larger proportion of male and female children, as well as children from low (88·01 %), mid (89·10 %) and high (89·10 %) socio-economic status, are exposed to advertising of unhealthy products, but no significant difference was found between these proportions.

CONCLUSION

The majority of foods and beverages advertised to Colombian children are unhealthy. These findings highlight a need to implement statutory measures to reduce children's exposure to unhealthy food advertising in Colombia, as obesity and overweight have been increasing among school-age children in Colombia, and exposure to television advertising of unhealthy foods is a known contributor to children's food intake and obesity.

Early consumption of ultra-processed foods among children under 2 years old in Brazil

Objective:

To evaluate the complementary food consumption according to the extent and purpose of food processing based on NOVA classification among children aged 6–24 months of Federal District, Brazil.

Design:

We performed a cross-sectional study using a 24-h recall to estimate the daily energy intake and nutrients according to NOVA classification. We conducted a linear regression to assess the association between the processed and ultra-processed foods (UPF) energy intake and the daily energy intake from saturated fat, daily energy intake from total sugars and daily intake of sodium.

Setting:

Federal District, Brazil.

Participants:

Five hundred and thirty-eight children aged between 6 and 24 months attended at Primary Health Care Units from March 2017 to March 2018.

Results:

On average, children aged from 6 to 12 and from 12 to 24 months consumed 2393 and 4054 kJ/d, respectively, and processed and UPF represented one-third of dietary energy intake. Group 2 (processed and UPF) was higher carbohydrate contributors, and lower protein, fibre and most micronutrient contributors, when compared with Group 1 (unprocessed, minimally processed foods and processed culinary ingredients). In addition, the higher the energy intake from processed and UPF, the higher was the daily energy intake from saturated fat, daily energy intake from total sugar and daily intake of sodium.

Conclusion:

Children are being exposed early to processed and UPF and their share affect the diet’s nutritional quality.

Ultra-processed food consumption, appetitive traits and BMI in children: a prospective study

This study aimed to investigate the association of ultra-processed food consumption at 4 and 7 years of age with appetitive traits at 7 years and BMI at 10 years of age. Participants were 1175 children of the population-based birth cohort Generation XXI, who provided food diaries and complete data on socio-demographic variables, anthropometric measures and the Portuguese Children's Eating Behaviour Questionnaire (P-CEBQ). Foods were grouped according to NOVA classification into: 'unprocessed, minimally or moderately processed, and culinary preparations'; 'processed' and 'ultra-processed'. To assess tracking of groups' consumption, Pearson's correlation coefficient (r) and the intraclass correlation coefficient (ICC) were calculated. Generalised linear models were fitted to test main associations, mediators and interactions among the variables. Ultra-processed consumption exhibited a fair level of stability between ages 4 and 7 years (r 0·34; ICC = 0·32; 95 % CI 0·25, 0·39), corresponding, respectively, to 27·3 % (1881·9 (SD 908·8) kJ/d) and 29·3 % (2204·5 (SD 961·1) kJ/d) of total energy intake. After adjusting for maternal and child characteristics, higher ultra-processed consumption at 4 years was associated directly with 'Food Responsiveness' (β = 0·019; 95 % CI 0·007, 0·037) and indirectly through energy intake with avoidant traits: 'Food Fussiness' (β = -0·007; 95 % CI 0·002, 0·012) and 'Satiety Responsiveness' (β = -0·007; 95 % CI 0·003, 0·012). Ultra-processed consumption at 4 years old was associated with BMI at 10 years old, but appetitive behaviours were not powerful mediators of this association. The results suggest a path by which ultra-processed products may impact on later appetitive traits and higher BMI in children.

How to protect both health and food system sustainability? A holistic 'global health'-based approach via the 3V rule proposal

OBJECTIVE

To define a generic diet to protect human health and food system sustainability based on three dimensions: animal:plant ratio, degree of food processing and food diversity.

DESIGN/SETTING

The percentages of maximum animal and ultra-processed energy content were evaluated from scientific papers (Web of Science database) and reports from international scientific institutions. Then, a weekly French standard diet, including these percentages and food diversity (≥42 different foods), was designed to calculate adequacy to nutritional needs.

RESULTS

Based on traditional and scientifically based healthy diets, and on foresight scenarios for sustainable diets at horizon 2050, a median daily animal energy content intake of 15 % was found to be protective towards both human health and environment. Based on epidemiological studies associating ultra-processed energy consumption with increased overweight/obesity risk, a precautionary threshold of approximately 15 % ultra-processed energy content was observed. The French diet allows addressing all nutritional needs and other nutritional indicators such as maximum salt and simple sugar consumption, α-linolenic acid:linoleic acid ratio and essential amino acids. This diet was named the '3V rule' for Végétal (plant), Vrai (real) and Varié (varied, if possible organic, local and seasonal). This generic diet can be adapted according to regional traditions and environmental characteristics. Excluding only one dimension of it would threaten both health and food system sustainability.

