Ultra-Processed Food Consumption among the Paediatric Population: An Overview and Call to Action from the European Childhood Obesity Group

Ultra-Processed Food Consumption Among College Students and Their Association With Body Composition, Bowel Movements and Menstrual Cycle

Objectives

The current research aimed to explore the association of ultra-processed food consumption among college students with body composition, bowel movements, and menstrual irregularities with a focus on females.

Methods

A cross-sectional study was conducted in Pune, India among 110 university students of both genders aged 18-25 years. A developed and validated Food Frequency Questionnaire (FFQ) based on the NOVA classification was used to evaluate UPF consumption, while the Constipation Scoring System (CSS) and the Premenstrual Symptoms Screening Tool assessed bowel habits and menstrual health, respectively. Anthropometric measurements, including BMI, body fat percentage,and visceral fat were recorded using an Omron Karada Analyzer.

Results

A higher percentage of participants were female (74.8%). Most participants (52.3%) consumed more than three meals daily, while 42.1% ate outside food 2-3 times per week. Higher UPF consumption showed a trend toward increased body fat (p = 0.053) and was significantly associated with greater visceral fat accumulation (p < 0.05). No significant associations were found between UPF intake and bowel movement, gastrointestinal symptoms, or menstrual cycle irregularities (p > 0.05).

Conclusion

Higher UPF consumption showed a trend toward increased body fat percentage, though not statistically significant. These findings highlight the need to reduce UPF intake to mitigate potential risks of increased adiposity and metabolic disturbances.

Higher consumption of ultra-processed foods is associated with higher odds of overweight and obesity amongst under-five children: A national cross-sectional study in Lebanon

INTRODUCTION

Limited evidence exists on the relationship between ultra-processed food (UPF) consumption and overweight/obesity amongst young children. This study aimed to assess UPF consumption, its socioeconomic correlates and its association with overweight/obesity amongst under-five children in Lebanon.

MATERIALS AND METHODS

Data pertinent to children aged 6 months to 4.9 years (n = 893) from a cross-sectional national survey were used. Anthropometric measurements were obtained, and multi-component questionnaires were administered to mothers. Dietary intake was assessed using the 24-h recall approach. NOVA classification was used to assign food items into four groups according to the extent of industrial processing. Contributions of each group to total energy intake (EI) and macronutrient and micronutrient intakes were estimated. Regression models were conducted to explore the correlates of UPF consumption as well as the association between UPF consumption and overweight/obesity status.

RESULTS

UPFs were found to contribute 47% of daily EI. Girls and children with higher household income had significantly higher UPF intakes. Children whose mothers had an intermediate, high school, or technical diploma and were employed and whose fathers had higher education levels consumed significantly less EI from UPFs. Children whose %EI fell within the second and third tertiles of UPF intake had significantly higher odds of overweight/obesity as compared to those in the first tertile (adjusted odds ratio [AOR]: 1.21, 95% confidence interval [CI]: 1.09, 1.32 and AOR: 1.61, 95% CI: 1.47, 1.76, respectively), after adjusting for confounders.

CONCLUSION

The high intake of UPFs coupled with its association with overweight/obesity call for public health nutrition interventions aimed at improving feeding and dietary practices in this age group.

Ultra-Processed Food and Its Impact on Bone Health and Joint Diseases: A Scoping Review

Background/Objectives: This scoping review explores the relationship between ultra-processed food (UPF), bone health, and joint diseases, focusing on its potential impact on bone mineral density (BMD), osteoporosis, osteoarthritis, and inflammatory arthritis, including rheumatoid arthritis (RA), gout, and spondyloarthritis. Methods: A search strategy was developed using key terms such as "ultra-processed food" and related terms like "fast food," alongside various definitions of bone health impairment, chronic degenerative joint diseases, and inflammatory arthritis. Results: A total of 19 studies were included: 12 on bone health, 3 on osteoarthritis, and 4 on inflammatory arthritis. Preclinical studies showed that UPF consumption negatively affects bone structure and strength. In studies on children and adults, four investigations (2013-2017) found no association between fast food intake and BMD. However, more recent large-scale cross-sectional studies linked higher UPF consumption to lower BMD, increased osteoporosis risk, and greater prevalence of osteopenia, particularly in postmenopausal women. UPF intake was associated with knee osteoarthritis risk, with evidence suggesting an interaction with cartilage thickness, though no association was found for hip osteoarthritis. In inflammatory arthritis, UK Biobank data indicated a higher risk of RA and gout in UPF consumers, while a Brazilian study reported worse metabolic profiles in RA patients. No significant differences in UPF intake were found in spondyloarthritis. Conclusions: This review highlights relevant considerations about the deleterious role of UPF on bone health and joint diseases, providing additional evidence to suggest healthier dietary patterns to patients and to the general population.

The Relationship Between Dietary Patterns and the Epidemiology of Food Allergy

Food allergies are increasing globally, particularly in Asia; however, the etiologies of allergic diseases remain poorly understood despite comprehensive studies conducted across a variety of populations. Epidemiological research demonstrates that food allergy is more prevalent in Westernized or urbanized societies than in rural or developing ones. As such, comparing the distribution and patterns of food allergies as well as the environmental exposures between regions may provide insight into potential causal and protective factors of food allergy. Diet is an important exposome that has been shown to modulate the immune system both directly and indirectly via pathways involving the microbiota. Changes in dietary patterns, especially the shift to a Westernized diet with reduced dietary fiber and an abundance of processed foods, impact the gut and skin epithelial barrier and contribute to the development of chronic inflammatory diseases, such as food allergy. Although dietary intervention is believed to have tremendous potential as a strategy to promote immunological health, it is essential to recognize that diet is only one of many factors that have changed in urbanized societies. Other factors, such as pollution, microplastics, the use of medications like antibiotics, and exposure to biodiversity and animals, may also play significant roles, and further research is needed to determine which exposures are most critical for the development of food allergies.

Cohort profile: Health and Attainment of Pupils in a Primary Education National Cohort (HAPPEN) - a hybrid total population cohort in Wales, UK

PURPOSE

Health and Attainment of Pupils in a Primary Education National (HAPPEN) is a primary school national cohort which brings together education, health and well-being research in line with the Curriculum for Wales framework. Health, education and social care data are linked and held in the Secure Anonymised Information Linkage (SAIL) Databank. In addition, school-aged children complete the HAPPEN Survey to inform the design and implementation of the Health and Well-being curriculum. Over 600 schools take part in the HAPPEN Survey. Linkage of health and education records from the HAPPEN national cohort with HAPPEN Survey responses gives enriched cohort detail which can be used to extrapolate to other schools in Wales. We present the descriptive data available in HAPPEN, and the future expansion plans.

PARTICIPANTS

The HAPPEN cohort includes 37 902 primary-aged school children from 2016 to July 2023. Of this number, 28 019 can be linked in SAIL with their anonymised linkage field. In addition, to date (May 2024), HAPPEN Survey data have been captured from over 45 000 children, which can be linked to the electronic data. The survey continues to rise by 7000-8000 responses annually.

