Ultra-processed food and beverage advertising on Brazilian television by International Network for Food and Obesity/Non-Communicable Diseases Research, Monitoring and Action Support benchmark

Association between ultra-processed food and snacking behavior in Brazil

PURPOSE

Ultra-processed food may play a role in facilitating snacking behavior because of their convenience and low satiety potential. This study aimed to describe the association between consumption of ultra-processed foods and frequency of snacking.

METHODS

We analyzed data from 46,164 participants (≥ 10 years old) in the 2017-2018 Brazilian Household Budget Survey. Dietary data were collected by 24-h dietary recalls over one or two days for each participant. We estimated energy intake, ultra-processed food consumption, and level of snacking. We measured the association between ultra-processed food consumption and level of snacking using multinomial logistic regression, stratified by age group (adolescents, 10-19 years old; adults, 20-64 years old; elders, 65 or older).

RESULTS

We found a statistically significant tendency of increased daily energy intake and consumption of snacks and that ultra-processed food consumption was positively associated with the level of snacking for all age groups. For adolescents, adults, and elders in the highest quintile of ultra-processed food consumption as a share of their entire diet, the relative risk ratio (95% CI) of having more than two snacks per day compared to no snacks was 14.21 (9.09-22.21), 4.44 (3.54-5.57), and 4.21 (2.67-6.64), respectively, when compared to the lowest quintile.

CONCLUSION

Higher consumption of ultra-processed food was associated with snacking behavior, and the strength of this association was stronger among adolescents. Efforts to mitigate ultra-processed food attributes that facilitate snacking should be incorporated into strategies to promote healthier food choices, especially among adolescents.

Exposure and power of TV food advertising during the COVID-19 pandemic in Brazil: a content analysis

BACKGROUND

With the COVID-19 pandemic and the restrictions imposed to contain the spread of SARS-CoV-2, the Brazilian population has increased the time spent at home and watching television (TV). Since food advertising exposure is a key driver of food choices, this study described the content of food advertisements (ads) on Brazilian TV during the COVID-19 pandemic.

METHODS

This is an exploratory study. A total of 684 h of TV programming comprised of three free-to-air channels and two pay-per-view channels was recorded from 06 a.m. to 12 a.m. for eight non-consecutive days in June 2020. A content analysis of all the food-related ads was carried out. The data collection process followed INFORMAS Protocol for TV food advertising monitoring.

RESULTS

The sample was composed of 7,083 ads, 752 (10.6%) of which were food-related and 487 (6.9%) were promoting ultra-processed foods. The content analysis indicated seven thematic categories, all of them with reference to the COVID-19 pandemic: brand and product differentials (79.8%); visual and sound effects (70.2%); thematic campaigns (56.0%); digitization (22.9%); convenience (16.5%); economic benefits (11.9%); and commensality and social interaction (6.1%). Ads content varied according to the day of the week, the time of the day, the length of the ad, and the channel type.

CONCLUSIONS

The thematic of food advertising on Brazilian TV during the COVID-19 pandemic is aligned with the country's health crisis context and varied during the programming.

Opportunities to improve population health: possibilities for healthier food environments

The recent Covid-19 pandemic highlighted stark social inequalities, notably around access to food, nutrition and to green or blue space (i.e. outdoor spaces with vegetation and water). Consequently, obesity is socio-economically patterned by this inequality; and while the environmental drivers of obesity are widely acknowledged, there is currently little upstream intervention. We know that living with obesity contributes to increasing health inequalities, and places healthcare systems under huge strain. Our environment could broadly be described obesogenic, in the sense of supporting unhealthful eating patterns and sedentary behaviour. Evidence points to the existence of nearly 700 UK obesity policies, all of which have had little success. Obesity prevention and treatment has focused on educational and behavioural interventions targeted at individual consumers. A more sustainable approach would be to try and change the environments that promote less healthy eating and high energy intake as well as sedentary behaviour. Approaches which modify the environment have the potential to assist in the prevention of this complex condition. This review paper focuses on the role of wider food environments or foodscapes. While there is an imperfect evidence base relating to the role of the foodscape in terms of the obesity crisis, policy, practice, civic society and industry must work together and take action now, in areas where current evidence suggests change is required. Despite the current cost-of-living crisis, shaping the foodscape to better support healthful eating decisions has the potential to be a key aspect of a successful obesity prevention intervention.

