Assessment of ultra processed foods consumption in Senegal: validation of the Nova-UPF screener

BACKGROUND

Ultra-processed foods (UPF), as proposed by the Nova food classification system, are linked to the development of obesity and several non-communicable chronic diseases and deaths from all causes. The Nova-UPF screener developed in Brazil is a simple and quick tool to assess and monitor the consumption of these food products. The aim of this study was to adapt and validate, against the 24-hour dietary recall, this short food-based screener to assess UPF consumption in the Senegalese context.

METHODS

The tool adaptation was undertaken using DELPHI methodology with national experts and data from a food market survey. Following the adaptation, sub-categories were renamed, restructured and new ones introduced. The validation study was conducted in the urban area of Dakar in a convenience sample of 301 adults, using as a reference the dietary share of UPF on the day prior to the survey, expressed as a percentage of total energy intake obtained via 24-hour recall. Association between the Nova-UPF score and the dietary share of UPF was evaluated using linear regression models. The Pabak index was used to assess the agreement in participants' classification according to quintiles of Nova-UPF score and quintiles of the dietary share of UPF.

RESULTS

The results show a linear and positive association (p-value < 0.001) between intervals of the Nova-UPF score and the average dietary share of UPF. There was a near perfect agreement in the distribution of individuals according to score's quintiles and UPF dietary share quintiles (Pabak index = 0.84).

CONCLUSION

The study concluded that the score provided by the Nova-UPF screener adapted to the Senegalese context is a valid estimate of UPF consumption.

The bio-food industry's corporate political activity during Health Canada's revision of Canada's food guide

INTRODUCTION

We analyzed the bio-food industry's corporate political activity (CPA) during the revisions of Canada's food guide between 2016 and 2019.

METHODS

We undertook a content analysis of the websites of 11 bio-food industry organizations and of the briefs that 10 of them submitted to the Canadian House of Commons Standing Committee on Health, as part of this Committee's review of the food guide. Data were classified according to an existing conceptual framework.

RESULTS

We identified 366 examples of CPA used by the bio-food industry during and immediately after the development of the food guide. Most of the industry actors opposed the guide's recommendations. The most common CPA strategies were information management (n = 197), used to create and disseminate information in industry's favour, and discursive strategies (n = 108), used to defend food products and promote the industry's position regarding the food guide. Influencing public policy (n = 40), by gaining indirect access to policy makers (e.g. through lobbying) and becoming active in government decision-making, as well as coalition management (n = 21), by establishing relationships with opinion leaders and health organizations, were also common strategies.

CONCLUSION

Bio-food industry actors used many different CPA strategies during the revisions of the food guide. It is important to continue to document the bio-food industry's CPA to understand whether and how this is shaping public policy development in Canada and elsewhere.

Protecting traditional cultural food practices: Trends in diet quality and intake of ultra-processed foods by Indigenous status and race/ethnicity among a nationally representative sample of adults in Canada

Background

The traditional cultural food practices of Indigenous people and adults from racial/ethnic minority groups may be eroded in the current food system where nutrient-poor and ultra-processed foods (UPF) are the most affordable and normative options, and where experiences of racism may promote unhealthy dietary patterns. We quantified absolute and relative gaps in diet quality and UPF intake of a nationally representative sample of adults in Canada by Indigenous status and race/ethnicity, and trends between 2004 and 2015.

Methods

Adults (≥18 years) in the Canadian Community Health Survey-Nutrition self-reported Indigenous status and race/ethnicity and completed a 24-h dietary recall in 2004 (n = 20,880) or 2015 (n = 13,970) to calculate Healthy Eating Index-2015 (HEI-2015) scores from 0 to 100 and proportion of energy from UPF. Absolute and relative dietary gaps were quantified for Indigenous people and six racial/ethnic minority groups relative to White adults and trends between 2004 and 2015.

Results

Adults from all six racial/ethnic minority groups had higher mean HEI-2015 scores (58.7-61.9) than White (56.3) and Indigenous adults (51.9), and lower mean UPF intake (31.0%-41.0%) than White (45.9%) and Indigenous adults (51.9%) in 2015. As a result, absolute gaps in diet quality were positive and gaps in UPF intake were negative among racial/ethnic minority groups-indicating more favourable intakes-while the reverse was found among Indigenous adults. Relative dietary gaps were small. Absolute and relative dietary gaps remained largely stable.