FINDINGS TO DATE

The cohort is 49% girls, 47% boys (3% prefer not to state their gender and 1% of this data is missing) and 14% are from an ethnic minority background (10% prefer not to state their ethnicity). Initial findings have explored the impact of COVID-19 on well-being and play opportunities, along with a longitudinal exploration of well-being throughout the years.

FUTURE PLANS

HAPPEN is an ongoing dynamic cohort of data collection. Access to the cohort is available through SAIL. Ongoing research includes the evaluation of interventions for primary school children such as natural experiment methods, free school meal roll-out in Wales, interventions to improve physical literacy including changes to the built environment and interventions to improve the health and well-being of primary school children.

Comparative effectiveness of school-based obesity prevention programs for children and adolescents: a systematic review and network meta-analysis

Introduction

While many randomized controlled trials (RCTs) have demonstrated the positive effects of school-based programs in reducing body fat among children and teenagers, there is no conclusive evidence to indicate that one approach is superior to another, largely due to the lack of direct and indirect comparisons. This study evaluated the relative effectiveness of various school-based obesity prevention initiatives in improving body mass index (BMI) among children and adolescents using network meta-analysis.

Methods

Searches included four databases focusing on articles published in English between the years 2002 and 2024. The primary outcomes were the BMI and BMI z-scores (BMIz) (kg/m2). The mean differences (MDs) for each outcome were calculated before and after treatment. The current systematic review synthesized 53 RCTs with a sample of 68,489 children and adolescents.

Results

The results illustrated that the physical activity (PA) only arm was the most effective intervention in improving BMI (MD: -0.42, 95% credible interval (Crl) -0.79, -0.07; p = 0.02), while the multiple-component intervention was the most effective in improving BMIz (MD: -0.08, 95% Crl: -0.16, -0.01; p = 0.03). Inversely, PA and another component arm were the least effective interventions in improving BMI (MD: 0.64, 95% Crl: -0.23, 1.53; p = 0.15). In addition, diet and nutrition only arm was the least effective intervention in improving BMIz (MD: 0.09, 95% Crl: -0.11, 0.28; p = 0.36).

Discussion

In conclusion, both PA-only and multiple-component arms are effective intervention tools/strategies for reducing BMI-related outcomes. However, further large-scale, well-designed studies are needed to investigate the elements of multiple-component arms.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/ identifier CRD42021234742.

Impact of breastfeeding and formula feeding on immune cell populations and blood cell parameters: an observational study

OBJECTIVE

Breastfeeding is associated with improved health outcomes in infancy and throughout adulthood as breast milk encompasses diverse immune-active factors that affect the ontogeny of the immune system in breastfed (BF) infants. Nevertheless, the impact of infant feeding on the immune system is poorly understood, and a comprehensive understanding of immune system development in human infants is lacking. In this observational study, we addressed the effects of different infant feeding approaches on cell populations and parameters in the peripheral blood of infants to gain insight into the innate and adaptive arms of the immune system.

METHODS

Using flowcytometric analysis, we performed complete blood counts and immunoprofiling of peripheral blood collected from BF and formula-fed (FF) infants at different ages.

RESULTS

Our results showed that the blood of BF infants had a higher frequency of leukocytes and erythrocytes in early infancy. The hemoglobin concentration was enhanced in BF infants. However, the platelet count was comparable regardless of feeding regimen.

CONCLUSIONS

We observed immunophenotypic differences between the two populations of infants, mirrored by improved frequency of innate and adaptive immune cells in BF infants.

Factors influencing perceptions of processed baby foods and feeding practices among Indian mothers: a qualitative investigation

OBJECTIVE

To explore how professionally qualified, working Indian mothers conceptualize healthy foods in general, perceive processed infant and baby foods available commercially and what feeding practices they actually follow with their children at home.

DESIGN

Five focus groups with 8-12 participants were conducted around the participants' conceptualization of healthy food, their perceptions about commercially available processed baby and infant foods and their actual feeding practices that they routinely follow with their children. Discussion transcripts were analyzed using an inductive coding approach.

SETTING

India.

PARTICIPANTS

Fifty-one professionally qualified, working women with at least one child under 5 years of age.

RESULTS

Participants agreed that fresh food is healthiest. They also had favorable opinions about processed infant and baby foods with regards to healthfulness, hygiene and safety. Healthy foods were largely conceptualized in relation to nutrient claims, ingredients and discernible health outcomes. They use cues, such as health claims, brand, price, package design and others to determine healthfulness of the product. Perception was heavily influenced by these extrinsic cues rather than by participants' own nutrition knowledge. Despite having the knowledge, most participants admitted to using these foods on account of factors such as their own inability to lactate, social pressure, lack of time and convenience.

CONCLUSIONS

Most educated and well off people continue to use these products. While they rue the lack of stringent regulatory measures in India, they feel there is an urgent need to address this huge policy gap by way of legislation and regulation.

Human Milk Feeding and Ultraprocessed Food Intake in Toddlerhood

Objective: The objective of the study was to estimate associations between early-life human milk feeding and ultraprocessed food (UPF) intake at two timepoints during toddlerhood among children born at <35 weeks' gestation. Study Design: Children were enrolled in the Omega Tots trial (2012-2017, Ohio) at 10-17 months' corrected age after having discontinued human milk and formula feeding. Caregivers reported children's human milk feeding history at baseline and past month diet through a food frequency questionnaire at baseline and follow-up (180 days later). We used the NOVA classification system to estimate UPF intake. We estimated covariate-adjusted associations between human milk feeding (ever and duration) and UPF intake at baseline and follow-up using linear and logistic regression. Results: Nearly 89% (n = 295) of 333 toddlers had received human milk but only 4.2% (n = 14) were fed exclusively human milk to 6 months of age. UPFs represented 37.7 (standard deviation [SD] = 13.2)% and 43.4 (SD = 11.3)% of total calories at the two timepoints. Human milk feeding (exclusive or otherwise) was unassociated with UPF intake in toddlerhood (e.g., months of exclusive human milk feeding with the number of daily servings of UPFs at follow-up: β = -0.09, 95% confidence interval [CI]: -0.26, 0.08). Conclusion: In this sample of toddlers born preterm, any exposure to as well as the duration of human milk feeding was unassociated with UPF intake during the second year of life. These results require replication in larger samples given the small number of children in some human milk feeding categories.

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.

Building Capacity and Advancing Regulatory Measures to Improve Food Environments in the Region of the Americas

Noncommunicable diseases (NCDs) are the main cause of death globally (70%) and in the Region of the Americas (80%), and poor diets are a leading driver of NCDs. In response, the Pan American Health Organization (PAHO)/World Health Organization (WHO) introduced a set of evidence-based regulatory measures to help countries improve diets through the reduced consumption of processed and ultra-processed foods. This paper aims to describe the needs of and propose actions for key actors to advance these measures. A workshop was designed to assess member states' regulatory capacity. A thematic analysis was conducted to analyze regional needs, successes and challenges. Thereafter, the Government Capacity-Building Framework for the prevention and control of NCDs was used to examine findings. The findings were organized in two sets: (i) PAHO/WHO actions to support member states and (ii) key actors' actions to advance regulatory policies. The results show notable regulatory progress across the Region of the Americas. However, progress differs between countries, with opportunities to strengthen measures in most countries, mainly in conflict of interest management. The results identified important actions to strengthen the regulatory capacity of PAHO/WHO member states. To maximize momentum for these actions, timelines must be identified, and political commitment can be boosted by applying human rights-based and food system-wide approaches.