Food advertising aimed at children and adolescents in Brazil: a longitudinal analysis of denouncements in CONAR

Scientific evidences show that self-regulation models fail to protect children and adolescents from commercial exploitation. In Brazil, the "Conselho Nacional de Autorregulamentação Publicitária - CONAR" is the entity that proposes guidelines for the products advertising and services to regulated sector. The aim is to analyze the denouncements of food advertising aimed at children and adolescents sent to CONAR between 2010 and 2020. The denouncements were described regarding the type of product and service, authorship (consumers/companies or CONAR), and CONAR decision (archiving/penalties). Descriptive and association analyzes were performed. Ninety-eight denouncements were identified, 74.8% of ultra-processed foods. There was an oscillation in the submission of denouncements over the years, with a general decline trend. Consumers were more frequent among the denouncements (58.6%) and 53.3% of total were penalty. Denouncements sent by CONAR or companies were more frequently penalized than those sent by consumers. There was a predominance of denouncements of advertisements for ultra-processed foods and low application of penalties. There was a lack of isonomy in CONAR decision pattern on advertisements.

Ultra-processed food consumption is positively associated with the incidence of depression in Brazilian adults (CUME project)

OBJECTIVE

To evaluate the association between the consumption of ultra-processed food and the incidence of depression in Brazilian adults.

METHODS

This longitudinal study included 2572 participants (M = 936 and F = 1636, mean age of 36.1 years) from the Cohort of Universities of Minas Gerais - CUME Project, Brazil. Ultra-processed food (UPF) consumption (in % of daily energy intake, DEI), as defined by the NOVA food classification system, was assessed at baseline using a validated semi-quantitative 144-item food frequency questionnaire. Participants were classified as incident cases of depression if they reported a medical diagnosis of depression in at least one of the follow-up questionnaires. Crude and adjusted cox regression models were used to assess the relationship between UPF consumption and the incidence of depression.

RESULTS

After a mean of follow-up of 2,96 years, a total of 246 incident cases of depression were identified. The mean consumption of UPF was 44 g/d or 24 % of DEI. Participants in the highest quartile of UPF consumption (31 to 72 % of DEI) had a higher risk of developing depression (HR = 1.82 95 % CI = 1.15-2.88) than those in the lowest quartile (0 to 16 % of DEI) after adjusting for potential confounders.

CONCLUSION

Higher UPF consumption is a risk factor of depression incidence in Brazilian adults with high education level.

Educational inequality in consumption of in natura or minimally processed foods and ultra-processed foods: The intersection between sex and race/skin color in Brazil

Background

It remains uncertain how the intersection between educational, gender, and race/skin color inequalities influences food consumption in Brazil. In this study, we examined the educational inequality in the consumption of in natura/minimally processed and ultra-processed foods by Brazilians with an intersectional perspective between sex and race/color.

Methods

We used cross-sectional data from the Telephone Surveillance System (VIGITEL 2019), comprising 52,443 participants ≥ 18 years. Daily food consumption was considered high when consumption of ≥5 foods for each food group was reported the day before the survey. Educational inequality in food consumption was assessed by the slope index of inequality (SII) and the relative index of inequality (RII) according to sex and race/color (White; Black/Brown). Positive SII and RII values > 1.0 indicate higher food consumption among more educated participants.

Results

The consumptions of in natura/minimally processed and ultra-processed foods were more prevalent in those with the highest level of education (≥12 years) and intermediate education (9-11 years), respectively. However, highly educated White women had higher consumption of in natura/minimally processed foods than Black women with the same education level, and White men in low and intermediate school levels had higher consumption of these foods than Black men with the same education levels. We found higher absolute educational inequality for in natura/minimally processed foods among White women (SII 21.8, 95% CI 15.3, 28.4) and Black/Brown men (SII 19.3, 95% CI 12.5, 26.1). Black/Brown men (SII 7.3, 95% CI 0.5, 14.0) and Black/Brown women (SII 5.6, 95% CI 1.0, 10.2) had higher absolute educational inequality than White men (SII -3.3, 95% CI -10.9, 4.3; P = 0.04) in the consumption of ultra-processed foods.

Conclusion

Educational inequalities influenced the consumption of in natura/minimally processed more than ultra-processed foods, and, for the latter, inequalities were greater among Black/Brown men and women than among White men.

