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Leitão AE, Esteves GP, Mazzolani BC, Smaira FI, Santini MH, Santo André HC, Gualano B, Roschel H. Protein and Amino Acid Adequacy and Food Consumption by Processing Level in Vegans in Brazil. JAMA Netw Open 2024; 7:e2418226. [PMID: 38913373 PMCID: PMC11197455 DOI: 10.1001/jamanetworkopen.2024.18226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/21/2024] [Indexed: 06/25/2024] Open
Abstract
Importance Major concerns regarding individuals who adhere to a vegan diet are whether they meet protein and essential amino acid recommendations and how reliant they are on ultraprocessed foods. Objectives To investigate whether individuals who adhere to a vegan diet meet protein and essential amino acid recommendations and, as secondary objectives, to determine ultraprocessed food intake and potential factors associated with inadequate protein intake in this population. Design, Setting, and Participants This cross-sectional survey study was conducted between September 2021 and January 2023 in Brazil among male and female adults (aged 18 years or older) who adhered to a vegan diet recruited from social media platforms. Exposure Adherence to a vegan diet and unprocessed and minimally processed foods and ultraprocessed food consumption. Main Outcomes and Measures Protein and essential amino acid intake and food consumption by processing level were assessed using a 1-day food diary. Nutrient adequacy ratios were calculated by dividing nutrient intake by its recommendation (using scores truncated at 1) for each participant and then finding the mean across participants for each nutrient. The mean adequacy ratio was the mean of all nutrient adequacy ratios. Results Of 1014 participants who completed the survey, 774 individuals (median [IQR] age, 29 [24-35] years; 637 female [82.3%]) were confirmed as adhering to a vegan diet and provided adequate food recalls, among whom 558 individuals reported body weight and so had relative protein and amino acid intake values available. The median (IQR) body mass index (calculated as weight in kilograms divided by height in meters squared) of participants was 22.6 (20.3-24.8). The nutrient adequacy ratio of protein was 0.93 (95% CI, 0.91-0.94); for essential amino acids, ratios ranged from 0.90 (95% CI, 0.89-0.92) for lysine to 0.98 (95% CI, 0.97-0.99) for phenylalanine and tyrosine. The mean adequacy ratio for protein and all amino acids was 0.95 (95% CI, 0.94-0.96). The median intake level was 66.5% (95% CI, 65.0%-67.9%) of total energy intake for unprocessed and minimally processed food and 13.2% (95% CI, 12.4%-14.4%) of total energy intake for ultraprocessed food. Adjusted logistic regression models showed that consuming protein supplements (odds ratio [OR], 0.06 [95% CI 0.02-0.14]; P < .001) or textured soy protein (OR, 0.32 [95% CI, 0.17-0.59]; P < .001) was associated with decreased odds of inadequate protein intake. Higher ultraprocessed food intake levels were also associated with decreased odds of inadequate protein intake (eg, fourth vs first quartile of intake: OR, 0.16 [95% CI, 0.07-0.33]; P < .001), and higher unprocessed and minimally processed protein intake levels were associated with increased odds of inadequate protein intake (eg, fourth vs first quartile of intake: OR, 12.42 [95% CI, 5.56-29.51]; P < .001). Conclusions and Relevance In this study, most individuals who adhered to a vegan diet attained protein and essential amino acid intake recommendations, largely based their diet of unprocessed and minimally processed food, and had a significantly lower proportion of ultraprocessed food intake compared with previous reports. Participants consuming less ultraprocessed food were more likely to have inadequate protein intake, suggesting a significant reliance on ultraprocessed proteins for this population.
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Affiliation(s)
- Alice Erwig Leitão
- Applied Physiology and Nutrition Research Group–School of Physical Education and Sport and Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, São Paulo, Brazil
- Center of Lifestyle Medicine; Laboratory of Assessment and Conditioning in Rheumatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, São Paulo, Brazil
| | - Gabriel P. Esteves
- Applied Physiology and Nutrition Research Group–School of Physical Education and Sport and Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, São Paulo, Brazil
- Center of Lifestyle Medicine; Laboratory of Assessment and Conditioning in Rheumatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, São Paulo, Brazil
| | - Bruna Caruso Mazzolani
- Applied Physiology and Nutrition Research Group–School of Physical Education and Sport and Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, São Paulo, Brazil
- Center of Lifestyle Medicine; Laboratory of Assessment and Conditioning in Rheumatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, São Paulo, Brazil
| | - Fabiana Infante Smaira
- Applied Physiology and Nutrition Research Group–School of Physical Education and Sport and Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, São Paulo, Brazil
- Center of Lifestyle Medicine; Laboratory of Assessment and Conditioning in Rheumatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, São Paulo, Brazil
| | - Martin Hindermann Santini
- Applied Physiology and Nutrition Research Group–School of Physical Education and Sport and Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, São Paulo, Brazil
- Center of Lifestyle Medicine; Laboratory of Assessment and Conditioning in Rheumatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, São Paulo, Brazil
| | | | - Bruno Gualano
- Applied Physiology and Nutrition Research Group–School of Physical Education and Sport and Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, São Paulo, Brazil
- Center of Lifestyle Medicine; Laboratory of Assessment and Conditioning in Rheumatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, São Paulo, Brazil
- Food Research Center, University of São Paulo, São Paulo, Brazil
| | - Hamilton Roschel
- Applied Physiology and Nutrition Research Group–School of Physical Education and Sport and Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, São Paulo, Brazil
- Center of Lifestyle Medicine; Laboratory of Assessment and Conditioning in Rheumatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, São Paulo, Brazil
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Real Rodrigues CC, Crispim D, Busnello FM, Sahade V, Correa D, Dos Santos TA, Bersch-Ferreira AC, Marcadenti A, de Almeida JC. Food intake, plasma copeptin and cardiovascular risk in patients with type 2 diabetes: A cross-sectional analysis. Nutr Metab Cardiovasc Dis 2024; 34:1427-1437. [PMID: 38503617 DOI: 10.1016/j.numecd.2024.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/04/2024] [Accepted: 01/29/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND AND AIM Increased consumption of ultra-processed foods has been linked to both mortality and cardiovascular risk. Copeptin levels may serve as potential risk markers for cardiovascular death and events. This cross-sectional analysis seeks to assess the potential correlation between the intake of ultra-processed foods and copeptin levels in outpatients diagnosed with type 2 diabetes, based on estimates of cardiovascular risk. METHODS AND RESULTS Outpatients underwent clinical and nutritional assessments. Dietary information was gathered using a validated quantitative food frequency questionnaire, and the consumption of all foods, beverages, and food products was assessed according to the NOVA food classification system. Fasting plasma-EDTA samples were collected and preserved at -80 °C. Plasma copeptin measurements were analyzed using an enzyme-linked immunosorbent assay based on the competition principle. Participants were categorized into two groups: high risk and very high risk, based on cardiovascular risk calculated by the HEARTS calculator. A total of 190 participants were included in the evaluation, with an average age of 60 ± 9 years, glycated hemoglobin of 8.4 ± 1.4%, and a diabetes duration of 11 (5-19) years. Patients at a very high cardiovascular risk exhibited higher plasma copeptin levels compared to those at high cardiovascular risk. Notably, 92.1% of patients reported consuming more than 10% of total energy intake from ultra-processed foods, although this proportion did not differ between the two groups. CONCLUSION This patient sample reported elevated consumption of ultra-processed foods; nevertheless, the correlation between ultra-processed foods and plasma copeptin has not been substantiated.