CONCLUSIONS

Tending towards a 3V-based diet, while respecting local constraints, should allow preserving human health, environment (greenhouse gas emissions, pollution, deforestation, etc.), small farmers, animal welfare and biodiversity, culinary traditions and socioeconomics (including an alleviation of public health cost).

Ultra-Processed Foods and Food System Sustainability: What Are the Links?

Global food systems are no longer sustainable for health, the environment, animal biodiversity and wellbeing, culinary traditions, socioeconomics, or small farmers. The increasing massive consumption of animal foods has been identified as a major determinant of unsustainability. However, today, the consumption of ultra-processed foods (UPFs) is also questioned. The main objective of this review is therefore to check the validity of this new hypothesis. We first identified the main ingredients/additives present in UPFs and the agricultural practices involved in their provision to agro-industrials. Overall, UPF production is analysed regarding its impacts on the environment, biodiversity, animal wellbeing, and cultural and socio-economic dimensions. Our main conclusion is that UPFs are associated with intensive agriculture/livestock and threaten all dimensions of food system sustainability due to the combination of low-cost ingredients at purchase and increased consumption worldwide. However, low-animal-calorie UPFs do not produce the highest greenhouse gas emissions (GHGEs) compared to conventional meat and dairy products. In addition, only reducing energy dense UPF intake, without substitution, might substantially reduce GHGEs. Therefore, significant improvement in food system sustainability requires urgently encouraging limiting UPF consumption to the benefit of mildly processed foods, preferably seasonal, organic, and local products.

Adherence to Mediterranean diet is inversely associated with the consumption of ultra-processed foods among Spanish children: the SENDO project

Objective:

To assess whether higher adherence to the traditional Mediterranean diet (MedDiet) was associated with lower consumption of ultra-processed foods (UPF) and lower free sugar intake.

Design:

Cross-sectional analysis of baseline information among participants in the SENDO project, a Spanish paediatric cohort. Dietary information was collected through a semi-quantitative FFQ. Food items were classified according to the NOVA classification. Adherence to the MedDiet was evaluated through the KIDMED index.

Setting:

Spain.

Participants:

Three hundred eight-six children (52 % boys) with a mean age of 5·3 years old (sd 1·0) were included in the analysis.

Results:

74·4 % of the children had moderate adherence to the MedDiet (mean KIDMED score: 5·9 points; sd 1·7) and overall, 32·2 % of the total energy intake came from UPF. Each two additional points in the KIDMED score was associated with 3·1 % (95 % CI 2·1, 4·0) lower energy intake from UPF. Compared to those with low adherence to the MedDiet, children with medium and high adherence reported 5·0 % (95 % CI 2·2, 7·7) and 8·5 % (95 % CI 5·2, 11·9) lower energy intake from UPF, respectively. We also found that 71·6 % of the variability in free sugar intake was explained by the variability in UPF consumption.

Conclusions:

Adherence to the traditional MedDiet was inversely associated with energy intake from UPF. Furthermore, most of the variability in free sugar intake was explained by the variability of UPF consumption. Public health strategies are needed to strengthen the adherence to the MedDiet in pre-schoolers while regulating the production, marketing and advertising of UPF.

Changes in diet quality over 10 years of nutrition transition in Colombia: analysis of the 2005 and 2015 nationally representative cross-sectional surveys

OBJECTIVES

To describe the changes in diet quality in Colombians using nationally representative samples from the 2005 and 2015 nutrition surveys.

METHODS

Repeated cross-sectional analyses of the National Nutrition Surveys from 2005 and 2015. Children (4-17 y.o.) and adults (≥ 18 y.o.) were included. The Alternative Healthy-Eating Index (AHEI) was derived from 24-h recall questionnaires and used to examine diet quality.

RESULTS

A total of 33,971 participants (20,122 children, 13,849 adults) were included in 2005, and 26,445 participants (15,304 children, 11,141 adults) in 2015. Over the ten-year period, the AHEI decreased from 46.3 to 44.3 in children (Cohen's d = 0.19) and from 49.0 to 46.2 in adults. (Cohen's d = 0.25). On average, those in the highest socioeconomic level had the worst diet quality; however, the difference between the less and most affluent groups shrank by 4.0% over the observation period.

CONCLUSIONS

Between 2005 and 2015, there was a worsening in the diet quality of Colombian children and adults. Less affluent individuals had a greater worsening of diet quality compared to groups from higher socioeconomic levels.