Conclusions

Adults from six racial/ethnic minority groups had higher diet quality and lower UPF intake, whereas Indigenous adults had poorer diet quality and higher UPF intake compared to White adults between 2004 and 2015. Absolute and relative dietary gaps remained largely stable. Findings suggest racial/ethnic minority groups may have retained some healthful aspects of their traditional cultural food practices while highlighting persistent dietary inequities that affect Canada's Indigenous people.

Interactions Between Nutrition Professionals and Industry: A Scoping Review

BACKGROUND

In recent years, interactions between nutrition professionals (NPs) and the food industry, such as sponsorship arrangements, have raised concerns, particularly as these may negatively impact the trustworthiness and credibility of the nutrition profession. This study aimed to map the literature and identify knowledge gaps regarding interactions between NPs and industry. We sought to examine the nature of such interactions and NPs perspectives about these, as well as the risks and solutions.

METHODS

We conducted a scoping review according to a pre-registered protocol, searching eight electronic databases and grey literature sources in March 2021 to identify documents for inclusion. Two independent reviewers screened citations for inclusion and conducted data extraction. Quantitative and qualitative syntheses were conducted.

RESULTS

We identified 115 documents for analysis, published between 1980 to 2021, with a majority from the United States (n=59, 51%). Only 32% (n=37) were empirical studies. The food industry was the most frequent industry type discussed (n=91, 79%). We identified 32 types of interactions between NPs and industry, such as continuing education provided by industry and sponsorship of professional bodies and health and nutrition organizations. The financial survival of nutrition organizations and continuing education access for NPs were the most frequently cited advantages of industry-NPs interactions. On the other hand, undermining public trust, NPs credibility and public health nutrition recommendations were pointed out as risks of these interactions. Following a code of ethics, policies, or guidelines was the most frequently proposed solution for managing these interactions.

CONCLUSION

Despite the increasing attention given to this issue, few empirical papers have been published to date. There is a need for more research to better and systematically document industry interactions with NPs and the impacts associated with these, as well as more research on effective management strategies. Registry Name and Number: Interactions between nutrition professionals and industry actors: A scoping review protocol. doi:10.17605/OSF.IO/Q6PUA.

Canadians Adults Fail Their Dietary Quality Examination Twice

For many years, dietary quality among Canadians has been assessed using an index that gives criticized scores and does not allow for comparison with Americans. In Canadians aged ≥19 years, we aimed to (1) determine the dietary quality by using a more widely used evidence-based index that has shown associations with health outcomes, the alternative Healthy Eating Index (aHEI-2010); (2) assess changes in aHEI-2010 score and its components between 2004 and 2015; and (3) identify factors associated with aHEI-2010 score. We relied on the Canadian Community Health Survey 2004 (n = 35,107) and 2015 (n = 20,487). We used adjusted linear models with a time effect to compare the total aHEI-2010 score and its components. The overall aHEI-2010 score increased from 36.5 (95%CI: 36.2-36.8) in 2004 to 39.0 (95%CI: 38.5-39.4) in 2015 (p < 0.0001). Participants with less than a high school diploma showed the lowest score and no improvement from 2004 to 2015 (34.8 vs. 35.3, p = 0.4864). In each period, higher scores were noted among immigrants than non-immigrants (38.3 vs. 35.9 in 2004, p < 0.0001; 40.5 vs. 38.5 in 2015 p < 0.0001), and lower scores were observed in current smokers (33.4 vs. 37.1 in 2004, p < 0.0001; 34.5 vs. 39.9 in 2015, p < 0.0001). The use of the aHEI-2010 tool suggests a lower score among Canadians than the previous index, more comparable to the score among Americans.

Evaluation and prioritization of actions on food environments to address the double burden of malnutrition in Senegal: perspectives from a national expert panel

OBJECTIVE

To evaluate the extent of implementation of public policies aimed at creating healthy eating environments in Senegal compared to international best practice and identity priority actions to address the double burden of malnutrition.

DESIGN

The Healthy Food Environment Policy Index (Food-EPI) was used by a local expert panel to assess the level of implementation of 43 good practice policy and infrastructure support indicators against international best practices using a Likert scale and identify priority actions to address the double burden of malnutrition in Senegal.

SETTING

Senegal, West Africa.

PARTICIPANTS

A national group of independent experts from academia, civil society, non-governmental organizations and United Nations bodies (n =15) and a group of government experts from various ministries (n =16) participated in the study.