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Affiliation(s)
- Cíntia C Real Rodrigues
- Graduate Medical Sciences Program in Endocrinology, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Daisy Crispim
- Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
| | - Fernanda M Busnello
- Department of Nutrition, Universidade Federal de Ciências da Saúde de Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Daniela Correa
- Universidade Federal de Juiz de Fora, Minas Gerais, Brazil
| | - Tainara A Dos Santos
- Graduate Medical Sciences Program in Endocrinology, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil
| | | | - Aline Marcadenti
- Hcor Research Institute, São Paulo, Brazil; Graduate Program in Health Sciences (Cardiology), Instituto de Cardiologia/Fundação Universitária de Cardiologia, Rio Grande do Sul, Brazil; Graduate Program in Epidemiology, Universidade de São Paulo, São Paulo, Brazil
| | - Jussara C de Almeida
- Graduate Medical Sciences Program in Endocrinology, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil; Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil; Nutrition and Dietetics Service, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil; Department of Nutrition, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil.
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3
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Werneck AO, Steele EM, Delpino FM, Lane MM, Marx W, Jacka FN, Stubbs B, Touvier M, Srour B, Louzada ML, Levy RB, Monteiro CA. Adherence to the ultra-processed dietary pattern and risk of depressive outcomes: Findings from the NutriNet Brasil cohort study and an updated systematic review and meta-analysis. Clin Nutr 2024; 43:1190-1199. [PMID: 38613906 DOI: 10.1016/j.clnu.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/24/2024] [Accepted: 03/24/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND & AIMS We aimed to analyze the prospective association between adherence to the ultra-processed dietary pattern and risk of depressive outcomes using original data from the NutriNet Brasil cohort and via a systematic review and meta-analysis of observational studies that have investigated the same association. METHODS In our original research analysis, we used data from 15,960 adults (≥18 y) participating in the NutriNet Brasil cohort study, free of depression or depressive symptoms during the baseline (77.5% women, 45.8 ± 13.0 y). The mean dietary share of ultra-processed foods (%Kcal/d), calculated from two baseline 24-h dietary recalls, was used to measure the adherence to the ultra-processed dietary pattern. New cases of depressive symptoms were assessed using the Patient Health Questionnaire-9 over the follow-up period (mean: 18.3 months). Cox proportional hazards models were used for the main analyses. In our systematic review and meta-analysis, we incorporated effect estimates from six prospective cohort studies that have examined the same association, including ours. RESULTS In the adjusted model, each 10% increase in the dietary share of ultra-processed foods was associated with a 10% increase in the hazard of incident cases of depressive symptoms (HR:1.10; 95%CI: 1.07-1.14). This association was slightly attenuated in the models including potential mediators. In our meta-analysis of six prospective studies, high versus low exposure to ultra-processed foods was associated with a summary hazard ratio of depressive outcomes of 1.32; 95%CI: 1.19-1.46; I2: 71%. CONCLUSION A higher adherence to the ultra-processed dietary pattern was associated with a higher risk of developing depressive outcomes in the NutriNet Brasil cohort and in the meta-analysis.
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Affiliation(s)
- André O Werneck
- Center for Epidemiological Research in Nutrition and Health, Department of Nutrition, School of Public Health, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Euridice M Steele
- Center for Epidemiological Research in Nutrition and Health, Department of Nutrition, School of Public Health, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Felipe M Delpino
- Postgraduate in Nursing, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
| | - Melissa M Lane
- Deakin University, IMPACT (the Institute for Mental and Physical Health and Clinical Translation), Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Wolfgang Marx
- Deakin University, IMPACT (the Institute for Mental and Physical Health and Clinical Translation), Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Felice N Jacka
- Deakin University, IMPACT (the Institute for Mental and Physical Health and Clinical Translation), Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Mathilde Touvier
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Villetaneuse, France
| | - Bernard Srour
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Villetaneuse, France
| | - Maria Lc Louzada
- Center for Epidemiological Research in Nutrition and Health, Department of Nutrition, School of Public Health, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Renata B Levy
- Center for Epidemiological Research in Nutrition and Health, Department of Nutrition, School of Public Health, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Carlos A Monteiro
- Center for Epidemiological Research in Nutrition and Health, Department of Nutrition, School of Public Health, University of São Paulo (USP), São Paulo, SP, Brazil.
