Association between watching TV whilst eating and children's consumption of ultraprocessed foods in United Kingdom

The consumption of ultra-processed foods was associated with adiposity, but not with metabolic indicators in a prospective cohort study of Chilean preschool children

BACKGROUND

Increasing consumption of ultra-processed foods (UPF) has been identified as a risk factor for obesity and various diseases, primarily in adults. Nonetheless, research in children is limited, especially regarding longitudinal studies with metabolic outcomes. We aimed to evaluate the longitudinal association between consumption of UPF, adiposity, and metabolic indicators in Chilean preschool children.

METHODS

We conducted a prospective analysis of 962 children enrolled in the Food and Environment Chilean Cohort (FECHIC). Dietary data were collected in 2016 at age 4 years with 24-h recalls. All reported foods and beverages were classified according to the NOVA food classification, and the usual consumption of UPF in calories and grams was estimated using the Multiple Source Method. Adiposity (z-score of body mass index [BMI z-score], waist circumference [WC], and fat mass [in kg and percentage]) and metabolic indicators (fasting glucose, insulin, HOMA-IR, triglycerides, total cholesterol, and cholesterol fractions) were measured in 2018, at the age of 6 years. Linear regression models ((0) crude, (1) adjusted for covariables, and (2) adjusted for covariables plus total caloric intake) were used to evaluate the association between UPF and outcomes. All models included inverse probability weights to account for the loss to the follow-up.

RESULTS

At 4 years, usual consumption of UPF represented 48% of the total calories and 39% of the total food and beverages grams. In models adjusted for covariables plus caloric intake, we found a positive association between UPF and BMI z-score (for 100 kcal and 100 g, respectively: b = 0.24 [95%CI 0.16-0.33]; b = 0.21 [95%CI 0.10-0.31]), WC in cm (b = 0.89 [95%CI 0.41-1.37]; b = 0.86 [95%CI 0.32-1.40]), log-fat mass in kg b = 0.06 [95%CI 0.03-0.09]; b = 0.04 [95%CI 0.01-0.07]), and log-percentage fat mass (b = 0.03 [95%CI 0.01-0.04]; b = 0.02 [95%CI 0.003-0.04]), but no association with metabolic indicators.

CONCLUSIONS

In this sample of Chilean preschoolers, we observed that higher consumption of UPF was associated with adiposity indicators 2 years later, but not with metabolic outcomes. Longer follow-up might help clarify the natural history of UPF consumption and metabolic risks in children.

Television watching during meals is associated with higher ultra-processed food consumption and higher free sugar intake in childhood

BACKGROUND

The consumption of ultra-processed foods (UPFs) is associated with an increased risk of noncommunicable diseases and mortality in adults. The aim of this study was to analyse the association between mealtime television (TV) watching and UPF consumption in childhood.

MATERIALS AND METHODS

Participants in the SENDO project recruited in 2015-2023 were classified into three categories based on the frequency at which they watched TV during meals. Dietary information was collected with a validated 147-item semi-quantitative food frequency questionnaire. Generalized mixed models were used to compare mean UPF consumption between groups after accounting for the main confounders. The predictive margins of participants who had a free sugar intake >10% of their energy intake in each category were also calculated.

RESULTS

Totally 970 subjects (482 girls) with a mean age of 5.00 years (SD = 0.85) were studied. Children who watched TV during meals ≥4 times/week consumed a mean of 4.67% more energy from UPF than those who watch TV <3 times/month. The adjusted proportions of children who had a free sugar intake >10% of their energy intake in the categories of <3 times/month, 1-3 times/week and ≥4 times/week exposure to TV during meals were 44.9%, 45.9% and 58.7%, respectively.

CONCLUSION

TV watching during meals is associated with higher consumption of UPFs and a higher risk of exceeding 10% of TEI in free sugar intake in childhood.

Ultra-processed food consumption in UK adolescents: distribution, trends, and sociodemographic correlates using the National Diet and Nutrition Survey 2008/09 to 2018/19

PURPOSE

We quantified levels of ultra-processed food (UPF) consumption and investigated consumption patterns in a representative sample of UK adolescents.

METHODS

We used data from 4-day food diaries from adolescents in the UK National Diet and Nutrition Survey (NDNS) (2008/09-2018/19). UPF were identified using the NOVA classification. We estimated the percentage of Total Energy Intake (%TEI) and the absolute weight (grams). Linear regression models quantified differences in UPF consumption across survey years and its association with participant's individual characteristics. This was an analysis of the repeated cross-sectional data from the UK NDNS Rolling Programme waves 1-11 (2008/09-2018/19). A total of 2991 adolescents (11-18y) with complete information on dietary intake were included.