RESULTS

Implementation of most indicators aimed at creating healthy eating environments were rated as "low" compared to best practice (31 on 43, or 72%). The Gwet AC2 inter-rater reliability was good at 0.75 (CI 0.70 - 0.80). In a prioritization workshop, experts identified forty-five actions, prioritizing ten as relatively most feasible and important and relatively most effective to reduce the double burden of malnutrition in Senegal (example: Develop and implement regional school menus based on local products (expand to 14 regions) and measure the extent of the promotion of unhealthy foods to children).

CONCLUSIONS

Significant efforts remain to be made by Senegal to improve food environments. This project allowed to establish an agenda of priority actions for the government to transform food environments in Senegal to tackle the double burden of malnutrition.

Project Earthrise: Proceedings of the Ninth Annual Conference of inVIVO Planetary Health

The “Earthrise” photograph, taken on the 1968 Apollo 8 mission, became one of the most significant images of the 20th Century. It triggered a profound shift in environmental awareness and the potential for human unity—inspiring the first Earth Day in 1970. Taking inspiration from these events 50 years later, we initiated Project Earthrise at our 2020 annual conference of inVIVO Planetary Health. This builds on the emergent concept of planetary health, which provides a shared narrative to integrate rich and diverse approaches from all aspects of society towards shared solutions to global challenges. The acute catastrophe of the COVID-19 pandemic has drawn greater attention to many other interconnected global health, environmental, social, spiritual, and economic problems that have been underappreciated or neglected for decades. This is accelerating opportunities for greater collaborative action, as many groups now focus on the necessity of a “Great Transition”. While ambitious integrative efforts have never been more important, it is imperative to apply these with mutualistic value systems as a compass, as we seek to make wiser choices. Project Earthrise is our contribution to this important process. This underscores the imperative for creative ecological solutions to challenges in all systems, on all scales with advancing global urbanization in the digital age—for personal, environmental, economic and societal health alike. At the same time, our agenda seeks to equally consider our social and spiritual ecology as it does natural ecology. Revisiting the inspiration of “Earthrise”, we welcome diverse perspectives from across all dimensions of the arts and the sciences, to explore novel solutions and new normative values. Building on academic rigor, we seek to place greater value on imagination, kindness and mutualism as we address our greatest challenges, for the health of people, places and planet.

Consumption of ultra-processed foods in Canada

BACKGROUND

A larger share of ultra-processed foods and drinks (UPF) in the diet is increasingly linked with poor diet quality, weight gain and elevated risk of diet-related chronic disease. This study used 2015 national-level data, the most recent available, to characterize the intake of UPF among Canadians and to examine changes since 2004.

DATA AND METHODS

The 2004 and 2015 Canadian Community Health Surveys provided 24-hour dietary recall data for Canadians aged 2 or older. All food and drink items were classified according to type of food processing using the NOVA classification. The mean energy contribution of UPF (as a percentage of total daily energy intake) was compared across survey years for the overall population and for eight age-sex groups. The National Cancer Institute's methodology was used to assess the distribution of usual energy contributed by UPF.

RESULTS

On average, UPF contributed 47.8% (95% CI: 47.3% to 48.3%) of total daily energy in 2004 and 45.7% (95% CI: 45.0% to 46.4%) in 2015 among the overall population, and more than half of total daily energy among children and adolescents. Both the mean energy contribution of UPF and their usual energy distribution shifted downward since 2004 for all age-sex groups, except among adults aged 55 or older. The energy contributions of soft drinks, fruit juices and fruit drinks declined, particularly among children and adolescents. Ultra-processed breads contributed more energy in 2015 for nearly all age-sex groups.

DISCUSSION

As in 2004, the overall dietary share of UPF in Canada remained high in 2015, but intakes of some UPF, particularly beverages, declined. The energy contribution of UPF remained highest among children and adolescents, and increased among adults aged 55 or older.

The burden of excessive saturated fatty acid intake attributed to ultra-processed food consumption: a study conducted with nationally representative cross-sectional studies from eight countries