The Human Interference Scoring System (HISS): A New Tool for Quantifying Food Quality Based on Its Level of Processing

The Human Interference Scoring System (HISS) is a novel food-based diet-quality-classification system based on the existing NOVA method. HISS involves food and fluid allocation into categories from digital imagery based on food processing levels, followed by meal plan analysis using food-servings quantification. The primary purpose of this work was to evaluate the reliability of HISS. Trained nutrition professionals analyzed digital photographs from five hypothetical 24 h food recalls and categorized foods into one of four HISS categories. A secondary purpose was to assess the nutrient composition of the food recalls and other selected foods from the HISS categories. Participants effectively categorized foods into HISS categories, with only minor discrepancies noted. High inter-rater reliability was observed in the outer HISS categories: unprocessed and ultra-processed foods. Ultra-processed items consistently displayed elevated energy, carbohydrates, and sugar compared to unprocessed foods, while unprocessed foods exhibited notably higher dietary fiber. This study introduces the HISS as a potentially useful tool for quantifying a food-quality-based system using digital-photography-based assessments. Its high inter-rater reliability and ability to capture relationships between food processing levels and nutrient composition make it a promising method for assessing dietary habits and food quality.

Neurodevelopment and Dietary Intake in Toddlers-A Cross-Sectional Study from the Healthy Children 2021 Project

Little is known about the potential associations between neurodevelopment, dietary diversity and food processing in the toddler period. This study aimed to estimate the association between these dietary quality dimensions and neurodevelopment in toddlers. Data for this cross-sectional analysis came from the Healthy Children 2021 project and included 212 toddlers (51.9% females, aged 12-36 months) from 15 Portuguese childcare centers. Neurodevelopment was assessed through Bayley Scales of Infant and Toddler Development. Dietary intake was gathered by a two-day non-consecutive dietary recall. The food items were categorised with NOVA classification. Dietary diversity was explored through Minimum Dietary Diversity (MDD). Logistic regression models adjusted for potential confounders were performed. Girls with a higher energy contribution of unprocessed/minimally processed foods and with an above median MDD score had higher odds of achieving a higher neurodevelopment score (aOR:1.04; 95%CI 1.01; 1.08 and aOR:2.26; 95%CI 1.01; 5.06, respectively); no significant association was observed in boys. Our findings suggest that these dietary dimensions are associated with a higher neurodevelopment in toddler girls. This should be further studied as a possible early link between dietary factors and neurodevelopment. Promotion of healthy eating can be promising in improving neurocognitive development and might help to introduce public health recommendations for toddlers' nutrition.

Economic Growth and Childhood Malnutrition in Low- and Middle-Income Countries

Importance

Economic growth may reduce childhood malnutrition through improvements of several contributing factors, but the empirical evidence is mixed. Identifying the most important factors that contribute to child malnutrition and their associations with economic growth can inform decision-making about targeted investments to improve children's health.

Objective

To assess the associations between economic growth and malnutrition, contributing factors and malnutrition, and economic growth and contributing factors of malnutrition in low- and middle-income countries (LMICs).

Design, Setting, and Participants

This cross-sectional study used data from 239 Demographic and Health Surveys from January 1, 1990, to December 31, 2021. Observations included 1 138 568 children aged 0 to 35 months with valid anthropometric measures and information on contributing factors of malnutrition from 58 LMICs. Data were analyzed from May 20, 2022, to February 16, 2023.

Exposure

National per-capita gross domestic product (GDP) was used as a proxy for economic growth.

Main Outcomes and Measures

Six measures of childhood malnutrition were constructed: stunting (height-for-age z score <-2), underweight (weight-for-age z score <-2), wasting (weight-for-height z score <-2), overweight (weight-for-height z score >2), obesity (weight-for-height z score >3), and dietary diversity failure (consumption of less than 5 of 8 different food groups in the past 24 hours). Eighteen contributing factors of malnutrition were constructed, of which 10 were underlying determinants (eg, access to improved sanitation) and 8 were immediate determinants (eg, breastfeeding initiation).

Results

A total of 1 138 568 children (mean [SD] age, 17.14 [10.26] months; 579 589 [50.9%] boys and 558 979 [49.1%] girls) were included in the analysis. Of these, 27.3% (95% CI, 27.2%-27.4%) had stunting; 25.7% (95% CI, 25.6%-25.8%), underweight; 11.2% (95% CI, 11.1%-11.2%), wasting; 3.8% (95% CI, 3.7%-3.8%), overweight; 1.1% (95% CI, 1.1%-1.1%), obesity; and 79.8% (95% CI, 79.7%-79.9%), dietary diversity failure. Per-capita GDP was weakly associated with childhood malnutrition. The odds ratios associated with a 5% increase in per-capita GDP were 0.99 (95% CI, 0.99-1.00) for stunting, 1.01 (95% CI, 1.00-1.01) for wasting, 1.00 (95% CI, 1.00-1.00) for underweight, 0.98 (95% CI, 0.98-0.98) for overweight, 0.98 (95% CI, 0.97-0.98) for obesity, and 1.03 (95% CI, 1.01-1.04) for dietary diversity failure. Although strong associations were found between many contributing factors and most outcomes for malnutrition, associations identified between per-capita GDP and these contributing factors themselves were ambiguous.

Conclusions and Relevance

In this multicountry cross-sectional study, economic growth was weakly associated with childhood malnutrition and several contributing factors. To reduce child malnutrition, economic growth may need to be accompanied by more targeted investments to improve contributing factors that are strongly associated with child malnutrition, such as maternal health and education.

Longer Breastfeeding Duration is Associated With Lower Consumption of Ultraprocessed Foods in a Sample of Spanish Preschoolers: The SENDO Project

BACKGROUND

Breastfeeding has been linked to a higher consumption of fruit and vegetables at ages 4 to 5 years. More recently, it has been suggested that it may also be associated with lower ultraprocessed food (UPF) consumption in childhood.

OBJECTIVE

The aim of this study was to assess whether breastfeeding duration was associated with consumption of UPF in a sample of Mediterranean preschoolers.

DESIGN

This study involved a cross-sectional analysis of baseline information of children in the Child Follow-Up for Optimal Development cohort. Children were enrolled at ages 4 to 5 years and information was gathered through an online questionnaire completed by parents. Dietary information was collected with a previously validated semi-quantitative food frequency questionnaire and foods were classified based on the degree of processing according to the NOVA classification.

PARTICIPANTS/SETTING

This study used baseline information for 806 participants enrolled in the Child Follow-Up for Optimal Development cohort between January 2015 and June 2021 in Spain.

MAIN OUTCOMES MEASURES

Main study outcome measures were difference in grams per day and in the percentage of total energy intake from UPF consumption related to breastfeeding duration, and odds ratio that UPF represents a high percentage of total energy intake.