RESULTS

Mean UPF consumption was 861 (SD 442) g/d and this accounted for 65.9% (SD 13.4%) of TEI. Between 2008 and 2019, mean UPF consumption decreased from 996 to 776 g/d [ - 211 (95%CI  - 302;  - 120)] and from 67.7% to 62.8% of TEI [ - 4.8% (95%CI  - 8.1;  - 1.5)]. Higher %TEI was consumed by adolescents with lower socioeconomic status; white ethnicity and living in England North. A higher weight of UPF consumption (g/d) was associated with being male, white, age 18y, having parents with routine or manual occupation, living in England North, and living with obesity.

CONCLUSION

Average energy intake from UPF has decreased over a decade in UK adolescents. We observed a social and regional patterning of UPF consumption, with higher consumption among adolescents from lower socioeconomic backgrounds, from a white ethnicity and living in England North. Our findings suggest inequalities associated with UPF intake and factors that might lie beyond individual choice.

What Is the Nutritional Quality of Pre-Packed Foods Marketed to Children in Food Stores? A Survey in Switzerland

Food marketing targeting children influences their choices and dietary habits, and mainly promotes food high in fat, sugar, and salt as well as ultra-processed food. The aim of this study was to assess the nutritional quality of food and beverages marketed to children over the age of 3 and available on the Swiss market. Products with at least one marketing technique targeting children on the packaging were selected from five food store chains. Three criteria to assess nutritional quality were used: (1) nutritional composition (using the Nutri-Score), (2) degree of processing (NOVA classification), and (3) compliance with the World Health Organization (WHO) Nutrient Profile Model (NPM). A total of 735 products were found and analyzed. The most common marketing techniques used were childish names/fonts (46.9%), special characters (39.6%), and children's drawings (31.3%). Most products had a Nutri-Score of D or E (58.0%) and were ultra-processed (91.8%). Only 10.2% of products displayed the Nutri-Score. The least processed products generally had a better Nutri-Score (p < 0.001). Most products (92.8%) did not meet the criteria of the WHO NPM. Products that met the WHO NPM criteria, organic products, and products with a nutritional claim generally had a better Nutri-Score and were less processed (ps < 0.05). Pre-packaged foods and beverages marketed to children in the Swiss market were mostly of poor nutritional quality. Public health measures should be adopted to improve the nutritional quality of foods marketed to children in Switzerland and restrict the marketing of unhealthy foods to children.

Food for thought or food for emotions? An analysis of marketing strategies in television food advertising seen by children in Colombia

OBJECTIVE

To establish the relationship between the marketing strategies and nutritional quality of foods and beverages promoted in television food advertisements (TV ads) seen by Colombian child audiences overall and based on child gender and socio-economic strata (SES).

DESIGN

A quantitative content analysis of marketing appeals was combined with nutritional data of the food products advertised and matched with TV audience ratings data for each food and beverage ads for Colombian children between 4 and 11 years.

SETTING

All beverages and foods TV ads cable or over-the-air channels in Colombia in 2017.

PARTICIPANTS

N/A.

RESULTS

Compared with rational appeals (e.g. freshness, health or nutrition messages), emotional appeals (referencing or depicting human senses or emotions, e.g. using cartoons to suggest fun) were more frequently used in the TV ads most viewed by Colombian children. Female children and children in lower SES tended to be more exposed to emotional appeals in TV ads than their male or higher SES counterparts. Furthermore, TV ads using more emotional appeals tended to be for products high in problematic nutrients.

CONCLUSION

The findings of this study highlight the need to implement statutory measures to reduce the deleterious effect of food marketing on children.

How French children food representations and tastes vary according to their social backgrounds: a study of disparities in food habitus

The diet of individuals is influenced by social and cultural factors. Children's food tastes and representations, being principally transmitted by their parents, are likely to depend on their social backgrounds. As it is known that parents' feeding strategies and food education differ depending on their social positions, this study aimed at examining how food representations and tastes vary among children. A qualitative sociological study, using semi-structured interviews, was conducted with 40 children, aged from 9 to 11 years, from four French elementary schools. Results showed that children from disadvantaged social backgrounds mentioned less foods, seemed to have a less varied diet, to consume less vegetables, and to enjoy eating ultra-processed foods more than other children. Different food habitus were found, that can be put into perspective using Bourdieu's distinction theory, including different preoccupations regarding health and necessity among social groups. Disparities in children's food habitus could be theoretically linked with observed and growing social inequalities in health, when taking into consideration the potential practises that these habitus imply, and their probable effects on health. Participatory food education classes at school could aim to reduce such disparities, although some concerns and limits must be acknowledged.