The Potential Impact of Different Taxation Scenarios towards Sugar-Sweetened Beverages on Overweight and Obesity in Brazil: A Modeling Study

The adoption of fiscal policies based on the specific taxation of sugar-sweetened beverages (SSBs) has been recommended by international health agencies, as they are measures that potentially reduce consumption. This study is an ex ante risk comparison that estimates the impact of three tax scenarios (20, 25, and 30%) with a 100% pass-on rate to SSBs on the prevalence of high weight and obesity in the Brazilian population. Data on the consumption habits, weight, and height of 46,164 adults aged 20 years or over from Brazilian recent national surveys were used. The shift in consumption after taxation was estimated based on the price elasticity of the demand. The percentage changes in overweight for 20, 25, and 30% taxation were 1.84% (95%CI: 1.82; 1.86), 1.89% (95%CI: 1.87; 1.90), and 2.25% (95%CI: 2.24; 2.27), respectively. The change in the prevalence of obesity was 1.93% (95%CI: 1.87; 2.00), 2.90% (95%CI: 2.80; 3.02), and 4.16% (95%CI: 4.01; 4.32), respectively. Taxes on SSBs may have a more favorable result among the heaviest consumers, who are young adults (20-29 years), especially men, thereby promoting a greater reduction in the prevalence of high weight and obesity.

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.

Eating contexts and their associations with socio-demographic factors in Brazilian adolescents (EVA-JF Study)

OBJECTIVE

To describe the eating contexts and estimate their associations with socio-demographic factors in a sample of Brazilian adolescents.

DESIGN

Cross-sectional study. We used an exploratory questionnaire about eating contexts (encompassing regularity of meals, places where they occur and if they take place with attention and in company), which was submitted to cluster analysis. Subsequently, three clusters were identified: cluster 1, 'appropriate eating contexts at breakfast, lunch and dinner'; cluster 2, 'inappropriate eating context at breakfast' and cluster 3, 'inappropriate eating context at dinner'. Multinomial logistic regression models were performed, without and with adjustments, using cluster 1 as reference.

SETTING

Twenty-nine public schools of Juiz de Fora, MG, Southeast Brazil.

PARTICIPANTS

Adolescents, 14-19-year-olds (n 835).

RESULTS

We observed relevant prevalence of adolescents omitting breakfast (52·9 %) and dinner (39·3 %), and who had the habit of eating sitting/lying on the couch/bed or standing/walking, and in front of screens. Breakfast usually occurred unaccompanied (70·8 %); around half (47·5 %) and little over a third (36·1 %) of the sample also would usually have lunch and dinner unaccompanied, respectively. Furthermore, through multivariate analysis, we found associations of eating contexts clusters with female sex (more likely in clusters 2 and 3), age range 14-15-year-olds (less likely in cluster 2) and higher mother's schooling (more likely in cluster 3).

CONCLUSIONS

We verified an alarming prevalence of adolescents with eating contexts unaligned with healthy eating recommendations. Additionally, inappropriate eating contexts at breakfast and/or at dinner were associated with socio-demographic factors (sex, age range and mother's schooling).

Potential impacts of policies to reduce purchasing of ultra-processed foods in Mexico at different stages of the social transition: an agent-based modelling approach

OBJECTIVES

To develop a simulation framework for assessing how combinations of taxes, nutrition warning labels and advertising levels could affect purchasing of ultra-processed foods (UPF) in Latin American countries and to understand whether policies reinforce or reduce pre-existing social disparities in UPF consumption.

DESIGN

We developed an agent-based simulation model using international evidence regarding the effect of price, nutrition warning labels and advertising on UPF purchasing.

SETTING

We estimated policy effects in scenarios representing two stages of the 'social transition' in UPF purchasing: (1) a pre-transition scenario, where UPF purchasing is higher among high-income households, similar to patterns in Mexico; and (2) a post-transition scenario where UPF purchasing is highest among low-income households, similar to patterns in Chile.

PARTICIPANTS

A population of 1000 individual agents with levels of age, income, educational attainment and UPF purchasing similar to adult women in Mexico.