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Meller FO, Costa CDS, Quadra MR, Miranda VIA, Eugênio FD, da Silva TJ, Teixeira MVR, Schäfer AA. Consumption of ultra-processed foods and mental health of pregnant women from the South of Brazil. Br J Nutr 2024:1-8. [PMID: 38644622 DOI: 10.1017/s0007114524000783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
The objective of this study is to evaluate the association between the consumption of ultra-processed foods (UPF) and the mental health of pregnant women from the South of Brazil. This is a cross-sectional study carried out in Criciúma, Brazil, through face-to-face interviews, from April to December 2022. Pregnant women aged 18 or older who underwent prenatal care in the forty-eight basic health care units of the municipality and who were in their third trimester of pregnancy were included. High consumption of UPF was considered as six or more items or subgroups of UPF consumed on the day before the interview, using the Nova-UPF screener. The mental health variables were depressive symptoms, stress, sadness and anxiety. Crude and adjusted analyses were conducted using the Fisher's exact test and the Poisson regression with robust variance. In total, 428 pregnant women were studied; most of them were aged between 20 and 25 years and were white. Pregnant women who presented high consumption of UPF were 1·42-fold (95 % CI 1·06, 1·92) more likely to experience anxiety and presented a prevalence 56 % (95 % CI 1·18, 2·07) higher of stress when compared with those who did not present high consumption of UPF. The prevalence of depressive symptoms and feelings of sadness was 1·31-fold (95 % CI 1·08, 1·60) and 3·41-fold (95 % CI 1·77, 6·58) higher among those with high consumption of UPF, respectively. The results suggest that diet quality is associated with the mental health of pregnant women. Promoting joint actions focused on food and nutritional education, and mental health, for pregnant women, is necessary.
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Affiliation(s)
- Fernanda Oliveira Meller
- Public Health Graduate Program, University of the Extreme South of Santa Catarina, Criciúma, Santa Catarina, Brazil
| | | | - Micaela Rabelo Quadra
- Health Sciences Graduate Program, University of the Extreme South of Santa Catarina, Criciúma, Santa Catarina, Brazil
| | | | | | - Tamara Justin da Silva
- Public Health Graduate Program, University of the Extreme South of Santa Catarina, Criciúma, Santa Catarina, Brazil
| | | | - Antônio Augusto Schäfer
- Public Health Graduate Program, University of the Extreme South of Santa Catarina, Criciúma, Santa Catarina, Brazil
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Canella DS, Louzada MLDC, Oliveira N, Azevedo ABCD, Levy RB. Evolution of household availability of added sugars and their sources in Brazil: analysis of Household Budget Surveys from 2002 to 2017. Br J Nutr 2024:1-8. [PMID: 38634261 DOI: 10.1017/s0007114524000813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
The objective of this study was to describe the evolution of household purchase of added sugars and their main food sources in Brazil. Nationally representative data from the Household Budget Surveys from 2002-2003, 2008-2009 and 2017-2018 were used. Energy and added sugar quantities were estimated by means of per capita food quantities. The items considered as food sources were: (1) table sugar: refined sugar and other energetic sweeteners and (2) processed and ultra-processed foods with added sugar: soft drinks; other drinks; sweets, candies and chocolates; cookies; cakes and pies and other foods. The parameters estimated were: mean share of added sugar in total energy and, for food sources, the share of added sugar in total sugar intake and the impact of variations in sources of added sugar between 2008 and 2017. There was a regular share of energy from added sugar to total energy intake between 2002 and 2008 but a reduced share in 2017. Between 2008 and 2017, there was a decrease in the share of refined sugar and other sweeteners and soft drinks to total sugar intake and an increased share of all other items. High-income households had a lower share of refined sugar and other energetic sweeteners, but a higher share of soft drinks, sweets, candies and chocolates. The decrease in added sugar in 2017 was mainly due to the lower share of soft drinks. In conclusion, Brazilians' total intake of added sugar was decreased, mostly owing to reduced consumption of sugar from soft drinks.
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Affiliation(s)
- Daniela Silva Canella
- Department of Applied Nutrition, Institute of Nutrition, Rio de Janeiro State University, Rio de Janeiro, Brazil
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | - Maria Laura da Costa Louzada
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Natália Oliveira
- Postgraduate Program in Food, Nutrition and Health, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | - Renata Bertazzi Levy
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
- Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
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Nilson EAF, Andrade GC, Claro RM, Louzada MLDC, Levy RB. Sodium intake according to NOVA food classification in Brazil: trends from 2002 to 2018. CAD SAUDE PUBLICA 2024; 40:e00073823. [PMID: 38422246 PMCID: PMC10896487 DOI: 10.1590/0102-311xen073823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 11/14/2023] [Accepted: 12/01/2023] [Indexed: 03/02/2024] Open
Abstract
Excessive sodium intake is a major global public health issue and the identification of dietary sources and temporal trends in its consumption are a key to effective sodium reduction policies. This study aims to update estimates of sodium intake and its dietary sources in Brazil according to the NOVA food classification system. Records of 7-day food purchases of households from the Brazilian Household Budgets Survey of 2002-2003, 2008-2009, and 2017-2018 were converted into nutrients using food composition tables and the mean availability was estimated per 2,000kcal/day. Mean daily sodium available for consumption in Brazilian households has increased from 3.9 to 4.7g per 2,000kcal, from 2002-2003 to 2017-2018, over twice the recommended levels of sodium intake. From 2002-2003 to 2017-2018, the processed culinary ingredients, including table salt, represented the largest dietary source of sodium, although their participation in dietary sodium was reduced by 17% (66.6% to 55%), while the percentage of dietary sodium from processed foods increased by 20.3% and from ultra-processed foods increased by 47.6% (11.3% to 13.6% and 17% to 25.1%, respectively). In conclusion, the total household sodium availability remains high and has increased over time in Brazil, yet the participation of different dietary sources of sodium have gradually changed.