Ultra-Processed Food, Reward System and Childhood Obesity

Obesity and overweight are a major public health problem globally. Diet quality is critical for proper child development, and an unhealthy diet is a preventable risk factor for noncommunicable diseases (NCDs), such as obesity. Consumption of sugar-sweetened beverages and ultra-processed foods (UPFs) in childhood may increase the BMI/BMI z-score, body fat percentage, or likelihood of overweight. A strict feeding regulation system allows for sufficient food to be consumed to meet ongoing metabolic demands while avoiding overconsumption. This narrative review explores the issues of obesity and the regulation of food intake related to reward systems and UPF consumption. Nutrient composition alone cannot explain the influence of UPFs on the risk of obesity. Furthermore, the non-nutritional properties of UPFs may explain the mechanisms underlying the relationship with obesity and NCDs. UPFs are designed to be highly palatable, appealing, and energy dense with a unique combination of the main taste enhancer ingredients to generate a strong rewarding stimulus and influence the circuits related to feeding facilitation. How individual UPF ingredients influence eating behavior and reward processes remains not fully elucidated. To increase the knowledge on the relationship between UPFs and pediatric obesity, it may be useful to limit the rapid growth in the prevalence of obesity and subsequent related complications, and to develop new strategies for appropriate food and nutrition policies.

Evidence for protein leverage in a general population sample of children and adolescents

BACKGROUND/OBJECTIVES

The strong regulation of protein intake can lead to overconsumption of total energy on diets with a low proportion of energy from protein, a process referred to as protein leverage. The protein leverage hypothesis posits that protein leverage explains variation in energy intake and potentially obesity in ecological settings. Here, we tested for protein leverage and the protein leverage hypothesis in children and adolescents.

SUBJECTS/METHODS

A population sample of children, mean (SD) age 7.6 (0.4) years (n = 422), followed up at age 9.8 (0.4) years (n = 387) and at age 15.8 (0.4) years (n = 229), participating for the Physical Activity and Nutrition in Children (PANIC) study.

EXPOSURES

4-day food records-related proportional energy intake of proteins, fats, and carbohydrates.

OUTCOMES

energy intake, body mass index (BMI) z-score and dual-energy X-ray absorptiometry-related energy expenditure.

RESULTS

Proportional energy intake of proteins was inversely associated with energy intake following power functions at all 3 ages (mean [95%CI] strength of leverage of L = -0.36 [-0.47 to -0.25]; L = -0.26 [-0.37 to -0.15]; L = -0.25 [-0.38 to -0.13]; all P < 0.001). Mixture analysis indicated that variance in energy intake was associated primarily with the proportional intake of energy from proteins, not with either fats or carbohydrates. At all 3 ages, energy intake was not associated with BMI z-score but positively associated with energy expenditure (all P < 0.001).

CONCLUSIONS

This study provides evidence consistent with protein leverage in a population sample of children and adolescents. Increased energy intake on diets with lower protein content was counterbalanced by increased energy expenditure and therefore did not translate into increased adiposity.

Changes in lifestyle behaviors during the COVID-19 pandemic in children and adolescents with congenital heart disease

OBJECTIVE

To describe the changes in lifestyle behaviors during the COVID-19 pandemic in children and adolescents with congenital heart disease and to investigate the association of congenital heart disease complexity with lifestyle behavior changes.

METHODS

Cross-sectional study with 127 children and adolescents with congenital heart disease, who underwent cardiac procedure (mean postoperative time: 10.11±3.13 years), conducted between December 2020 and January 2021. Lifestyle behaviors, such as dietary intake, physical activity, sedentary behavior, and sleep, were assessed through telephone interview based on validated questionnaires. Dietary patterns were identified using principal component analysis. Frequency of general and specific combinations of healthy and unhealthy lifestyle behavior changes was evaluated. Multinomial logistic regressions were used to test the association between congenital heart disease complexity and changes in lifestyle behavior.

RESULTS

The main lifestyle behaviors acquired during pandemic were: 83.5% decreased physical activity; 37.0% increased sedentary behavior; 26.0% slept more than usual; and 23.6% adopted a less-healthy dietary pattern. Almost half of the participants (41.8%) had at least one unhealthy change in lifestyle behavior. Complex congenital heart diseases were associated with increased sedentary behavior (OR 3.49, 95%CI 1.23-9.90).

CONCLUSIONS

Children and adolescents with congenital heart disease had unhealthy lifestyle behavior during the pandemic, mainly in the form of reduced physical activity and increased sedentary behavior.

Dissecting ultra-processed foods and drinks: Do they have a potential to impact the brain?

Ultra-processed foods and drinks (UPF) are formulation of ingredients, mostly of exclusive industrial use, that result from a series of industrial processes. They usually have a low nutrient but high energy density, with a high content of saturated and trans fats, and added sugars. In addition, they have characteristic organoleptic properties, and usually contain sophisticated additives, including artificial sweeteners, to intensify their sensory qualities and imitate the appearance of minimally processed foods. In addition, recent research has warned about the presence of chemicals (e.g., bisphenol) and neo-formed contaminants in these products. UPF production and consumption growth have been spectacular in the last decades, being specially consumed in children and adolescents. UPF features have been associated with a range of adverse health effects such as overeating, the promotion of inflammatory and oxidative stress processes, gut dysbiosis, and metabolic dysfunction including problems in glucose regulation. The evidence that these UPF-related adverse health effects may have on the neural network implicated in eating behavior are discussed, including the potential impact on serotonergic and dopaminergic neurotransmission, brain integrity and function. We end this review by placing UPF in the context of current food environments, by suggesting that an increased exposure to these products through different channels, such as marketing, may contribute to the automatic recruitment of the brain regions associated with food consumption and choice, with a detrimental effect on inhibitory-related prefrontal cortices. While further research is essential, preliminary evidence point to UPF consumption as a potential detrimental factor for brain health and eating behavior.