RESULTS

A 20 % tax would decrease purchasing by 24 % relative to baseline in both the pre- and post-transition scenarios, an effect that is similar in magnitude to that of a nutrition warning label policy. A 50 % advertising increase or decrease had a comparatively small effect. Nutrition warning labels were most effective among those with higher levels of educational attainment. Labelling reduced inequities in the pre-transition scenario (i.e. highest UPF purchasing among the highest socio-economic group) but widened inequities in the post-transition scenario.

CONCLUSIONS

Effective policy levers are available to reduce UPF purchasing, but policymakers should anticipate that equity impacts will differ depending on existing social patterns in UPF purchasing.

Use of persuasive strategies in food advertising on television and on social media in Brazil

We analyzed the use of persuasive advertising strategies by 18 food brands on TV and Facebook, Instagram, and YouTube in Brazil in April 2018. Advertising strategies were investigated from three groups: power of advertising strategies (n = 10) (e.g., use of licensed character, celebrities, awards, etc), use of the prize offering (n = 9) (e.g., pay 2 take 3 or more, gifts or collectable, limited edition, etc), and use of brand benefit claims (n = 8) (e.g., messages that exalt sensory-based characteristics such as flavor, taste, aroma and recommend how to use/consume the product, etc). Almost 90% of the brands were ultra-processed foods producers and they carried 52 ads on TV and 194 posts on social media platforms. A higher frequency of the strategy ‘cartoon/company owned character’ was found on TV ads (19.2%; p < 0.0001) in comparison to social media platforms (0% on the three platforms) while the presence of ‘famous sportsperson/team’ prevailed on YouTube (41.4%) in comparison to TV (19.2%), Facebook (10.9%) and Instagram (9.1%), p < 0.0001. On YouTube ads, the claims ‘sensory-based characteristics’ (86.2%), ‘suggested use’ (51.7%), and ‘emotive claims’ (31.0%) were more commonly seen in comparison to the other media, while the claims about ‘new brand developments’ (23.1%), ‘price’ (9.6%) and ‘suggesting to children and the whole family to use the advertised product’ (21.1%) prevailed on TV. Ultra-processed food brands are the main food companies that advertise on Brazilian TV and social media and the message transmitted by these brands varies in each media according to the advertising strategies that are used.

Independent and combined associations of sugar-sweetened beverage consumption, TV viewing, and physical activity with severe depressive symptoms among 59,402 adults

OBJECTIVE

Our aim was to analyze the association between sugar-sweetened beverage consumption and depressive symptoms, as well as the extent to which TV viewing and physical activity moderate this association.

METHODS

We used cross-sectional data from the 2013 Brazilian National Survey (Pesquisa Nacional de Saúde) of 59,402 adults (33,482 women, mean age = 42.9 years, 95%CI 42.7-43.2 years). Depressive symptoms (Patient Health Questionnaire-9), physical activity, TV viewing, and sugar-sweetened beverage consumption, as well as potential confounders (chronological age, ethnicity, consumption of candy/sweets and fruit, multimorbidity, education, and employment status) were self-reported. Poisson regression models were used for association analyses.

RESULTS

The consumption of 16 or more glasses/week of sugar-sweetened beverages was associated with higher levels of severe depressive symptoms among women compared to no consumption (prevalence ratio [PR] 1.71 [95%CI 1.38-2.11]). Consistent interactions were observed between 1-5 glasses and TV viewing (PR 2.09 [95%CI 1.06-4.12]) and between 11-15 glasses and TV viewing (PR 2.90 [95%CI 1.29-6.50]) among men compared to no consumption, given that the co-occurrence of sugar-sweetened beverage consumption and elevated TV viewing was associated with higher odds of severe depressive symptoms. Sugar-sweetened beverage consumption did not interact with physical activity, only presenting an independent association.

CONCLUSION

Sugar-sweetened beverage consumption was independently associated with severe depressive symptoms among women and interacted with TV viewing, but not with physical activity among men.