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Affiliation(s)
- Eduardo Augusto Fernandes Nilson
- Programa de Alimentação, Nutrição e Cultura, Fundação Oswaldo Cruz, Brasília, Brasil
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de São Paulo, São Paulo, Brasil
| | - Giovanna Calixto Andrade
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de São Paulo, São Paulo, Brasil
| | - Rafael Moreira Claro
- Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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Abstract
The analysis of food using a perspective centred on nutrients seems inadequate for understanding the dietary transition and its impact on the growth of obesity and chronic diseases. Industrial food processing is now proposed as the key to explain the relationship between food and health. The NOVA food classification considers the degree and the purpose of food processing, which includes physical, biological and chemical processes used after foods are separated from nature, and before being consumed or prepared as dishes and meals. NOVA has four food groups: (1) unprocessed and minimally processed foods; (2) processed culinary ingredients; (3) processed foods and (4) ultra-processed foods, which are formulations made mostly or entirely from substances derived from group 1 foods and additives, with little if any intact group 1 food. Many investigations linking high ultra-processed food consumption with deterioration of diets and adverse health outcomes are reinforced by prospective studies, systematic reviews and meta-analyses. There are various plausible explanations of why diets high in ultra-processed foods are harmful. Their production and consumption continue to rise worldwide. Efficient and effective public policies and actions that reduce production and consumption of ultra-processed products are needed, to protect human health now and in future.
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Affiliation(s)
- Renata Bertazzi Levy
- Preventive Medicine Department, Medical School, University of Sao Paulo, Ave. Dr Arnaldo, 455, Zip Code: 01246-903, São Paulo, SP, Brazil
- Center for Epidemiological Studies in Nutrition and Health, University of São Paulo (Nupens/USP), Ave. Dr Arnaldo, 715, Zip Code: 01246-90, Sao Paulo, SP, Brazil
| | - Mayra Figueiredo Barata
- Preventive Medicine Department, Medical School, University of Sao Paulo, Ave. Dr Arnaldo, 455, Zip Code: 01246-903, São Paulo, SP, Brazil
- Center for Epidemiological Studies in Nutrition and Health, University of São Paulo (Nupens/USP), Ave. Dr Arnaldo, 715, Zip Code: 01246-90, Sao Paulo, SP, Brazil
| | - Maria Alvim Leite
- Preventive Medicine Department, Medical School, University of Sao Paulo, Ave. Dr Arnaldo, 455, Zip Code: 01246-903, São Paulo, SP, Brazil
- Center for Epidemiological Studies in Nutrition and Health, University of São Paulo (Nupens/USP), Ave. Dr Arnaldo, 715, Zip Code: 01246-90, Sao Paulo, SP, Brazil
| | - Giovanna Calixto Andrade
- Center for Epidemiological Studies in Nutrition and Health, University of São Paulo (Nupens/USP), Ave. Dr Arnaldo, 715, Zip Code: 01246-90, Sao Paulo, SP, Brazil
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da Cruz GL, da Costa Louzada ML, da Silva JT, Maria Fellegger Garzillo J, Rauber F, Schmidt Rivera X, Reynolds C, Levy RB. The environmental impact of beef and ultra-processed food consumption in Brazil. Public Health Nutr 2024; 27:e34. [PMID: 38173129 PMCID: PMC10897569 DOI: 10.1017/s1368980023002975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 11/30/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE This study evaluated the independent and combined environmental impacts of the consumption of beef and ultra-processed foods in Brazil. DESIGN Cross-sectional study. SETTING Brazil. PARTICIPANTS We used food purchases data from a national household budget survey conducted between July 2017 and July 2018, representing all Brazilian households. Food purchases were converted into energy, carbon footprints and water footprints. Multiple linear regression models were used to assess the association between quintiles of beef and ultra-processed foods in total energy purchases and the environmental footprints, controlling for sociodemographic variables. RESULTS Both beef and ultra-processed foods had a significant linear association with carbon and water footprints (P < 0·01) in crude and adjusted models. In the crude upper quintile of beef purchases, carbon and water footprints were 47·7 % and 30·8 % higher, respectively, compared to the lower quintile. The upper quintile of ultra-processed food purchases showed carbon and water footprints 14·4 % and 22·8 % higher, respectively, than the lower quintile. The greatest reduction in environmental footprints would occur when both beef and ultra-processed food purchases are decreased, resulting in a 21·1 % reduction in carbon footprint and a 20·0 % reduction in water footprint. CONCLUSIONS Although the environmental footprints associated with beef consumption are higher, dietary patterns with lower consumption of beef and ultra-processed foods combined showed the greatest reduction in carbon and water footprints in Brazil. The high consumption of beef and ultra-processed foods is harmful to human health, as well as to the environment; thus, their reduction is beneficial to both.
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Affiliation(s)
- Gabriela Lopes da Cruz
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Research in Nutrition and Health (NUPENS), University of São Paulo, São Paulo, Brazil
| | - Maria Laura da Costa Louzada
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Research in Nutrition and Health (NUPENS), University of São Paulo, São Paulo, Brazil
| | - Jacqueline Tereza da Silva
- Center for Epidemiological Research in Nutrition and Health (NUPENS), University of São Paulo, São Paulo, Brazil
- Global Academy of Agriculture and Food Systems, The University of Edinburgh, Edinburgh, UK
| | - Josefa Maria Fellegger Garzillo
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Research in Nutrition and Health (NUPENS), University of São Paulo, São Paulo, Brazil
| | - Fernanda Rauber
- Center for Epidemiological Research in Nutrition and Health (NUPENS), University of São Paulo, São Paulo, Brazil
- Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ximena Schmidt Rivera
- Equitable Development and Resilience Research Group, Department of Chemical Engineering, College of Engineering, Design and Physical Science, Brunel University London, London, UK
| | - Christian Reynolds
- Centre for Food Policy, City University, London, UK
- Department of Geography, University of Sheffield, Sheffield, UK
| | - Renata Bertazzi Levy
- Center for Epidemiological Research in Nutrition and Health (NUPENS), University of São Paulo, São Paulo, Brazil
- Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
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Fraga ACSA, Bastos MP, Theme-Filha MM. Increased consumption of ultra-processed foods during pregnancy is associated with sociodemographic, behavioral, and obstetric factors: A cohort study. Nutr Res 2024; 121:28-38. [PMID: 38039599 DOI: 10.1016/j.nutres.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/28/2023] [Accepted: 10/28/2023] [Indexed: 12/03/2023]
Abstract
A diet based on ultra-processed food (UPF) does not meet nutritional needs, especially during pregnancy. The aim of this study is to assess the change in UPF consumption from preconception to pregnancy and associated factors. Our hypothesis is that women tend to adopt a healthier eating pattern during pregnancy, decreasing the intake of UPF and increasing the intake of unprocessed/minimally processed foods. A prospective cohort study with 326 participants was carried out from 2016 to 2019 in 2 health units in Rio de Janeiro, Brazil. Pregestational food consumption assessed using the food frequency questionnaire in the prenatal interview in women up to 20 gestational weeks and gestational consumption in the interview 2 months after delivery. Food items classified according to the NOVA system. For the mean variation from preconception to gestational UPF consumption, we used the generalized estimating equations model with linear distribution. Control of confounding variables was based on the literature on factors associated with UPF consumption, using a 3-level hierarchical model. The proportion of UPF energy consumption was 28.9% in preconception and 33% during pregnancy. Older and more educated women had a lower mean variation in the consumption of UPF during the pregnancy. A higher average consumption of UPF observed among women physically inactive before pregnancy, who smoked during pregnancy, were multiparous, and with had a low pregestational weight. These results reflect similar behavior to that of the general population, aggravated by a significant increase during pregnancy. However, older and more educated women and those with healthy behaviors showed lower UPF intake in pregnancy.