A Systematic Review on Processed/Ultra-Processed Foods and Arterial Hypertension in Adults and Older People

The increase in the availability of processed and ultra-processed foods has altered the eating patterns of populations, and these foods constitute an exposure factor for the development of arterial hypertension. This systematic review analyzed evidence of the association between consumption of processed/ultra-processed foods and arterial hypertension in adults and older people. Electronic searches for relevant articles were performed in the PUBMED, EMBASE and LILACS databases. The review was conducted following the PRISMA guidelines and the Newcastle–Ottawa Scale. The search of the databases led to the retrieval of 2323 articles, eight of which were included in the review. A positive association was found between the consumption of ultra-processed foods and blood pressure/arterial hypertension, whereas insufficient evidence was found for the association between the consumption of processed foods and arterial hypertension. The results reveal the high consumption of ultra-processed foods in developed and middle-income countries, warning of the health risks of such foods, which have a high energy density and are rich in salt, sugar and fat. The findings underscore the urgent need for the adoption of measures that exert a positive impact on the quality of life of populations, especially those at greater risk, such as adults and older people.

Ultraprocessed food consumption and dietary nutrient profiles associated with obesity: A multicountry study of children and adolescents

This study assessed associations between ultraprocessed food consumption and dietary nutrient profile linked to obesity in children and adolescents in Argentina, Australia, Brazil, Chile, Colombia, Mexico, the United Kingdom, and the United States using nationally representative data collected between 2004 and 2014. Linear regression models were used to evaluate associations between dietary share of ultraprocessed foods (country and age group-specific quintiles and a 10% share increase) and the energy density of diets and their content of free sugars and fiber. Ultraprocessed foods, defined by the NOVA system, ranged from 18% of total energy intake among preschool children in Colombia to 68% among adolescents in the United Kingdom. In almost all countries and age groups, increases in the dietary share of ultraprocessed foods were associated with increases in energy density and free sugars and decreases in fiber, suggesting that ultraprocessed food consumption is a potential determinant of obesity in children and adolescents. Effective global policy action to address growing ultraprocessed food consumption and childhood obesity is urgently needed.

Nutritional Quality and Degree of Processing of Children's Foods Assessment on the French Market

Food packaging marketing techniques which appeal to children (such as cartoon characters and brand mascots) affect children's choices, preferences, and eating habits. Several studies have assessed the nutritional quality of food intended to children in various countries and concluded that most were high in fat, salt, and sugar (HFSS) and ultra-processed foods. The aim of this study is to analyse products intended for children over the age of 3 (foods and beverages with relevant marketing elements on the packaging) available on the French market as regards: (1) nutritional quality, based on the Nutri-Score labelling system, (2) compliance with expected nutritional profile suitable for children, according to the criteria of the WHO Europe Nutrient Profile Model, and (3) degree of processing, as defined by the NOVA classification, from packaging collected in 20 stores (hyper/supermarkets, hard-discount retail chains, and organic food stores). The marketing strategies most often used on children's products are cartoons (97.22%; n = 1120) and mascots (77.78%; n = 896). A total of 1155 products were included in the study, most of which were sugary foods: almost a quarter of the products in the sample (23.81%; n = 275) list a sweetener as the first ingredient, and most of them (89.52%; n = 1034) contain free sugars according to the WHO definition. All the products included in our study feature marketing elements targeting on the packaging, yet 94.88% do not meet the criteria of the WHO Europe Nutrient Profile Model. Most (58.68%; n = 676) belong to Nutri-Score groups D and E, with the highest proportion in group D (39.32%; n = 453) and are ultra-processed (87.97%; n = 1016), especially through the use of flavourings and ultra-processed sugars. Using the Nutri-Score, the WHO Europe Nutrient Profile Model, and the NOVA classification, this study suggests that a significant share of pre-packaged foods marketed to children do not have an adequate nutritional profile. As such, measures are needed to regulate what marketing elements aimed at children can be included on packaging, based on these criteria.

Early nutritional influences of cardiovascular health

INTRODUCTION

Increasing evidence shows that nutritional choices during children's formative years, including prenatally, impacts the development of adult onset cardiovascular diseases (CVDs), such as hypertension, myocardial infarction, or stroke.

AREAS COVERED

This literature review aims to synthesize the current body of evidence on nutritional factors, from conception through adolescence, which may influence a person's risk factors for future development of CVD.