STATISTICAL ANALYSES

Crude and multivariable adjusted estimates were calculated with generalized estimating equations to account for intracluster correlation between siblings.

RESULTS

The prevalence of breastfeeding in the sample was 84%. After adjusting for potential confounders, children who were breastfed for some time reported significantly lower consumption of UPF than children who were not breastfed at all. The mean differences were -19.2 g (95% CI -44.2 to 10.8) for children who were breastfed for <6 months, -42.5 g (95% CI -77.2 to -7.80) for those who were breastfed for 6 to 12 months, and -43.6 g (95% CI -79.8 to -7.48) for those who were breastfed for 12 months or more (P value for trend = 0.01). After adjusting for potential confounders, compared with children who were not breastfed, those who were breastfed for ≥12 months had consistently lower odds of UPF representing more than 25%, 30%, 35%, and 40% of total energy intake.

CONCLUSIONS

Breastfeeding is associated with lower consumption of UPF in Spanish preschoolers.

Understanding the relationship between orofacial structures and feeding habits of preschoolers: A multivariate analysis

The understanding of the relationship between orofacial structures and feeding habits in preschoolers is helpful for health professionals and those dedicated to food science. The hypothesis tested was whether this relationship is already present even at a very young age. This cross-sectional study included 91 healthy caries-free children (50 girls/41 boys; 3.4-6.2 years; mean 4.1 years) and a comprehensive evaluation of the stomatognathic system was performed: dietary intake, facial and occlusal morphology, gustatory sensitivity, bite and lip forces, and orofacial myofunctional aspects (mastication, swallowing and breathing functions). Principal component analysis summarized the variables related to the form and function of the orofacial aspects; further, K-means analysis identified two clusters of participants with similar aspects. Cluster 1 ("Low orofacial myofunctional functioning"; n = 51) was characterized by children who showed the worst performance of mastication, swallowing and breathing functions and whose parents reported the consumption of sweets, cookies, chocolate, but not fresh fruits the day before, in addition to the higher bottle-feeding and pacifier use duration. This cluster also showed higher sweet taste threshold. Cluster 2 ("High orofacial myofunctional functioning"; n = 40) showed lower bottle-feeding and pacifier use duration, higher gustatory sensitivity, greater maxillo-mandibular dimensions, and better orofacial function performance. The variables sex and BMI did not associate to clusters profile. The frequencies of open bite and current sucking habit (pacifier) also differed between clusters. The results showed that an association between form and function of the structures that comprise the stomatognathic system and dietary intake is already present in children with primary dentition.

Ultra-processed foods: a fit-for-purpose concept for nutrition policy activities to tackle unhealthy and unsustainable diets

Modern nutrition science began approximately 100 years ago in the context of nutrient deficiency diseases. Nutrition research and policy activities were framed mostly within a reductionist paradigm in which foods were analysed as being a collection of their constituent nutrients. Today, nutrition problems extend to all forms of malnutrition as well as environmental sustainability considerations and are associated with food and dietary pattern exposures. In 2009, researchers investigating the nutrition transition in Brazil proposed that industrial food processing was a key determinant of nutrition problems. The NOVA food classification system which is based on the nature, extent and purposes of food processing was developed to operationalise this proposition. The ultra-processed food (UPF) concept within NOVA is receiving much attention in relation to nutrition research and policy activities. This commentary describes the UPF concept as being fit-for-purpose in providing guidance to inform policy activities to tackle unhealthy and unsustainable diets. There is now a substantial body of evidence linking UPF exposure with adverse population and planetary health outcomes. The UPF concept is increasingly being used in the development of food-based dietary guidelines and nutrition policy actions. It challenges many conventional nutrition research and policy activities as well as the political economy of the industrial food system. Inevitably, there are politicised debates associated with UPF and it is apparent a disproportionate number of articles claiming the concept is controversial originate from a small number of researchers with declared associations with UPF manufacturers. Prominent examples of these claims are assessed.

Food allergy: cause or consequence of pediatric eosinophilic esophagitis? Potential implications of ultraprocessed foods in prevention and management

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease characterized by eosinophilic infiltration, leading to esophageal dysfunction, inflammation, and fibrotic remodeling. In the last few decades, there has been an increased prevalence of EoE at an alarming rate in the pediatric age. The pathogenesis of EoE is still largely undefined, and this limits the definition of effective strategies for the prevention and management of this condition. EoE is considered a multifactorial disease arising from a negative interaction between environmental factors and genetic background, causing an impaired esophageal epithelial barrier with subsequent abnormal allergen exposure activating type 2 (Th2) inflammation. Food antigens have been suggested as key players in Th2 inflammation in pediatric patients with EoE, but emerging evidence suggests a potential role of other dietary factors, including ultraprocessed foods, as possible triggers for the occurrence of EoE. In this paper, we discuss the potential role of these dietary factors in the development of the disease, and we propose a new approach for the management of pediatric patients with EoE.

Ultra-processed foods: a fit-for-purpose concept for nutrition policy activities to tackle unhealthy and unsustainable diets

Modern nutrition science began approximately 100 years ago in the context of nutrient deficiency diseases. Nutrition research and policy activities were framed mostly within a reductionist paradigm in which foods were analysed as being a collection of their constituent nutrients. Today, nutrition problems extend to all forms of malnutrition as well as environmental sustainability considerations and are associated with food and dietary pattern exposures. In 2009, researchers investigating the nutrition transition in Brazil proposed that industrial food processing was a key determinant of nutrition problems. The NOVA food classification system which is based on the nature, extent and purposes of food processing was developed to operationalise this proposition. The ultra-processed food (UPF) concept within NOVA is receiving much attention in relation to nutrition research and policy activities. This commentary describes the UPF concept as being fit-for-purpose in providing guidance to inform policy activities to tackle unhealthy and unsustainable diets. There is now a substantial body of evidence linking UPF exposure with adverse population and planetary health outcomes. The UPF concept is increasingly being used in the development of food-based dietary guidelines and nutrition policy actions. It challenges many conventional nutrition research and policy activities as well as the political economy of the industrial food system. Inevitably, there are politicised debates associated with UPF and it is apparent a disproportionate number of articles claiming the concept is controversial originate from a small number of researchers with declared associations with UPF manufacturers. Prominent examples of these claims are assessed.

A comprehensive review on infant formula: nutritional and functional constituents, recent trends in processing and its impact on infants' gut microbiota

Human milk is considered the most valuable form of nutrition for infants for their growth, development and function. So far, there are still some cases where feeding human milk is not feasible. As a result, the market for infant formula is widely increasing, and formula feeding become an alternative or substitute for breastfeeding. The nutritional value of the formula can be improved by adding functional bioactive compounds like probiotics, prebiotics, human milk oligosaccharides, vitamins, minerals, taurine, inositol, osteopontin, lactoferrin, gangliosides, carnitine etc. For processing of infant formula, diverse thermal and non-thermal technologies have been employed. Infant formula can be either in powdered form, which requires reconstitution with water or in ready-to-feed liquid form, among which powder form is readily available, shelf-stable and vastly marketed. Infants' gut microbiota is a complex ecosystem and the nutrient composition of infant formula is recognized to have a lasting effect on it. Likewise, the gut microbiota establishment closely parallels with host immune development and growth. Therefore, it must be contemplated as an important factor for consideration while developing formulas. In this review, we have focused on the formulation and manufacturing of safe and nutritious infant formula equivalent to human milk or aligning with the infant's needs and its ultimate impact on infants' gut microbiota.