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de Paula Matos J, Julião KCM, Horta PM. Characteristics of food establishments registered with a meal delivery app in Latin America. Br J Nutr 2023; 130:2155-2161. [PMID: 37317800 DOI: 10.1017/s0007114523001368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Numerous studies have characterised the establishments registered with meal delivery apps (MDA) in several countries. However, little evidence is available regarding these platforms in Latin America (LA). The purpose of this study is to characterise food establishments registered with an MDA in nine LA cities. The establishments (n 3339) were characterised by the following keyword groups: 'Typical cuisine', 'Meat and fish', 'Snacks', 'Breakfast', 'Desserts' and 'Healthy'. In addition, we identified the marketing strategies present in the establishments' advertisements: photos, discounts and free delivery. Mexico City had the highest number of establishments registered with MDA (773), followed by Bogotá (655), Buenos Aires (567) and São Paulo (454). There is a direct relationship between the number of inhabitants of the cities and the number of the registered establishments. 'Snacks' was the keyword group most used by establishments in five of the nine cities. Establishments in two cities were most often characterised by the terms 'Typical cuisine' (Mexico City and Santiago de Chile) and 'Meats and fish' (Quito and San Jose). Photos were present in the advertisements of at least 84·0 % of the establishments. In addition, at least 40 % of establishments in Montevideo, Bogotá, São Paulo, Lima and Santiago de Chile offered discounts. Free delivery was present in at least 50 % of establishments in Quito, San Jose, Mexico City, Santiago de Chile and Lima. Photos were also the most common marketing strategy used by the establishments classified in all groups of keywords, while free delivery and discounts differed among them.
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Affiliation(s)
- Juliana de Paula Matos
- Departamento de Nutrição, Universidade Federal de Minas Gerais (UFMG), Av. Alfredo Balena 190, 30130-100Belo Horizonte, MG, Brazil
| | - Karen Carolina Martins Julião
- Departamento de Nutrição, Universidade Federal de Minas Gerais (UFMG), Av. Alfredo Balena 190, 30130-100Belo Horizonte, MG, Brazil
| | - Paula Martins Horta
- Departamento de Nutrição, Universidade Federal de Minas Gerais (UFMG), Av. Alfredo Balena 190, 30130-100Belo Horizonte, MG, Brazil
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de Azevedo ABC, Bandoni DH, de Amorim ALB, Canella DS. Evaluation of food purchasing in the Brazilian School Feeding Programme: feasibility of the requirements and recommendations. Public Health Nutr 2023; 26:3331-3342. [PMID: 37905595 PMCID: PMC10755429 DOI: 10.1017/s136898002300229x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 08/01/2023] [Accepted: 10/23/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE To analyse the purchase of food for school feeding, according to the extent and purpose of industrial processing and variety, exploring the feasibility of achieving the requirements and recommendations of the Brazilian School Feeding Programme, and the variety of unprocessed or minimally processed foods according to the purchase of ultra-processed foods. DESIGN Secondary data from 2016 from the Accountability Management System of the National Fund for Educational Development, concerning the food items purchased, were used to explore the feasibility of the requirements and recommendations. The foods were grouped according to the NOVA classification system. Variety was assessed by counting different types of unprocessed or minimally processed foods. SETTING Brazil. PARTICIPANTS 3698 Brazilian municipalities. RESULTS Energy share from unprocessed or minimally processed foods was 44·1 % while that of ultra-processed foods was 29·9 %. The average of unprocessed or minimally processed food types purchased annually was 33·8 items. Of the municipalities, 35·8 % were within the limit established for the expenditure of funds for the purchase of processed and ultra-processed foods, while 8·7 % followed the recommendation for variety. The proportion of ultra-processed foods did not influence the variety of food items purchased. CONCLUSIONS The results showed the feasibility of achieving the requirements and recommendations and underscored the importance of continued efforts to promote the inclusion of unprocessed or minimally processed foods in the school feeding programme while addressing the challenges associated with expenditure limits of processed and ultra-processed foods and enhancing variety, which is strategic to promote adequate and healthy meals.