EXPERT OPINION

Given the escalating healthcare costs associated with CVD, it is imperative that medical professionals and scientists remain steadfast in prioritizing and promoting early CVD prevention, even within the first few years of life. Though not the only contributing risk factor, diet is a modifiable risk factor and has been shown to have a profound impact on the reduction of cardiovascular morbidity and mortality in adult literature. Nutritional choices should be targeted on multiple levels: prenatally with the mother, individually with the patient, in conjunction with their family unit, and also within the broader community wherein they reside. Healthcare providers can play a key advocacy role for local and national food environment policy changes.

Ultra-processed food consumption and its correlates among Italian children, adolescents and adults from the Italian Nutrition & Health Survey (INHES) cohort study

OBJECTIVE

To assess ultra-processed food (UPF) consumption and its socio-demographic, psychosocial and behavioural correlates in a general population of Italian children, adolescents and adults.

DESIGN

Cross-sectional telephone-based survey.

SETTING

Italy, 2010-2013.

PARTICIPANTS

In total, 9078 participants (5-97 years) from the Italian Nutrition & Health Survey. Dietary intakes were collected by a 1-d 24-h dietary recall. UPF was defined by the NOVA classification and expressed as percentage of total energies.

RESULTS

Average energy intake from UPF (95 % CI) was 17·3 % (17·1 %, 17·6 %) among adults and 25·9 % (24·8 %, 27·0 %) in children/adolescents. Top sources of UPF were processed meats (32·5 %) and bread substitutes (16·7 %). Among adults, age (β = -3·10; 95 % CI (-4·40, -1·80) for >65 years v. 20-40 years; βs are dimensionless) and residing in Southern Italy (β = -0·73; 95 % CI (-1·32, -0·14) v. Northern) inversely associated with UPF. Screen view during meals was directly linked to UPF, as well as poor self-rated health (β = 5·32; 95 % CI (2·66, 7·99)), adverse life events (β = 2·33; 95 % CI (1·48, 3·18)) and low sleep quality (β = 2·34; 95 % CI (1·45, 3·23)). Boys consumed two-point percent more UPF of the total energy than girls (β = 2·01; 95 % CI (0·20, 3·82)). For all ages, a Mediterranean diet was inversely associated with UPF (β = -4·86; 95 % CI (-5·53, -4·20) for good v. poor adherence in adults and (β = -5·08; 95 % CI (-8·38, -1·77) for kids).

CONCLUSIONS

UPF contributes a modest proportion of energy to the diets of Italian adults while being one-quarter of the total energies in children/adolescents. UPF was associated with several psychosocial factors and eating behaviours. Increased adherence to Mediterranean diet would possibly result in lower UPF consumption.

Effect of a healthy eating intervention in the first months of life on ultraprocessed food consumption at the age of 4-7 years: a randomised clinical trial with adolescent mothers and their infants

This randomised clinical trial aimed to evaluate the effect of a pro-breast-feeding (BF) and healthy complementary feeding intervention performed during infants' first months of life on ultraprocessed food (UPF) consumption at 4-7 years. We enrolled 323 teenage mothers and their infants from South Brazil, 163 allocated to the intervention group and 160 to the control group. Intervention consisted of sessions on BF and healthy complementary feeding promotion and was carried out in the maternity ward and at home after delivery. Food consumption was assessed using three 24-h food recalls at child's age of 4-7 years. Foods were classified according to NOVA classification. Dietary contribution of UPF was adjusted for intra-individual variability by the SPADE method and categorised into tertiles. We used Poisson regression models with robust variance, adjusted for confounders, to estimate the effect of the intervention and duration of BF on the risk of high consumption of UPF. Our final analysis included 194 children, with mean age of 6·1 (sd 0·5) years. Mean dietary contribution of UPF was 38 % in the intervention group and 42·7 % in the control group, from total daily intakes. Results adjusted for BF duration, propensity score, income and total energy content demonstrated that the intervention reduced the risk of high consumption of UPF by 35 % (relative risk 0·65, 95 % CI 0·43, 0·98). BF duration was not associated with UPF consumption. The intervention was effective in reducing the risk of high UPF consumption at the age of 4-7 years.

Corporate political activity in the context of unhealthy food advertising restrictions across Transport for London: A qualitative case study

BACKGROUND

Diets with high proportions of foods high in fat, sugar, and/or salt (HFSS) contribute to malnutrition and rising rates of childhood obesity, with effects throughout the life course. Given compelling evidence on the detrimental impact HFSS advertising has on children's diets, the World Health Organization unequivocally supports the adoption of restrictions on HFSS marketing and advertising. In February 2019, the Greater London Authority introduced novel restrictions on HFSS advertising across Transport for London (TfL), one of the most valuable out-of-home advertising estates. In this study, we examined whether and how commercial actors attempted to influence the development of these advertising restrictions.