The COVID-19 pandemic and its implications for the food information environment in Brazil

The food information environment includes food advertising disseminated in various media. With the COVID-19 pandemic and the shutdown of schools, universities, non-essential commerce, public leisure areas, bars, restaurants, among others, the food information environment has changed in Brazil. People spent more time at home which led to greater exposure to television and internet advertising content. During the COVID-19 pandemic, the food production sector has invested in new ways to advertise their products that include advertising messages of support, empathy and solidarity, as well as social responsibility campaigns looking for self-promotion such as food donation and financial aids. Sponsoring online events promoted by Brazilian musicians on social media was also enhanced during the pandemic and allowed food companies to become part of the consumer's leisure and entertainment moments. The advertising strategies adopted by the food industry during the COVID-19 pandemic are used to generate market demands, influence the consumer purchase decision and increase their loyalty to the supplier brands. Consequently, individuals may have been more vulnerable to excessive consumption of ultra-processed foods during this health crisis. This commentary aims to describe the changes in the food information environment during the COVID-19 pandemic in Brazil and propose a pathway to promote a healthier food information environment after this health crisis. Perspectives for promoting a healthier food information environment after the pandemic are also discussed, focusing on regulating food advertising with a shared responsibility between government, the food industry, the academy and civil society.

School Type, Eating Habits, and Screen Time are Associated With Ultra-Processed Food Consumption Among Brazilian Adolescents

BACKGROUND

The increasing consumption of ultra-processed foods (UPFs) may be a result of the environmental influences to which adolescents are exposed and/or habits acquired since childhood through family interactions.

OBJECTIVE

Our aim was to investigate whether type of school administration (public or private), eating habits, and screen time are associated with the percentage caloric contribution of UPFs to total kilocalories consumed by Brazilian adolescents.

DESIGN

A cross-sectional secondary analysis of the Study of Cardiovascular Risk in Adolescents (ERICA) performed between March 2013 and December 2014.

PARTICIPANTS/SETTING

Overall, 71,553 adolescents from 1,247 public and private schools in 124 Brazilian cities (with a population of more than 100,000) were included.

MAIN OUTCOME MEASURES

We measured the percentage caloric contribution of UPFs to the total kilocalories consumed, obtained using one 24-hour food recall.

STATISTICAL ANALYSES PERFORMED

Generalized linear models were used, guided by the hierarchical model. Sample complexity was considered using the Stata svy command, with a significance level of 5%.

RESULTS

Overall, UPFs contributed an average of 28% (95% CI, 27.80%-28.15%) of total energy intake. Based on the final multivariate analysis, a significantly higher UPF diet was observed among adolescents from private schools (P < .001), those who do not consume meals offered by schools (P < .001), those who do not eat breakfast regularly (P < .05), those who eat in front of screens almost every day or every day (P < .001), and those who spend more time in front of screens (P < .001).

CONCLUSIONS

The findings of this study indicate that UPF consumption is associated with school type, eating habits, and screen time among Brazilian adolescents.

Health behavior patterns of sugar-sweetened beverage consumption among Brazilian adolescents in a nationally representative school-based study

Studies on sugar-sweetened beverage consumption patterns can help in the individual and population level management of chronic non-communicable diseases and other conditions. This study aimed to identify the association between health behavior patterns and the consumption of sugar-sweetened beverages among Brazilian adolescents from a nationally representative school-based study. A cross-sectional study analyzed data from 71,553 adolescents aged 12-17 years who attended public and private schools in Brazilian cities, from the Study of Cardiovascular Risk in Adolescents. Principal component analysis was performed to identify health behavior patterns, and ordered logistic regression was performed to identify the association between health behavior patterns and sugar-sweetened beverage consumption. Sugar-sweetened beverage consumption (mL/day) was used as the dependent variable. The analyses were performed using Stata software version 14.0 with a significance level of 0.05. Patterns 2 (alcoholic beverage and smoking habit) and 3 (ultra-processed food and screen time) of health behaviors and regularly purchasing snacks in the school cafeteria increased the odds of sugar-sweetened beverage consumption, while pattern 1 (water, unprocessed and minimally processed food and physical activity) decreased these odds. The adoption of healthy habits can indirectly stimulate the adoption of other habits beneficial to health. These results indicate the importance of adopting a set of regulatory measures to reduce sugar-sweetened beverage consumption.