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Affiliation(s)
- Ana Beatriz Coelho de Azevedo
- Rio de Janeiro State University, Institute of Nutrition, Rua São Francisco Xavier, nº 524, Maracanã, Pavilhão João Lyra Filho, 12º andar, Bloco E, sala 12002, Rio de Janeiro, RJ, Brazil
| | - Daniel Henrique Bandoni
- Federal University of São Paulo, Center of Practices and Research in Nutrition and Collective Food Services, Edifício Central – Rua Silva Jardim, nº 136, Vila Matias, Santos, SP, Brazil
| | | | - Daniela Silva Canella
- Rio de Janeiro State University, Institute of Nutrition, Rua São Francisco Xavier, nº 524, Maracanã, Pavilhão João Lyra Filho, 12º andar, Bloco E, sala 12002, Rio de Janeiro, RJ, Brazil
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da Silva GM, de Assumpção D, Freiria CN, Borim FSA, de Brito TRP, Corona LP. Association of Food Consumption According to the Degree of Processing and Sociodemographic Conditions in Older Adults. Foods 2023; 12:4108. [PMID: 38002166 PMCID: PMC10670687 DOI: 10.3390/foods12224108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/07/2023] [Accepted: 10/10/2023] [Indexed: 11/26/2023] Open
Abstract
Several factors can impact food consumption in older adults, including those of sociodemographic, physiological, and chronic non-communicable diseases. This study aimed to evaluate the association of food consumption according to its degree of processing with sociodemographic conditions in community-dwelling older adults. Food intake was evaluated from 24-h recall data. All food items were classified according to the degree of processing into four groups as follows: in natura or minimally processed, culinary ingredients, processed, and ultra-processed foods. Food groups were considered dependent variables in a quantile regression model, adjusting for sex, age, schooling, ethnicity, and number of residents. Women and individuals with higher levels of education had lower consumption of in natura or minimally processed foods and higher consumption of ultra-processed foods. The yellow or indigenous ethnicity presented the lowest consumption of processed foods; older people who lived with three or more individuals had the highest consumption of culinary ingredients, whereas the older people who lived with one to two people had the highest consumption of processed foods and the lowest consumption of ultra-processed. These groups may be the target of educational and public policies to improve diet quality and contribute to quality of life in older ages.
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Affiliation(s)
- Graziele Maria da Silva
- Faculdade de Ciências Aplicadas, Universidade Estadual de Campinas, Street Pedro Zaccaria, 1300, Limeira 13484-350, São Paulo, Brazil;
| | - Daniela de Assumpção
- Faculdade de Ciências MédicasUniversidade Estadual de Campinas, Street Tessália Vieira de Camargo, 126-Cidade Universitária, Campinas 13083-887, São Paulo, Brazil; (D.d.A.); (C.N.F.); (F.S.A.B.)
| | - Carolina Neves Freiria
- Faculdade de Ciências MédicasUniversidade Estadual de Campinas, Street Tessália Vieira de Camargo, 126-Cidade Universitária, Campinas 13083-887, São Paulo, Brazil; (D.d.A.); (C.N.F.); (F.S.A.B.)
| | - Flávia Silva Arbex Borim
- Faculdade de Ciências MédicasUniversidade Estadual de Campinas, Street Tessália Vieira de Camargo, 126-Cidade Universitária, Campinas 13083-887, São Paulo, Brazil; (D.d.A.); (C.N.F.); (F.S.A.B.)
| | - Tábatta Renata Pereira de Brito
- School of Nutrition, Federal University of Alfenas, Street Nabor Toledo Lopes, 598-Parque das Nações, Alfenas 37130-000, Minas Gerais, Brazil;
| | - Ligiana Pires Corona
- Faculdade de Ciências Aplicadas, Universidade Estadual de Campinas, Street Pedro Zaccaria, 1300, Limeira 13484-350, São Paulo, Brazil;
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Louzada MLDC, Couto VDCS, Rauber F, Tramontt CR, Santos TSS, Lourenço BH, Jaime PC. Food and Nutrition Surveillance System markers predict diet quality. Rev Saude Publica 2023; 57:82. [PMID: 37971176 PMCID: PMC10631750 DOI: 10.11606/s1518-8787.2023057005087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/22/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE To investigate the performance of food consumption markers of the Food and Nutrition Surveillance System (Sisvan) in assessing the overall dietary quality. METHODS The study was carried out based on the reproduction of responses to markers in 24-hour recall data from 46,164 individuals aged ≥ 10 years, from the 2017-2018 Household Budget Survey (POF). Seven Sisvan markers were evaluated, and two scores were calculated for each participant, based on the sum of the number of healthy food markers (beans, fruits, and vegetables, ranging from 0 to 3) and unhealthy (hamburgers/sausages, sweetened beverages, instant noodles/salt snacks/crackers, stuffed cookies/sweets/candies, ranging from 0 to 4) consumed. Linear regression analyses were used to assess the association between scores and diet quality indicators (ultra-processed foods, dietary diversity, and levels of saturated and trans fat, added sugar, sodium, potassium, and fiber in the diet). RESULTS The score of healthy eating markers increased significantly with increasing dietary diversity and potassium and fiber contents in the diet, while the opposite trend was observed for the densities of added sugar, sodium, saturated and trans fat (p < 0.001). The score of unhealthy eating markers increased significantly with the increase in the consumption of ultra-processed foods and densities of added sugar, saturated and trans fat levels in the diet, while an inverse trend was observed for potassium and fiber (p < 0.001). The joint analysis of the combination of the two marker scores showed that individuals with better performance (3 in the healthy food score, and 0 in the unhealthy food score) have a lower number of inadequacies in nutrient consumption. CONCLUSION Sisvan food consumption markers, quickly and easily applied and already incorporated into the Brazilian public health system, have good potential to reflect the overall dietary quality.