METHODS AND FINDINGS

Using requests under the Freedom of Information Act, we obtained industry responses to the London Food Strategy consultation, correspondence between officials and key industry actors, and information on meetings. We used an existing model of corporate political activity, the Policy Dystopia Model, to systematically analyse arguments and activities used to counter the policy. The majority of food and advertising industry consultation respondents opposed the proposed advertising restrictions, many promoting voluntary approaches instead. Industry actors who supported the policy were predominantly smaller businesses. To oppose the policy, industry respondents deployed a range of strategies. They exaggerated potential costs and underplayed potential benefits of the policy, for instance, warning of negative economic consequences and questioning the evidence underlying the proposal. Despite challenging the evidence for the policy, they offered little evidence in support of their own claims. Commercial actors had significant access to the policy process and officials through the consultation and numerous meetings, yet attempted to increase access, for example, in applying to join the London Child Obesity Taskforce and inviting its members to events. They also employed coalition management, engaging directly and through business associations to amplify their arguments. Some advertising industry actors also raised the potential of legal challenges. The key limitation of this study is that our data focused on industry-policymaker interactions; thus, our findings are unable to present a comprehensive picture of political activity.

CONCLUSIONS

In this study, we identified substantial opposition from food and advertising industry actors to the TfL advertising restrictions. We mapped arguments and activities used to oppose the policy, which might help other public authorities anticipate industry efforts to prevent similar restrictions in HFSS advertising. Given the potential consequences of commercial influence in these kinds of policy spaces, public bodies should consider how they engage with industry actors.

A Systematic Review of Worldwide Consumption of Ultra-Processed Foods: Findings and Criticisms

A debate is ongoing on the significance and appropriateness of the NOVA classification as a tool for categorizing foods based on their degree of processing. As such, the role of ultra-processed food (UPF) on human health is still not completely understood. With this review, we aimed to investigate the actual level of consumption of UPF across countries and target populations to determine the impact in real contexts. Suitable articles published up to March 2021 were sourced through the PubMed and SCOPUS databases. Overall, 99 studies providing data on the level of UPF consumption expressed as the percentage of total energy intake were identified, for a total of 1,378,454 participants. Most of them were published in Brazil (n = 38) and the United States (n = 15), and the 24 h recall was the most-used tool (n = 63). Analysis of the results revealed that the United States and the United Kingdom were the countries with the highest percent energy intake from UPF (generally >50%), whereas Italy had the lowest levels (about 10%); the latter was inversely associated with adherence to the Mediterranean diet. High variability was also observed based on sex, age, and body mass index, with men, young people, and overweight/obese subjects generally having higher levels of consumption compared to older subjects. Overall, our findings underline the large differences in UPF intake. Since most of the observations derived from studies conducted with food questionnaires are not specifically validated for UPF, further efforts are essential to confirm the results previously obtained and to investigate further the association between UPF consumption and health status, also considering the actual contribution within different dietary patterns, which has been less investigated to date.

Snacking patterns throughout the life span: potential implications on health

Eating outside the three main meals - in other words, snacking - is a part of the dietary pattern of individuals in all stages of life. The quality and pattern of snacking have an impact on health during the life span. Thus, the aim of this review was to evaluate various patterns and health outcomes of the snacking habits of different demographical groups, from children to the elderly, throughout their life span. We discuss the snacking pattern among children and adolescents, which is characterized by consuming high energy foods with low nutrient value, and which is associated with increased risk of obesity. During university years, study stress and lack of time were obstacles to a healthy dietary pattern involving nutritious snacks, although awareness of the importance of healthy snacks was higher in this group than among younger age groups. Employment status and skipping regular meals were important factors affecting snacking quality and patterns in adulthood. Unhealthy snacks, high in energy, sugar, and salt and low in nutrients, were demonstrated to have a negative impact on individuals' health, such as oral health, blood pressure, obesity, and diabetes. In conclusion, encouraging individuals to consume healthy snacks that are high in nutrients through education to help them plan for their snacks is important to enhance health and reduce disease risk.

Examining the association between meal context and diet quality: an observational study of meal context in older adults

Background

Though a healthy diet is widely associated with reduced risks for chronic disease and mortality, older adults in the U.S. on average do not meet dietary recommendations. Given that few studies have examined the association between meal context on older adult diet quality, the aims of this study were (1) to compare the dietary quality of foods consumed in different meal contexts, as measured by the Healthy Eating Index 2015 (HEI-2015): meal location, the presence of others, and the use of electronic screens; and (2) to examine which components of the HEI-2015 drove differences in HEI-2015 total scores by meal context.

Methods

Interactive Diet and Activity Tracking in AARP study participants (50–74 years) completed the Automated Self-Administered 24-h Dietary Assessment tool (ASA24, version 2011) that included foods and beverages consumed and three meal contexts: “at home” versus “away from home,” “alone” versus “with company,” and “with screen time” versus “without screen time.” A population ratio approach was used to estimate HEI-2015 total and component scores for all food items consumed by meal context. Mean HEI-2015 scores (range: 0–100) for the three meal context variables were compared using t-tests. Where there were significant differences in total scores, additional t-tests were used to explore which HEI-2015 components were the primary drivers. All tests were stratified by sex and adjusted for multiple comparisons.