Ultra-Processed Food vs. Fruit and Vegetable Consumption before and during the COVID-19 Pandemic among Greek and Swedish Students

BACKGROUND

The COVID-19 pandemic has impacted children's lifestyles, including dietary behaviors. Of particular concern among these behaviors is the heightened prevalence of ultra-processed food (UPF) consumption, which has been linked to the development of obesity and related non-communicable diseases. The present study examines the changes in (1) UPF and (2) vegetable and/or fruit consumption among school-aged children in Greece and Sweden before and during the COVID-19 pandemic.

METHODS

The analyzed dataset consisted of main meal pictures (breakfast, lunch, and dinner) captured by 226 Greek students (94 before the pandemic and 132 during the pandemic) and 421 Swedish students (293 before and 128 during the pandemic), aged 9-18, who voluntarily reported their meals using a mobile application. The meal pictures were collected over four-month periods over two consecutive years; namely, between the 20th of August and the 20th of December in 2019 (before the COVID-19 outbreak) and the same period in 2020 (during the COVID-19 outbreak). The collected pictures were annotated manually by a trained nutritionist. A chi-square test was performed to evaluate the differences in proportions before versus during the pandemic.

RESULTS

In total, 10,770 pictures were collected, including 6474 pictures from before the pandemic and 4296 pictures collected during the pandemic. Out of those, 86 pictures were excluded due to poor image quality, and 10,684 pictures were included in the final analyses (4267 pictures from Greece and 6417 pictures from Sweden). The proportion of UPF significantly decreased during vs. before the pandemic in both populations (50% vs. 46%, p = 0.010 in Greece, and 71% vs. 66%, p < 0.001 in Sweden), while the proportion of vegetables and/or fruits significantly increased in both cases (28% vs. 35%, p < 0.001 in Greece, and 38% vs. 42%, p = 0.019 in Sweden). There was a proportional increase in meal pictures containing UPF among boys in both countries. In Greece, both genders showed an increase in vegetables and/or fruits, whereas, in Sweden, the increase in fruit and/or vegetable consumption was solely observed among boys.

CONCLUSIONS

The proportion of UPF in the Greek and Swedish students' main meals decreased during the COVID-19 pandemic vs. before the pandemic, while the proportion of main meals with vegetables and/or fruits increased.

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.

Assessing the per Capita Food Supply Trends of 38 OECD Countries between 2000 and 2019-A Joinpoint Regression Analysis

Food supply has an impact on the prevalence of diet-related non-communicable diseases. We aimed to analyze the protein, fat (g/capita/day) and calorie (kcal/capita/day) supply from 2000 to 2019 as derived from the OECD Health Statistics database. A joinpoint regression was used to examine the number and location of breakpoints in the time series. The annual percent change (APC) was calculated using Joinpoint 4.9.0.0. The per capita daily kcal per nutrient was calculated for each country and the resulting percentage distributions were compared to the acceptable macronutrient distribution ranges. Protein, fat and calorie supplies have increased significantly between 2000 and 2019. Each started to show a much steeper, positive change between 2012 and 2014 (APC_fat: 1.0; 95%CI: 0.8-1.1; APC_protein: 0.5; 95%CI: 0.3-0.6; APC_kcal: 0.4; 95%CI: 0.3-0.5). In terms of the composition of the daily calorie intake per capita, the overall share of fat (+4.9%) and protein (+1.0%) increased between 2000 and 2019. We found significant differences among countries and also an increasing and optimal proportion of consumed protein per total calorie in all countries over the last two decades. We concluded that several countries have access to fat availability above the optimal level, which deserves particular attention from health policy makers in the fight against obesity and diet-related diseases.

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).

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.

Does the concept of "ultra-processed foods" help inform dietary guidelines, beyond conventional classification systems? YES

The recommendation to prefer unprocessed/minimally processed foods and freshly made meals instead of ultra-processed foods (following the Nova food classification system) is being increasingly adopted in new official dietary guidelines issued by national governments and international health associations. This recommendation is supported by systematic reviews and meta-analyses of nationally representative dietary surveys and long-term cohort studies. These data show that increased intake of ultra-processed foods is associated with poor-quality diets and with increased morbidity and mortality from several chronic diseases. Various attributes of ultra-processed foods acting through known, plausible, or suggested physiologic and behavioral mechanisms relate them to ill health, and it is likely that different combinations of attributes and mechanisms affect different health outcomes. Although more research should be done to identify these mechanisms, existing evidence is sufficient to recommend the avoidance of ultra-processed foods to optimize health and policies to support and make feasible this recommendation.

Fighting Obesity-Related Micronutrient Deficiencies through Biofortification of Agri-Food Crops with Sustainable Fertilization Practices

Obesity is a critical medical condition worldwide that is increasingly involved with nutritional derangements associated with micronutrient deficiencies, including iron, zinc, calcium, magnesium, selenium, and vitamins A, C, D, and E. Nutritional deficiencies in obesity are mainly caused by poor-quality diets, higher nutrient requirements, alterations in micronutrient metabolism, and invasive obesity treatments. The current conventional agricultural system is designed for intensive food production, focusing on food quantity rather than food quality, consuming excessive agricultural inputs, and producing nutrient-deficient foods, thus generating severe health and environmental problems; agricultural food products may worsen obesity-related malnutrition. Therefore, modern agriculture is adopting new biofortification technologies to combat micronutrient deficiencies and improve agricultural productivity and sustainability. Biofertilization and nanofertilization practices are increasingly used due to their efficiency, safety, and reduced environmental impact. Biofertilizers are preparations of PGP-microorganisms that promote plant growth by influencing plant metabolism and improving the nutrient uptake, and nanofertilizers consist of synthesized nanoparticles with unique physicochemical properties that are capable of increasing plant nutrition and enriching agricultural products. This review presents the current micronutrient deficiencies associated with obesity, the modern unsustainable agri-food system contributing to obesity progression, and the development of bio- and nanofertilizers capable of biofortifying agri-food crops with micronutrients commonly deficient in patients with obesity.