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Affiliation(s)
- Maria Laura da Costa Louzada
- Universidade de São PauloFaculdade de Saúde PúblicaDepartamento de NutriçãoSão PauloSPBrazil Universidade de São Paulo . Faculdade de Saúde Pública . Departamento de Nutrição . São Paulo , SP , Brazil
| | - Vanessa Del Castillo Silva Couto
- Universidade de São PauloFaculdade de Saúde PúblicaDepartamento de NutriçãoSão PauloSPBrazil Universidade de São Paulo . Faculdade de Saúde Pública . Departamento de Nutrição . São Paulo , SP , Brazil
| | - Fernanda Rauber
- Universidade de São PauloFaculdade de MedicinaDepartamento de Medicina PreventivaSão PauloSPBrazil Universidade de São Paulo . Faculdade de Medicina . Departamento de Medicina Preventiva . São Paulo , SP , Brazil
| | - Claudia Raulino Tramontt
- Universidade de São PauloFaculdade de Saúde PúblicaDepartamento de NutriçãoSão PauloSPBrazil Universidade de São Paulo . Faculdade de Saúde Pública . Departamento de Nutrição . São Paulo , SP , Brazil
| | - Thanise Sabrina Souza Santos
- Universidade Federal de Minas GeraisGrupo de Pesquisa de Intervenções em NutriçãoBelo HorizonteMGBrazil Universidade Federal de Minas Gerais . Grupo de Pesquisa de Intervenções em Nutrição . Belo Horizonte , MG , Brazil
| | - Bárbara Hatzlhoffer Lourenço
- Universidade de São PauloFaculdade de Saúde PúblicaDepartamento de NutriçãoSão PauloSPBrazil Universidade de São Paulo . Faculdade de Saúde Pública . Departamento de Nutrição . São Paulo , SP , Brazil
| | - Patrícia Constante Jaime
- Universidade de São PauloFaculdade de Saúde PúblicaDepartamento de NutriçãoSão PauloSPBrazil Universidade de São Paulo . Faculdade de Saúde Pública . Departamento de Nutrição . São Paulo , SP , Brazil
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Monteiro RDCDA, Verly E. Evolution of household availability of regional foods in Amazonas. Rev Saude Publica 2023; 57:69. [PMID: 37878855 PMCID: PMC10547386 DOI: 10.11606/s1518-8787.2023057004804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 02/08/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE To evaluate the evolution of household availability of regional foods in the state of Amazonas, their distribution according to sociodemographic characteristics, and potential differences when compared to the remaining areas of Brazil. METHODS Data on food acquisition for home consumption from the 2002-2003, 2008-2009, and 2017-2018 Pesquisa de Orçamentos Familiares (POFs - Consumer Expenditure Surveys) were analyzed, covering, respectively, 48,470, 55,970, and 57,920 households in Brazil, of which 1,075, 1,344, and 1,833 are in Amazonas. Foods were categorized into three groups: cassava and its derivatives, freshwater fish, and regional fruits. The study analyzed the amount of regional food purchased, expressed in relative household caloric share, for the entire area of Amazonas. Additionally, the data was stratified and analyzed according to sociodemographic variables, with differences assessed through the overlapping of 95% confidence intervals. FINDINGS The household caloric share of the total regional foods in Amazonas was 22.54% in 2002-2003, 18.18% in 2008-2009, and 6.49% in 2017-2018. Across Brazil, those percentages were much lower in the same period: 3.67%, 3.34%, and 1.82%, respectively. Changes in Amazonas were primarily attributed to the steep drop in the cassava and derivatives group, which decreased from 14.30% in 2002-2003 to 12.74% in 2008-2009 and further declined to 3.09% in 2017-2018. Additionally, there was a gradual decline in household availability of freshwater fish, decreasing from 7.30% in 2002-2003 to 4.85% in 2008-2009 and reaching 2.90% in 2017-2018. Households in rural areas and with lower per capita income presented a higher proportion of calories from total regional foods; this particular stratum also experienced the most significant reductions in their consumption. CONCLUSION During the study period, there was a significant decrease in the consumption of regional foods in Amazonas, particularly in lower income households in rural areas. Among them, the family reference person was typically a younger male with a lower educational background.
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Affiliation(s)
- Rita de Cássia de Assunção Monteiro
- Universidade do Estado do AmazonasEscola Superior de Ciências da SaúdeManausAMBrazil Universidade do Estado do Amazonas. Escola Superior de Ciências da Saúde. Manaus, AM, Brazil.
| | - Eliseu Verly
- Universidade do Estado do Rio de JaneiroInstituto de Medicina SocialDepartamento de EpidemiologiaRio de JaneiroRJBrazilUniversidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Departamento de Epidemiologia. Rio de Janeiro, RJ, Brazil.
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15
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Silva ARC, Guandalini VR, Pereira TSS, Zhao L, Wirth MD, Hébert JR, Fernandes GA, de Assumpção PP, Barbosa MS, Curado MP. Association between Dietary Inflammatory Index and Gastric Adenocarcinoma: A Multicenter Case-Control Study in Brazil. Nutrients 2023; 15:2867. [PMID: 37447193 DOI: 10.3390/nu15132867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/18/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Few studies have evaluated the association between diet-related inflammation and gastric adenocarcinoma (GA) and evidence is scarce in Brazil. This study evaluated the association between a pro-inflammatory diet and GA. METHODS A multicenter case-control study was conducted in Brazil. A total of 1645 participants-492 cases, 377 endoscopy controls, and 776 hospital controls-were included. Energy-adjusted Dietary Inflammatory Index (E-DIITM) scores were derived from a validated food frequency questionnaire. We used binary and multinomial logistic regression models for the analysis of total GA, and its subtypes (cardia and non-cardia, intestinal, and diffuse histological subtypes). RESULTS In cases versus endoscopy controls, a pro-inflammatory diet, estimated by higher E-DII scores, was associated with a higher risk GA (ORQ4vsQ1: 2.60, 1.16-5.70), of non-cardia GA (OR: 2.90, 1.06-7.82), and diffuse subtype (OR: 3.93, 1.59-9.70). In cases versus hospital controls, higher E-DII scores were associated with a higher risk of GA (OR: 2.70, 1.60-4.54), of cardia GA (OR: 3.31, 1.32-8.24), non-cardia GA (OR: 2.97, 1.64-5.39), and both intestinal (OR: 2.82, 1.38-5.74) and diffuse GA (OR: 2.50, 1.54-5.11) subtypes. CONCLUSIONS This study provides evidence that a pro-inflammatory diet is associated with an increased risk of GA in Brazil. E-DII requires the inclusion of sodium due to its importance in carcinogenesis.