Results

HEI-2015 scores were lower for meals consumed away vs. at home (mean difference (SE), males: − 8.23 (1.02); females: − 7.29 (0.93); both p < 0.0001) and for meals eaten with vs. without company (mean difference (SE), males: − 6.61 (1.06); females: − 7.34 (1.18); both p < 0.0001). There was no difference comparing with vs. without screen time. When HEI-2015 component scores were examined, fewer total fruits, whole grains, and dairy were consumed away from home or with company; more total vegetables and greens and beans, and less added sugars were consumed with company.

Conclusions

Our findings suggest an association between the behavior cues of meal location and companions and dietary choices among older adults. Future studies can explore the individual and interactive effects of meal context on diet quality and subsequent health outcomes.

Eating context and ultraprocessed food consumption among UK adolescents

We aimed to evaluate the association between eating context patterns and ultraprocessed food consumption at two main meal occasions in a representative sample of UK adolescents. Data were acquired from 4-d food records of adolescents aged 11-18 years, who participated in the 2014-2016 UK National Diet and Nutrition Survey (n 542). The eating context was assessed considering the location of the meal (lunch and dinner) occasion, the individuals present, whether the television was on and if the food was consumed at a table. Ultraprocessed foods were identified using the NOVA classification. Exploratory factor analysis was used to identify eating context patterns for lunch and dinner. Linear regression models adjusted for the covariates were utilised to test the association between eating context patterns and the proportion of total daily energy intake derived from ultraprocessed foods. Their contribution was about 67 % to energy intake. Three patterns were retained for lunch ('At school with friends', 'TV during family meal' and 'Out-of-home (no school)'), and three patterns were retained for dinner ('Watching TV alone in the bedroom', 'TV during family meal' and 'Out-of-home with friends'). At lunch, there was no significant association between any of the three patterns and ultraprocessed food consumption. At dinner, the patterns 'Watching TV alone in the bedroom' (coefficient: 4·95; 95 % CI 1·87, 8·03) and 'Out-of-home with friends' (coefficient: 3·13; 95 % CI 0·21, 6·14) were associated with higher consumption of ultraprocessed food. Our findings suggest a potential relationship between the immediate eating context and ultraprocessed food consumption by UK adolescents.

Do TV viewing and frequency of ultra-processed food consumption share mediators in relation to adolescent anxiety-induced sleep disturbance?

OBJECTIVE

To investigate the role of potential shared mediators in the association of TV viewing and frequency of ultra-processed food consumption with anxiety-induced sleep disturbance.

DESIGN

Cross-sectional study.

SETTING

Data from the Adolescent School-Based Health Survey, a Brazilian nationally representative survey of ninth-grade adolescents conducted in 2015, were used.

PARTICIPANTS

99 791 adolescents (52 015 girls) with a mean age of 14·3 years (range 11-19) participated. All variables were collected through a self-reported questionnaire based on the Global School-Based Student Health Survey. Anxiety-induced sleep disturbance was the outcome. Over 4 h/d of TV viewing and daily consumption of ultra-processed foods were the exposures. Body satisfaction, loneliness, self-rated health and eating while watching TV or studying were mediators. Age, ethnicity, food insecurity, type of city (capital or interior), country region and physical activity were covariates. Logistic regression and mediation models (Karlsson-Holm-Breen method) assessed associations.

RESULTS

Both daily ultra-processed food consumption (boys: OR 1·48, 95 % CI 1·30, 1·70; girls: OR 1·46, 95 % CI 1·34, 1·60) and TV viewing (boys: OR 1 24, 95 % CI 1·08, 1·43; girls: OR 1·09, 95 % CI 1·00, 1·19) were associated with higher odds for anxiety-induced sleep disturbance. Loneliness and eating while watching TV or studying (only among girls) consistently mediated the association of both daily ultra-processed food consumption (loneliness: boys 17·4 %, girls 23·4 %; eat while watching TV or studying: girls 6·8 %) and TV viewing (loneliness: boys 22·9 %, girls 45·8 %; eat while watching TV or studying: boys 6·7 %, girls 17·9 %) with anxiety-induced sleep disturbance.

CONCLUSIONS

Daily ultra-processed food consumption and TV viewing share mediators and can act in synergic mechanisms in the association with anxiety-induced sleep disturbance. Therefore, future interventions should focus in the reduction of both behaviours in combination.