Application of Aroma Precursors in Food Plant Raw Materials: Biotechnological Aspect

The article is devoted to the analysis of the main factors accompanying the use of aroma precursors, in particular, of a lipid nature, in food raw materials. The prerequisites for the impact on the precursors of aroma with the help of plant enzymes are given. The purpose of the article is to analyze the biotechnological aspect, which is based on enzymatic reactions with aroma precursors and enzymes of plant origin. Features of the mechanism of action of lipid precursors are highlighted, their diversity causing various characteristic reactions is analyzed, and possible end products of reactions with certain odors are noted. The attention is paid to the issue of the status of the naturalness of flavor precursors in food products, which varies in different countries. A scheme of factors influencing the formation of aroma from lipid precursors has been developed. The influence of pigments of carotenoid nature on the aroma is considered, namely: examples of instantaneous change of watermelon aroma to pumpkin one due to isomerization of carotenoids are given. The main factors of enzymatic formation of aroma from precursors of polyunsaturated fatty acids for their effective use by creating micromicelles are summarized. A way to overcome the barrier of interaction between lipid precursors of a hydrophobic nature and hydrophilic enzymes has been substantiated. It is proposed to accelerate enzymatic reactions under in vitro conditions and use the vacuum effect to overcome the barrier between enzymes and precursors. To explain the effect of vacuum in a system with enzymes, ideas about disjoining pressure and the reasonable expediency of its use are considered. A schematic process flow diagram for the restoration of aroma lost during the technological processing of raw materials is given; it demonstrates the factors for ensuring interfacial activation conditions for enzymes and aroma precursors.

[Intake of energy and critical nutrients according to the NOVA classification in Argentina, time trend and differences according to income]

Growing evidence of the global transition in food systems exists, affecting the availability, accessibility, affordability, and convenience of highly processed foods. This study aimed to evaluate the apparent consumption of energy, saturated fat, added sugars, and sodium according to the degree of food processing in Argentina from 1996 to 2018 and according to income level. This is a descriptive and cross-sectional study with data on food and beverage expenditures and income from the National Household Expenditure Survey for years 1996-1997, 2004-2005, 2012-2013, and 2017-2018, including more than 20,000 households in each period. The apparent daily consumption of energy, saturated fat, added sugars, and sodium per adult for: (1) minimally processed foods; (2) processed culinary ingredients; (3) processed foods; and (4) ultra-processed products, was calculated for each period and according to per capita income quintile in each household. Descriptive statistical analysis was performed. Reductions in the proportion of energy and all nutrients evaluated from minimally processed foods, culinary ingredients and processed foods were observed, as well as an increase in the consumption of ultra-processed products. One also observes a greater share from ultra-processed foods as household income increases but with decreasing differences over time. Therefore, future strategies in Argentina should promote the consumption of minimally processed foods and discourage the availability and accessibility of ultra-processed ones, especially for the most vulnerable groups.

The Association between Ultra-Processed Foods, Quality of Life and Insomnia among Adolescent Girls in Northeastern Iran

Ultra-processed foods have been associated with increased risk of chronic disease, poor overall health and psychological outcomes. This study explored the association of ultra-processed foods with quality of life in adolescent girls from northeastern Iran. In an interdisciplinary cross-sectional study, n = 733 adolescent girls were recruited by random cluster sampling. Assessments were completed for demographics, physical activity, anthropometric and biochemical parameters, psychological health and dietary intake. The participants were categorized into quartiles of ultra-processed food intake, and multivariable logistic regression was used in several models to investigate the association between ultra-processed food intake and psychological health. The mean age of the participants was 14 years. There were no significant differences in participant demographics for the quartiles of ultra-processed food intake including weight, waist-hip ratio, waist circumference, depression, insomnia and cardiometabolic markers related to cardiovascular disease risk. Adjusted logistic regression showed participants in the highest category of ultra-processed food consumption had an increased likelihood of reduced quality of life (OR: 1.87, 95% CI: 1.13-3.11), with a greater chance for insomnia (OR: 4.04, 95% CI: 1.83-8.94) across all models. However, no significant associations were observed between consumption of ultra-processed foods and daytime sleepiness. We highlight the association between ultra-processed food consumption and poor quality of life and insomnia amongst adolescent girls. Large longitudinal integrated public health studies in different ethnicities are needed to confirm these associations and evaluate their possible impact for optimizing health promotion programs.

Commercial Baby Foods Aimed at Children up to 36 Months: Are They a Matter of Concern?

Proper nutrition in infancy and early childhood is crucial to ensuring optimal child development, growth, and better health outcomes later in life. The nutrient profile model proposed by WHO/Europe aims to assess the nutritional quality and promotional/marketing aspects of commercial baby foods aimed at children up to 36 months. We used commercial data from 191 baby foods collected between March 2021 and July 2021, from eight supermarket chains in the Lisbon Metropolitan area. According to the model specifications and the NOVA classification system, we assessed the nutritional quality and promotion aspects and the degree of processing, respectively. The presence of at least one sugar-contributing ingredient was found in 34.0% of the products; 13.9% of products listed sugars and 15.0% listed fruit juices or concentrates as an ingredient. The claim “No added sugar” was present in 69.6% of products. Only 35.1% of products comply with all the nutritional requirements of the model. Concerning processing classification, 61.8% of products were ultra-processed, and about 57.0% were indicated for children < 12 months. These findings reinforce the importance of implementing measures to ensure that commercial foods for infants are marketed appropriately and to promote foods with a lower degree of processing.

Consumer perceptions of non-caloric sweeteners and the content of caloric and non-caloric sweeteners in ultra-processed products in Brazil

Food industries are reformulating their products to lower total sugar and caloric content. Caloric sugars are often substituted by or combined with non-caloric sweeteners. Our study analyzed information about the presence, number and type, and content of different sweeteners displayed on the ingredient list of 10 key ultra-processed products (UPP), from 3 different categories. It also assessed consumers' opinions, perceptions and understanding of caloric and non-caloric sugars used in UPPs using data from 12 focus group discussions. Results indicate a large diversity in sweeteners, frequent use of a combination of multiple caloric and non-caloric sweeteners, often in the same product, and a lack of disclosure of the amounts of non-caloric sweeteners on the nutrition labels. Qualitative analysis reflected the inconsistency of information on nutrition labels and the challenges in compliance with regulations. Participants were unsure about the different types of sweeteners, examples of artificial sweeteners and their potential health consequences. Presenting clearer additive and nutrition information would facilitate consumer comprehension and support healthy food choices.

Factors Influencing Adolescents' Dietary Behaviors in the School and Home Environment in Addis Ababa, Ethiopia

Background

Malnutrition affects many adolescents in Ethiopia. Over one-third of adolescent girls and two-thirds of boys are thin. Overweight and obesity in Ethiopia is mostly a concern in urban populations of higher wealth quintiles. Urbanization and globalization of diets is shifting food environments. The objective of this study was to assess whether food environments in and around schools in urban Ethiopia influence dietary diversity, quality, BMI status or perceptions of adolescents.

Methods

Twelve high schools were selected in Addis Ababa (private/government). From each school, 20 pupils aged 15–19 years were randomly selected (n = 217) and interviewed about assets in their households, their diets (categorized into 10 food groups of the Minimum Dietary Diversity, the Global Dietary Recommendations scores and four categories of the NOVA classification based on level of processing) and their use of pocket money. In addition, food environment audits were conducted within the school compound and a 0.5 km radius around each school and types of food outlets.