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Affiliation(s)
| | - Valdete Regina Guandalini
- Postgraduate Program in Nutrition and Health, Health Sciences Center, Federal University of Espírito Santo, Vitória 29047-105, Brazil
- Department of Integrated Education, Health Sciences Center, Federal University of Espírito Santo, Vitória 29047-105, Brazil
| | | | - Longgang Zhao
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
- Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC 29208, USA
| | - Michael D Wirth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
- Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC 29208, USA
- College of Nursing, University of South Carolina, Columbia, SC 29208, USA
| | - James R Hébert
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
- Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC 29208, USA
| | - Gisele Aparecida Fernandes
- Postgraduate Program in Oncology, A.C. Camargo Cancer Center, São Paulo 01509-900, Brazil
- Group of Epidemiology and Statistics on Cancer, International Research Center, A.C. Camargo Cancer Center, São Paulo 01508-010, Brazil
| | | | - Mônica Santiago Barbosa
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia 74605-050, Brazil
| | - Maria Paula Curado
- Postgraduate Program in Oncology, A.C. Camargo Cancer Center, São Paulo 01509-900, Brazil
- Group of Epidemiology and Statistics on Cancer, International Research Center, A.C. Camargo Cancer Center, São Paulo 01508-010, Brazil
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Teixeira TV, Da Silva ACF, Rodrigues CDSC, Brito FDSB, Canella DS, Citelli M. Food Consumption of People with Sickle Cell Anemia in a Middle-Income Country. Nutrients 2023; 15:nu15061478. [PMID: 36986208 PMCID: PMC10054003 DOI: 10.3390/nu15061478] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/07/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
Sickle cell anemia (SCA) is a genetic and hemolytic disease globally characterized by social vulnerability. Food consumption has been insufficiently analyzed in SCA. Secondary iron overload is often observed. This leads to unreliable recommendations for dietary iron restriction. We assessed food consumption and iron intake among adults with SCA. Considering the guidelines for healthy eating, foods were grouped according to the NOVA classification. This transversal study included 74.4% of eligible patients who were registered in the reference center for SCA treatment in Rio de Janeiro, Brazil, in 2019. Data on food consumption were collected through 24 h recall. The monthly household income of 82.3% of patients was less than $770. The consumption of fresh or minimally processed foods was directly associated with monthly household income (p < 0.0001; η2 = 0.87). Ultra-processed foods provided more than one-third of the total energy intake (35.2%). The prevalence of inadequate iron intake was about 40% among women, while that of iron intake above the tolerable upper limit was 0.8%. People from lower socioeconomic classes had the lowest iron intake. Strategies to encourage the consumption of fresh or minimally processed foods are needed considering the requirement of an antioxidant diet in SCA. These findings highlight the need for health equity to ensure food security and healthy eating in SCA.
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Affiliation(s)
- Tamara Vilhena Teixeira
- Nutrition Institute, Rio de Janeiro State University, São Francisco Xavier Street, 524, Rio de Janeiro 20550-900, Brazil
| | | | | | | | - Daniela Silva Canella
- Nutrition Institute, Rio de Janeiro State University, São Francisco Xavier Street, 524, Rio de Janeiro 20550-900, Brazil
| | - Marta Citelli
- Nutrition Institute, Rio de Janeiro State University, São Francisco Xavier Street, 524, Rio de Janeiro 20550-900, Brazil
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Nilson EAF, Ferrari G, Louzada MLDC, Levy RB, Monteiro CA, Rezende LFM. The estimated burden of ultra-processed foods on cardiovascular disease outcomes in Brazil: A modeling study. Front Nutr 2022; 9:1043620. [PMID: 36466395 PMCID: PMC9712187 DOI: 10.3389/fnut.2022.1043620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/25/2022] [Indexed: 11/07/2023] Open
Abstract
Introduction Ultra-processed foods (UPF) have been associated with an increased risk of cardiovascular diseases (CVD). This study aimed to estimate CVD premature deaths, incident cases, and disability adjusted life-years (DALYs) attributable to the consumption of UPF in Brazilian adults in 2019. Methods A validated a comparative risk assessment model was adapted to estimate the burden of major CVD outcomes (coronary heart disease and stroke) attributable to the consumption of UPF in Brazilian adults aged 30 to 69 years. The model inputs included nationally representative data of the UPF contribution to the total energy of the diet, national official demographic records, CVD outcomes (incidence, deaths and DALYs) from the Global Burden of Disease study for 2019, and relative risks from meta-analysis studies. Results We estimated that approximately 19,200 premature deaths (95% uncertainty intervals - UI, 7,097 to 32,353), 74,900 new cases (95% UI, 25,983 to 128,725), and 883,000 DALYs/year (95% UI, 324,279 to 1,492,593) from CVD were attributable to the consumption of UPF in Brazil, corresponding to about 22% of the premature deaths from CVD and to 33% of the total premature all-cause deaths attributable to UPF intake among Brazilian adults. Reducing UPF consumption by 10% in the adult population would avert approximately 11% of the premature CVD deaths, equivalent to 2,100 deaths/year (95% UI, 697 to 4,511). A 20% reduction in UPF intake would avert approximately 21% of the premature CVD deaths or 4,100 deaths (95% UI, 1,413 to 8,047), and a 50% reduction in UPF intake would avert about 52% of the premature CVD deaths, corresponding to 9,900 deaths/year (95% UI, 3,682 to 17,820). If UPF consumption among adults was reduced to that of the first quintile of UPF intake in the baseline scenario, approximately 81% of the premature CVD deaths would be averted, corresponding to some 15,600 deaths/year (95% UI, 5,229 to 27,519). Conclusion Our study estimated a high burden of premature CVD outcomes attributable to the consumption of UPF in Brazil. Our findings support food policies aimed at reducing the consumption of UPF, such as fiscal and regulatory policies, which are imperative to prevent CVD in Brazil.
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Affiliation(s)
- Eduardo Augusto Fernandes Nilson
- Center for Epidemiological Research in Nutrition and Public Health, University of São Paulo, São Paulo, Brazil
- Oswaldo Cruz Foundation-Fiocruz, Brasília, Brazil
| | - Gerson Ferrari
- Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile (USACH), Santiago, Chile
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago, Chile
| | | | - Renata Bertazzi Levy
- Department of Preventive Medicine, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Carlos Augusto Monteiro
- Center for Epidemiological Research in Nutrition and Public Health, University of São Paulo, São Paulo, Brazil
| | - Leandro F. M. Rezende
- Department of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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