Diet quality, general health and anthropometric outcomes in a Latin American population: evidence from the Colombian National Nutritional Survey (ENSIN) 2010

OBJECTIVE

Colombia is experiencing a nutrition transition, characterised by nutritionally poor diets and an increased prevalence of non-communicable diseases (NCD). We aimed to investigate the association between diet quality and general health outcomes related to the risk of NCD, in a nationally representative sample of Colombian adolescents and adults.

DESIGN

Cross-sectional analysis. The Alternative Healthy-Eating Index (AHEI) was derived to calculate diet quality. Adjusted regressions were used to examine the association between AHEI, self-perceived general health status (GHS) and anthropometric variables (i.e. age-specific z-scores for height, and BMI for adolescents; waist circumference and BMI for adults).

SETTING

Nationally representative data from the Colombian National Nutrition Survey (ENSIN) 2010.

PARTICIPANTS

Adolescents aged 10-17 years (n 6566) and adults aged ≥18 years (n 6750).

RESULTS

AHEI scores were similar between adolescents (mean 29·3 ± 7·2) and adults (mean 30·5 ± 7·2). In the whole sample, a better diet quality (higher AHEI score) was associated with worse self-perceived GHS (adjusted (a) β-coefficient: -0·004; P < 0·001) and with a smaller waist circumference ((a) β-coefficient: -0·06; P < 0·01). In adults, a higher AHEI score was negatively associated with BMI ((a) β-coefficient: -0·02; P < 0·05), whilst in adolescents it was associated with a reduced height-for-age z-score ((a) β-coefficient: -0·009; P < 0·001).

CONCLUSIONS

A better diet quality was associated with reduced prevalence of predictors of NCD and with some indicators of general health in the Colombian population. In light of the high prevalence of overweight, our findings support the need for public health interventions focused on sustainable positive changes in dietary habits in the general population.

Intake of saturated fat, trans fat, and added sugars by the Brazilian population: an indicator to evaluate diet quality

BACKGROUND/OBJECTIVE

In recent decades, changes in the diet of Brazilians have been characterized by increased consumption of high energy-dense foods, rich in fat and sugar. This study was aimed at assessing diet quality based on the intake of foods with high content of solid fat and added sugars (SoFAS).

SUBJECTS/METHODS

The first Brazilian National Dietary Survey (2008-2009) is a nationwide representative cross-sectional study that collected food records from 34,003 ≥ 10-year-old individuals. A receiver-operating characteristic curve was used to determine the limit that would identify diets with high SoFAS content.

RESULTS

The limit of 45% of total dietary energy provided by SoFAS was adopted to classify diets with excessive content. The SoFAS provided 53% of daily energy intake to adolescents, 49% to adults, and 48% to the elderly. A high intake of SoFAS was found in 64.7% of adolescents, 59.1% of adults, and 57.8% of the elderly. The contribution of SoFAS to daily energy intake increased with income in all age groups. Those with high consumption of SoFAS had higher intakes of sugar-sweetened beverages, cookies and cakes, processed meats, chips, candy and chocolate, and sandwiches and snacks, when compared with those that had moderate SoFAS intake (<45% of daily energy).

CONCLUSIONS

The 45% cutoff point for the contribution of SoFAS foods to total energy intake, utilized to classify low-quality diets, allowed to point out the high-risk profile of the Brazilian diet.

Processed and ultra-processed foods are associated with high prevalence of inadequate selenium intake and low prevalence of vitamin B1 and zinc inadequacy in adolescents from public schools in an urban area of northeastern Brazil

Changes in eating behavior of adolescents are associated with high consumption of processed and ultra-processed foods. This study evaluated the association between these foods and the prevalence of inadequate micronutrient intake in adolescents. A cross-sectional study was conducted with 444 adolescents from public schools in the city of Natal, northeastern Brazil. The adolescents' habitual food consumption was evaluated using two 24-hour dietary recalls. Foods were categorized according to the degree of processing (processed and ultra-processed) and distributed into energy quartiles, using the NOVA classification system. Inadequacies in micronutrient intake were assessed using the estimated average requirement (EAR) as the cutoff point. Multivariate logistic regression models were used to estimate the relationship between energy percentage from processed and ultra-processed foods and prevalence of inadequate micronutrient intake. The mean (Standard Deviation (SD)) consumption of total energy from processed foods ranged from 5.8% (1.7%) in Q1 to 20.6% (2.9%) in Q4, while the mean consumption of total energy from ultra-processed foods ranged from 21.4% (4.9%) in Q1 to 61.5% (11.7%) in Q4. The rates of inadequate intake of vitamin D, vitamin E, folate, calcium, and selenium were above 80% for both sexes across all age groups. Energy consumption from processed foods was associated with higher prevalence of inadequate selenium intake (p < 0.01) and lower prevalence of inadequate vitamin B1 intake (p = 0.04). Energy consumption from ultra-processed foods was associated with lower prevalence of inadequate zinc and vitamin B1 intake (p < 0.01 and p = 0.03, respectively). An increase in the proportion of energy obtained from processed and ultra-processed foods may reflect higher prevalence of inadequate selenium intake and lower prevalence of vitamin B1 and zinc inadequacy.