Effects of an Educational Hybrid Physical Education Program on Physical Fitness, Body Composition and Sedentary and Physical Activity Times in Adolescents: The Seneb's Enigma

Physical activity (PA), body composition and sedentary behavior may affect the health of children. Therefore, this study examined the effect of an educational hybrid physical education (PE) program on physical fitness (PF), body composition and sedentary and PA times in adolescents. A 9-month group-randomized controlled trial was conducted in 150 participants (age: 14.63 ± 1.38 years) allocated into the control group (CG, n = 37) and experimental group (EG, n = 113). Cardiorespiratory fitness, speed, strength, agility, flexibility and body mass index (BMI) were assessed through previously validated field tests. Sedentary time, PA at school and afterschool were evaluated with the Youth Activity Profile-Spain questionnaire. Significant differences were observed concerning to the CG in APA-weekend (p = 0.044), speed-agility (p = 0.005) and agility (p = 0.008). Regarding the intervention, cardiorespiratory fitness (p = 0.000), speed-agility (p = 0.000), strength (p = 0.000), flexibility (p = 0.000), agility (p = 0.000), PA in school (p = 0.011), APA-weekday (p = 0.001), APA-weekend (p = 0.000), APA-week (p = 0.000), and sedentary time (p = 0.000) increased significantly in the EG. The use of a hybrid program based on teaching personal and social responsibility and gamification strategies produced enhancements in cardiorespiratory fitness, agility, speed, APA-weekdays and APA-weekends, reducing the sedentary time.

Changes in Eating Habits and Sedentary Behavior During the COVID-19 Pandemic in Adolescents With Chronic Conditions

Introduction: Among healthy adolescents, school closures and home confinement were shown to increase unhealthier eating habits and sedentary behavior. It remains unknown to which extent the pandemic has impacted the lifestyle of adolescents with chronic conditions. Thus, the aim of this study is to report on the impact of the COVID-19 outbreak on eating habits and sedentary behavior among adolescents with multiple chronic conditions (n = 347) from a tertiary, referral hospital vs. healthy peers. Methods: This observational study was conducted in São Paulo (Brazil) between July and October 2020, period in which a set of social distancing measures to contain the pandemic. Results: The main findings of this study were that adolescents with chronic conditions and health peers showed important changes in eating habits (e.g., more often cooking and eating in front of television than before quarantine). Also, 86.8% of adolescents with chronic conditions and 91.6% of healthy adolescents reported increasing screen time during pandemic. No major differences were observed between patients and controls. Conclusions: Adolescents with chronic conditions and healthy peers exposed to pandemic showed substantial changes in lifestyle, stressing the need for specific care to mitigate poor eating habits and excessive sedentary behavior for patients and healthy adolescents.

The habit of buying foods announced on television increases ultra-processed products intake among schoolchildren

This study aimed to verify the effects of buying television advertised food in schoolchildren eating behaviors. We performed a cross-sectional study with fourth grade students of an elementary education in Belo Horizonte, Minas Gerais State, Brazil. We analyzed anthropometric data, the habit of buying television advertised food/beverages, and food consumption (two 24-hour dietary recalls). Logistic regression models were conducted and adjusted for gender, age, caloric intake, nutritional status, and social deprivation of area of residence. In total, 797 children were evaluated, the mean age was 9.81 (0.59) years, 50.7% were female, and 32.4% overweight. The prevalence of the habit of buying television advertised food was 43.1%, among which 99.3% concerned ultra-processed foods, according to the classification proposed by Monteiro et al. (2016), mainly milk beverages (12.1%), industrialized biscuits (11.5%) and candies (9.5%). The habit of buying advertised food increased the chance of consuming ultra-processed foods (OR = 1.92; 95%CI: 1.06-3.46). We found no correlation between this habit and the consumption of minimally processed and processed foods (p < 0.05). This study findings may corroborate the debate on food advertising policy and the development of effective nutrition interventions among schoolchildren, which should involve integrated education bringing together children and parents.

Association between watching TV whilst eating and children's consumption of ultraprocessed foods in United Kingdom

This study aimed to assess the association between watching TV whilst eating and consumption of ultraprocessed foods amongst children aged 4-10 years old in the United Kingdom. Cross-sectional data from the UK National Diet and Nutrition Survey (NDNS 2008-2012) were analysed. Dietary data were derived from 4-day food diaries of 1,277 children, and the dietary contribution of ultraprocessed foods was assessed. Meals were classified based on time of day in which foods were consumed (lunch: 11 pm-3 pm and dinner: 6 pm-9 pm). Crude and adjusted linear regression models were employed to verify the effect of watching TV during meals on dietary contribution of ultraprocessed foods (% of total energy intake). More than 70% of the children watched TV during meals, and 31.4% presented the behaviour on both "lunch and dinner." Children's mean total energy intake was 1,532.3 kcal/day, of which 65.8% came from ultraprocessed foods. Findings indicated that children who watched TV whilst having both meals (lunch and dinner) consumed on average 85.5 kcal/day and 6.1% more energy from ultraprocessed foods than those who did not. Children who watched TV only during dinner consumed on average 37.1 kcal/day and 3.4% more energy from ultraprocessed foods than those who did not. The behaviour of watching TV whilst eating meals was associated with higher total daily consumption of ultraprocessed foods by children in the United Kingdom. Therefore, interventions designed to promote healthy eating habits should include aspects related to the context of meals.