Results

On average there were 436 food outlets and 246 food or drink advertisements around each school. The majority of the advertisements (89.9%) were of ultra-processed foods, mostly sugar-sweetened beverages (SSBs). Most were positioned on food outlets (89.1%). SSBs or sweets were visibly on display in 26.3% of the outlets and fresh fruits and vegetables in 17.9% of outlets. Dietary diversity of adolescents was poor with an average of 3.6 food groups out of 10 consumed in the last 24 h. Ultra-processed foods and beverages were consumed by 23.5% of adolescents. The majority of adolescents spent their pocket money on SSBs, sweets or fried foods. Our analysis found that higher assets in adolescents' households were associated with higher dietary diversity and consumption of healthy food groups. We found no association between the food environment and dietary indicators or the BMI-z-score.

Conclusion

While the school food environments investigated were not conducive with promoting healthy dietary behaviors, we cannot conclude that these environmental factors directly influence adolescents' diets. The pervasive advertising and availability of unhealthy foods and beverages requires policy action for healthy school food environments.

'The second mother': How the baby food industry captures science, health professions and civil society in France

Most babies in France are fed with infant formula and then commercial complementary foods, many of which are ultra-processed and harmful to health. Internationally, there is opposition by the baby food industry to the introduction of public health policies that would limit the marketing and consumption of such products. Our aim was to identify the key baby food industry actors, describe their history and corporate political activity (CPA) in France. We sourced publicly available information, which we triangulated with data from 10 semi-structured interviews. Qualitative thematic analysis was undertaken simultaneously to data collection, guided by an existing classification of the CPA of the food industry. The baby food industry in France has shaped the science on infant and young child nutrition and nurtured long-established relationships with health professionals. This corporate science and these relationships helped baby food companies to portray themselves as experts on child-related topics. The baby food industry has also engaged with a broad range of civil society organisations, particularly through the concept of the first 1000 days of life, and during the covid-19 pandemic. We found evidence, although limited, that the baby food industry directly lobbied the French government. Since its early development in France in the 19th century, the baby food industry used its CPA to promote its products and protect and sustain its market. Our findings can be used to recognise, anticipate and address the CPA of this industry, and to minimise any negative influence it may have on babies' and mother's health.

Ultra-processed foods and obesity and adiposity parameters among children and adolescents: a systematic review

PURPOSE

According to the NOVA classification, ultra-processed foods are products made through physical, biological and chemical processes and typically with multiple ingredients and additives, in which whole foods are mostly or entirely absent. From a nutritional point of view, they are typically energy-dense foods high in fat, sugar, and salt and low in fiber. The association between the consumption of ultra-processed food and obesity and adiposity measurements has been established in adults. However, the situation remains unclear in children and adolescents.

METHODS

We carried out a systematic review, in which we summarize observational studies investigating the association between the consumption of ultra-processed food, as defined by NOVA classification, and obesity and adiposity parameters among children and adolescents. A literature search was performed using PUBMED and Web of Science databases for relevant articles published prior to May 2021.

RESULTS

Ten studies, five longitudinal and five cross-sectional, mainly conducted in Brazil, were included in this review. Four longitudinal studies in children with a follow-up longer than 4 years found a positive association between the consumption of ultra-processed food and obesity and adiposity parameters, whereas cross-sectional studies failed to find an association.

CONCLUSION

These data suggest that a consistent intake of ultra-processed foods over time is needed to impact nutritional status and body composition of children and adolescents. Further well-designed prospective studies worldwide are needed to confirm these findings considering country-related differences in dietary habits and food production technologies.

Sugar-sweetened beverages, effects on appetite and public health strategies to reduce the consumption among children: a review

Sugar-sweetened beverages (SSBs) consumption have been of public health concern and a target of interventions due to their high consumption and burden in health-related consequences, particularly in children and adolescents. SSBs provide high energy intake with low nutritional value and are a major contributor for added and free sugars intake of Portuguese in all age-groups, especially adolescents. Despite its recognized effect on weight gain, it might also disrupt appetite regulation. Research on the effect of SSBs on appetitive traits is still scarce and unclear, and the current knowledge of these potential effects will be discussed in this review. This review also aims to describe public health strategies implemented to decrease SSBs consumption among children, particularly in Portugal, such as: (i) implemented taxation measures and its impact in sales and in preventable cases of disease and death, (ii) marketing regulations applied to children and adolescents, and ultimately (iii) the intention of application of a single Front-of-Package labeling system in all countries, aiming to increase consumers’ food literacy.

Toddler foods and milks don't stack up against regular foods and milks

AIM

To compare the cost and nutritional profiles of toddler-specific foods and milks to 'regular' foods and milks.

METHODS

Cross-sectional audit of non-toddler specific ('regular') foods and milks and secondary analysis of existing audit data of toddler specific (12-36 months) foods and milks in Australia.

MAIN FINDINGS

The cost of all toddler-specific foods and milks was higher than the regular non-toddler foods. Foods varied in nutritional content, but toddler foods were mostly of poorer nutritional profile than regular foods. Fresh milk cost, on average, $0.22 less per 100 mL than toddler milk. Toddler milks had higher mean sugar and carbohydrate levels and lower mean protein, fat, saturated fat, sodium and calcium levels per 100 mL, when compared to fresh full fat cow's milk.

CONCLUSIONS

Toddler specific foods and milks cost more and do not represent value for money or good nutrition for young children.

Animal board invited review: Animal source foods in healthy, sustainable, and ethical diets - An argument against drastic limitation of livestock in the food system

Animal source foods are evolutionarily appropriate foods for humans. It is therefore remarkable that they are now presented by some as unhealthy, unsustainable, and unethical, particularly in the urban West. The benefits of consuming them are nonetheless substantial, as they offer a wide spectrum of nutrients that are needed for cell and tissue development, function, and survival. They play a role in proper physical and cognitive development of infants, children, and adolescents, and help promote maintenance of physical function with ageing. While high-red meat consumption in the West is associated with several forms of chronic disease, these associations remain uncertain in other cultural contexts or when consumption is part of wholesome diets. Besides health concerns, there is also widespread anxiety about the environmental impacts of animal source foods. Although several production methods are detrimental (intensive cropping for feed, overgrazing, deforestation, water pollution, etc.) and require substantial mitigation, damaging impacts are not intrinsic to animal husbandry. When well-managed, livestock farming contributes to ecosystem management and soil health, while delivering high-quality foodstuffs through the upcycling of resources that are otherwise non-suitable for food production, making use of marginal land and inedible materials (forage, by-products, etc.), integrating livestock and crop farming where possible has the potential to benefit plant food production through enhanced nutrient recycling, while minimising external input needs such as fertilisers and pesticides. Moreover, the impacts on land use, water wastage, and greenhouse gas emissions are highly contextual, and their estimation is often erroneous due to a reductionist use of metrics. Similarly, whether animal husbandry is ethical or not depends on practical specificities, not on the fact that animals are involved. Such discussions also need to factor in that animal husbandry plays an important role in culture, societal well-being, food security, and the provision of livelihoods. We seize this opportunity to argue for less preconceived assumptions about alleged effects of animal source foods on the health of the planet and the humans and animals involved, for less top-down planning based on isolated metrics or (Western) technocratic perspectives, and for more holistic and circumstantial approaches to the food system.