Global trends in ultraprocessed food and drink product sales and their association with adult body mass index trajectories

This study evaluated global trends in ultraprocessed food and drink (UPFD) volume sales/capita and associations with adult body mass index (BMI) trajectories. Total food/drink volume sales/capita from Euromonitor for 80 countries (2002-2016) were matched to mean adult BMI from the NCD Risk Factor Collaboration (2002-2014). Products were classified as UPFD/non-UPFD according to the NOVA classification system. Mixed models for repeated measures were used to analyse associations between UPFD volume sales/capita and adult BMI trajectories, controlling for confounding factors. The increase in UPF volume sales was highest for South and Southeast Asia (67.3%) and North Africa and the Middle East (57.6%), while for UPD, the increase was highest for South and Southeast Asia (120.0%) and Africa (70.7%). In 2016, baked goods were the biggest contributor to UPF volume sales (13.1%-44.5%), while carbonated drinks were the biggest contributor to UPD volume sales (40.2%-86.0%). For every standard deviation increase (51 kg/capita, 2002) in UPD volume sales, mean BMI increased by 0.195 kg/m² for men (P < .001) and 0.072 kg/m² for women (P = .003). For every standard deviation (40 kg/capita, 2002) increase in UPF volume sales, mean BMI increased by 0.316 kg/m² for men (P < .001), while the association was not significant for women. Increases in UPFD volume sales/capita were positively associated with population-level BMI trajectories.

Obesity à la carte? Children’s meal options in German full-service restaurants

Objective:

In light of the increasing prevalence of juvenile obesity seen around the world, obesogenic environments in general and the food environment in particular are receiving increasing attention in current public health research. Restaurants play a significant role in the food environment. The present study aimed to quantitatively describe and qualitatively evaluate the range of children’s meals available in full-service restaurants in Germany.

Design:

Five hundred restaurants were identified using a systematic quota sampling technique. The individual meals were evaluated using quality standards stipulated by the German Nutrition Society (DGE).

Setting:

Nationwide sample of menus from full-service restaurants.

Participants:

Meals (n 1877) from 500 menus were analysed.

Results:

Menus included 3·76 (sd 1·31) meals for children. About 70 % of the meals were limited to six typical dishes of low nutritional quality. In total, 54 % of meals included French fries or another form of fried potatoes. Of all meals, 23 % did not fulfil any of the eleven quality criteria set by the DGE and 38 % satisfied only one criterion. The majority of dishes on offer featured high energy density while simultaneously having low nutrient density. Healthy dishes were not highlighted visually in any menu.

Conclusions:

The range of dishes on offer for children in German restaurants is severely lacking in variety and in need of improvement from a nutritional point of view. Considering the growing importance of restaurants as food environments, there is a need to improve the presentation of menus and the meals offered.

Predictor factors of glycemic control in children and adolescents with type 1 diabetes mellitus treated at a referral service in Rio de Janeiro, Brazil

AIM

To evaluate the predictive factors of glycemic control in children and adolescents with type 1 diabetes mellitus (T1DM).

METHODS

Cross-sectional study at a referral service in Rio de Janeiro, Brazil. Sociodemographic, anthropometric, clinical, and dietary factors were evaluated. Food consumption was evaluated by 24 h dietary recall and the NOVA system was adopted for classifying the foods according to the extent and purpose of industrial processing. The predictive factors were evaluated by multivariate linear regression, adopting p < 0.05.

RESULTS

One hundred and twenty children and adolescents participated, with a mean age of 11.74 years (±2.88) and HbA1c of 8.13% (±1.26). The mean diabetes duration was 6.68 years (±3.33) and the insulin used was 1.05 units per kilogram of ideal weight (IU/kg of ideal weight; ±0.46) About 80% (n = 96) used carbohydrate counting and it was verified that 24.27% (±17.89) of the participants' total calories came from ultraprocessed foods. For each year of diagnosis with T1DM and for each IU/kg of weight used, HbA1c increased by 0.087% (β = 0.087, p = 0.007) and 0.651%, respectively (β = 0.651; p = <0.001). Use of carbohydrate counting was associated with a 1.058% reduction in HbA1c (β = -1.058; p = 0.001).

CONCLUSION

Disease duration and insulin dose were directly reflected in HbA1c concentrations, while carbohydrate counting showed an inverse association.