Food consumption, overweight, obesity, and sociodemographic profile in a Brazilian capital: a time trend analysis between 2006 and 2018

ABSTRACT Objective To analyze the time trend of sociodemographic characteristics and the prevalence of food consumption, overweight, and obesity variables among adults in the city of Belo Horizonte, Brazil, between 2006 and 2018. Methods A time series study involving data from the Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel, Surveillance System of Risk and Protective Factors for Chronic Diseases by Telephone Survey), between 2006 and 2018 in Belo Horizonte (n=25,443). The annual prevalence of the population’s sociodemographic characteristics (sex, age groups, and years of schooling), and risk and protective factors for chronic diseases related to food consumption and nutritional status were estimated. Prais-Winsten regression models were used to investigate the temporal variation of each variable. Results From 2006 to 2018, there was a significant increase in the age and educational level of the adult population of Belo Horizonte. In the same period, the prevalence of recommended consumption of fruits and vegetables increased (from 23.0% to 29.2%), while that of consumption of fat-rich meat and regular consumption of soft drinks decreased (respectively, from 41.9% to 38.0%; from 35.3% to 15.2%). In parallel, the prevalence of overweight and obesity increased (respectively, from 38.5% to 53.3%; from 9.8% to 17.2%). Conclusions An important change in the population’s sociodemographic profile was noted. There are also favorable changes regarding the investigated aspects of food consumption, without these being sufficient to prevent the significant increase in the prevalence of overweight and obesity in the population.

Food availability and advertising within food outlets around primary healthcare services in Brazil

The consumer food environment is changing: an extensive variety of foods are now available in most markets, offering palatability, convenience and novelty. However, little is known about the availability and advertising of food items within food outlets, especially among developing countries. The present study examined these dimensions in 281 food outlets located around eighteen primary healthcare services in Belo Horizonte, Brazil, in 2013. These establishments were classified as large-chain supermarkets; specialised fruits and vegetable (F&V) markets; and local grocery stores, convenience stores or bakeries. Availability of F&V, availability of ultra-processed foods (UPF) and food advertising were compared across the food outlet categories by applying the χ² test. Almost 60 % of the food outlets were specialised F&V markets, 21⋅4 % were large-chain supermarkets and 19⋅2 % were local grocery stores, convenience stores or bakeries. Almost 80 % contained at least eight types of fruits and vegetables, and 60 % contained UPF. Food advertisement was absent in 59⋅8 % of the food outlets, 19⋅6 % were advertising only F&V and 17⋅4 % were advertising only UPF. Higher F&V availability was noted inside specialised F&V markets and large-chain supermarkets than local grocery stores, convenience stores or bakeries. Advertising of F&V was more common within specialised F&V markets. However, large-chain supermarkets and local grocery stores, convenience stores or bakeries contained more frequent UPF food advertising isolated: 38⋅3 and 35⋅2 %, respectively. Therefore, the availability and advertising of food items within food outlets around primary healthcare services are different according to the type of food outlet.

Associations of sedentary behaviours and incidence of unhealthy diet during the COVID-19 quarantine in Brazil

OBJECTIVE

Our aim was to analyse the association of change patterns on TV-viewing and computer/tablet use and incidence of elevated consumption of ultra-processed food consumption and lower consumption of fruits and vegetables during the COVID-19 pandemic.

DESIGN

Data of 39 208 Brazilian adults from a Behaviour Web Survey were used. Unhealthy nutrition habits were eating fruits or vegetables for <5 d/week and ultra-processed food (sugary foods, snacks, ready-to-eat frozen foods and embedded foods) for ≥5 d/week. For incidence indicators, we only considered participants without unhealthy behaviour before the quarantine. We created four categories of change in TV-viewing and computer/tablet use, considering a cut-off point of 4 h/d for each behaviour (1 - consistently low, 2 - become low during the quarantine, 3 - become high during the quarantine or 4 - consistently high). Analyses were adjusted for sex, age group, highest academic achievement, per capita income, working status during the quarantine, skin colour and adherence to the quarantine.

SETTING

Brazil.

PARTICIPANTS

Brazilian adults (nationally representative).

RESULTS

Logistic regression models revealed that high TV-viewing and computer/tablet use incidence were associated with higher odds for elevated frequency of ultra-processed food consumption (TV-viewing: OR 1·70; 95 % CI 1·37, 2·12; computer/tablet: OR 1·73; 95 % CI 1·31, 2·27) and low consumption of fruit and vegetables (TV-viewing: OR 1·70; 95 % CI 1·29, 2·23; computer/tablet: OR 1·53; 95 % CI 1·08, 2·17) incidence. Consistent high computer/tablet use also presented higher odds for incidence of elevated frequency of ultra-processed food consumption.

CONCLUSIONS

Participants with incidence of sedentary behaviours were also more likely to present incidence of unhealthy diet during the COVID-19 pandemic quarantine.