Evaluating intake levels of nutrients linked to non-communicable diseases in Australia using the novel combination of food processing and nutrient profiling metrics of the PAHO Nutrient Profile Model

PURPOSE

To investigate intake levels of nutrients linked to non-communicable diseases in Australia using the novel combination of food processing and nutrient profiling metrics of the PAHO Nutrient Profile Model.

METHODS

Dietary intakes of 12,153 participants from the Australian Health Survey (2011-12) aged 2 + years were evaluated. Food items reported during a 24 h recall were classified using the NOVA system. The Pan-American Health Organization Nutrient Profile Model (PAHO NPM) was applied to identify processed and ultra-processed products with excessive content of critical nutrients. Differences in mean intakes and prevalence of excessive intakes of critical nutrients for groups of the population whose diets were made up of products with and without excessive content in critical nutrients were examined.

RESULTS

The majority of Australians consumed daily at least three processed and ultra-processed products identified as excessive in critical nutrients according to the PAHO NPM. Individuals consuming these products had higher intakes of free sugars (β = 8.9), total fats (β = 11.0), saturated fats (β = 4.6), trans fats (β = 0.2), and sodium (β = 1788 for adolescents and adults; β = 1769 for children 5-10 years; β = 1319 for children aged < 5 years) (p ≤ 0.001 for all nutrients) than individuals not consuming these foods. The prevalence of excessive intake of all critical nutrients also followed the same trend.

CONCLUSION

The PAHO NPM has shown to be a relevant tool to predict intake levels of nutrients linked to non-communicable diseases in Australia and, therefore, could be used to inform policy actions aimed at increasing the healthiness of food environments.

Healthy and Safe School Cafeteria Program: a randomized controlled study

ABSTRACT Objective To assess the effect of an educational intervention program focused on health risk conditions, based on an assessment of the hygiene and quality of food sold in school cafeterias. Methods This is a controlled, parallel, randomized, two-arm, community study. Public and private schools with cafeterias were invited to participate. This study was conducted in 27 school cafeterias in northern and northwestern Rio Grande do Sul, a state in southern Brazil. Representatives of the school communities in the intervention group received an educational program consisting of 160-hour distance training. The most relevant outcomes were the assessment of the hygienic conditions and composition of the menus sold in school cafeterias. All outcomes were analyzed as intention-to-treat and per-protocol. For the analysis of continuous data with normal distribution, an analysis of covariance and the Generalized Linear Model were used. The level of statistical significance considered was p<0.05 for a 95% CI. Results No statistically significant difference was observed between the intervention group and the control group in the studied outcomes. There was a reduction of 76.2 points in the score for hygienic handling conditions (95% CI: -205 to 357; p=0.581). Regarding menu composition, the difference between groups was 0.48% (95% CI: -2.69 to 3.64; p=0.760) for ultra-processed foods, 0.23% (95% CI: -1.13 to 1.60; p=0.740) for processed foods, and 1.02% (95% CI: -2.59 to 4.64; p=0.581) for fresh foods. Conclusion There is not enough evidence to conclude that the intervention had a positive impact on any of the outcomes studied.

Eating contexts at breakfast, lunch, and dinner: Associations with ultra-processed foods consumption and overweight in Brazilian adolescents (EVA-JF Study)

This cross-sectional study estimated associations of eating contexts (including regularity of meals, places where they occur, and if they take place with attention and in company) with food consumption by degree of industrial processing and overweight indicators in a sample of Brazilian adolescents (14-19 years old) enrolled in 29 public schools in Juiz de Fora, MG (n = 805). We used an exploratory questionnaire, which was submitted to cluster analysis. Three clusters were identified: cluster 1 (n = 572), "appropriate eating contexts at breakfast, lunch, and dinner"; cluster 2 (n = 139), "inappropriate eating context at breakfast"; and cluster 3 (n = 94) "inappropriate eating context at dinner". The evaluation of food consumption involved two 24-h dietary recalls, whose items were analyzed according to the NOVA classification system. Linear regression models were performed, using cluster 1 as reference. Clusters 2 and 3 were associated with an increase in the energy fraction from ultra-processed foods [respectively, β = 2.55% (IC 95%: 0.50; 5.05) and β = 4.18% (IC 95%: 1.21; 7.14)]; and cluster 2 was associated with a reduction in the energy fraction from unprocessed or minimally processed foods and processed culinary ingredients [β = -3.61% (IC 95%: -6.40; -0.82)]. Additionally, clusters 2 and 3 were associated with an increase of body mass index for age [respectively, β = 0.23 z-score (IC 95%: 0.01; 0.46) and β = 0.27 z-score (IC 95%: 0.02; 0.54)]; and cluster 2 was associated with an increase of body fat [β = 1.21% (IC 95%: 0.23; 2.64)]. In conclusion, inappropriate eating contexts at breakfast and dinner were associated with higher ultra-processed food intake, higher body mass index and higher body fat percentage.

Parental feeding practices and ultra-processed food consumption in preschool children

ABSTRACT: Objective: To investigate the association between parental feeding practices and the consumption of ultra-processed foods in preschool children. Methods: Cross-sectional study with 140 parents (father and mother) and their children (2-6 year-old). Parental feeding practices were assessed using the Comprehensive Feeding Practices Questionnaire. Children’s body weight and height were measured, and body mass index z-score per age was calculated. Parental anthropometric measurements (body weight and height) were obtained by self-report, and body mass index was calculated. The consumption of ultra-processed foods was assessed through the Child Food Frequency Questionnaire and the daily intake score was calculated. Multivariable linear regression analyses were performed to investigate the association between parental feeding practices and the consumption of ultra-processed foods. Results: Children’s ultra-processed food consumption was negatively associated with the “Monitoring” parental feeding practices. On the other hand, “Emotion Regulation” and “Health restriction” parental feeding practices were positively associated with the ultra-processed food consumption score. Conclusion: Ultra-processed food consumption was associated to the “Monitoring”, “Emotion regulation” and “Health restriction” parental feeding practices in preschool children. These results support the importance of using successful parental feeding practices to promote healthy eating in preschoolers.

The Nutritional Profile and On-Pack Marketing of Toddler-Specific Food Products Launched in Australia between 1996 and 2020

With the food system evolving, it is not clear how the nutrition and on-pack claims of toddler foods have been impacted. Data on the trends in Australia are lacking, so we sought to determine the changes in the nutrition and on-pack claims of toddler-specific packaged foods over time. A retrospective cross-sectional analysis was conducted using the Mintel Global New Products Database. The number of toddler-specific foods increased from 1996 to 2020. Over time, a lower proportion of meals and snacks were classified as “ultra-processed”, but a higher proportion of snacks were classified as “discretionary”. Meals launched after 2014 had higher median values for energy, saturated fat, and sugar than those in earlier years. Toddler snacks launched after 2014 had lower median values for sodium, and higher median values for fat, saturated fat, and sugar than those in earlier years. The mean number of total claims per package increased over time for snacks, with an increase in unregulated claims for both meals and snacks. Public health action is needed to ensure that the retail food environment for young children is health-promoting, including stringent and clear regulations for on-pack claims, and compositional guidelines and guidance on how to reduce the number of ultra-processed foods for toddlers.

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.