Cross-sectional nutritional survey data collected in eight countries were used to estimate saturated fatty acid intakes. Our objective was to estimate the proportion of excessive saturated fatty acid intakes (>10 % of total energy intake) that could be avoided if ultra-processed food consumption was reduced to levels observed in the first quintile of each country. Secondary analysis was performed of 24 h dietary recall or food diary/record data collected by the most recently available nationally representative cross-sectional surveys carried out in Brazil (2008-9), Chile (2010), Colombia (2005), Mexico (2012), Australia (2011-12), the UK (2008-16), Canada (2015) and the US (2015-16). Population attributable fractions estimated the impact of reducing ultra-processed food consumption on excessive saturated fatty acid intakes (above 10 % of total energy intake) in each country. Significant relative reductions in the percentage of excessive saturated fatty acid intakes would be observed in all countries if ultra-processed food consumption was reduced to levels observed in the first quintile's consumption. The reductions in excessive intakes ranged from 10⋅0 % (95 % CI 6⋅2-13⋅6 %) in Canada to 35⋅0 % (95 % CI 28⋅7-48⋅0 %) in Mexico. In all eight studied countries, all presenting more than 30 % of intakes with excessive saturated fatty acids, lowering the dietary contribution of ultra-processed foods to attainable, context-specific levels was shown to be a potentially effective way to reduce the percentage of intakes with excessive saturated fatty acids, which may play an important role in the prevention of non-communicable diseases, particularly cardiovascular diseases.

Consumption of ultra-processed foods is associated with obesity, diabetes and hypertension in Canadian adults

OBJECTIVE

To assess the association between consumption of ultra-processed foods and obesity, diabetes, hypertension and heart disease in a nationally representative sample of Canadian adults.

METHODS

This study used cross-sectional data from 13,608 adults (aged 19+ years) from the 2015 Canadian Community Health Survey-Nutrition. The survey provided data on food consumption (from 24-h recall) and prevalent obesity (BMI ≥ 30 kg/m2) and self-reported diabetes, hypertension and heart disease. All foods and drinks consumed were classified according to the extent and purpose of industrial processing using the NOVA classification. Ultra-processed food consumption was estimated as proportion of total daily energy intake. Multivariable logistic regression models assessed the association between ultra-processed food consumption and obesity, diabetes, hypertension and heart disease, adjusting for a range of socio-demographic and lifestyle factors.

RESULTS

In 2015, ultra-processed food contributed, on average, to 24% of total daily energy intake in the lowest tertile of ultra-processed food consumption and 73% in the highest tertile. Compared with those in the lowest tertile, adults in the highest tertile of ultra-processed food consumption had 31% higher odds of obesity (OR = 1.31, 95% CI: 1.06-1.60), 37% higher odds of diabetes (OR = 1.37, 95% CI: 1.01-1.85) and 60% higher odds of hypertension (OR = 1.60, 95% CI: 1.26-2.03), adjusting for a range of covariates.

CONCLUSION

Higher consumption of ultra-processed foods is associated with higher prevalence of obesity, diabetes and hypertension among Canadian adults. A comprehensive set of strategies and policies is needed to discourage consumption of ultra-processed foods in Canada and to make unprocessed or minimally processed foods more affordable, available and appealing.

Public health response to ultra-processed food and drinks

Growing evidence confirms a link between consumption of ultra-processed food and drinks and non-communicable diseases. Jean Adams and colleagues explore the implications for public health action

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

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

Comparing the ways a sample of Brazilian adults classify food with the NOVA food classification: An exploratory insight

The aim of this study is to have an exploratory insight on how a sample of Brazilian adults classify food, attempting to identify the main factors involved in this process, and to compare these classifications to the NOVA food classification of the 2014 Brazilian dietary guidelines. An exploratory and qualitative approach was conducted with a selected sample of teachers, administrative technicians, and students (N = 24) from the Federal University of Grande Dourados, Brazil. First, using the pile sort method, participants were asked to freely classify 24 pictures of food (sourced from examples of the four food groups specified in NOVA) into food groups meaningful to them. Next, in semi-structured interviews, participants were asked to describe the food groups they created. The food groups created by participants were analyzed using non-metric multidimensional scaling followed by hierarchical cluster analysis, and the interviews were analyzed using content analysis. Participants had a mean age of 30 (±9.4) years. A total of 128 food groups were created by 24 participants (an average of five food groups per person); and a total of 55 non-mutually exclusive groups names were used by them to describe these food groups. Sixteen themes emerged from the content analysis. The most recurrent themes were food groups, nutrients, foods I consume, foods I do not consume, and food processing. Contrasting themes such as real food and junk foods, meals and ready-made foods, healthy foods and unhealthy foods were also noted. Six clusters emerged from the cluster analysis, each related to one or more themes. Overall, a striking similarity was observed between the ways the individuals classified food and the NOVA food classification.

Association between ultra-processed food consumption and the nutrient profile of the Colombian diet in 2005

Objective. To evaluate the consumption of ultra-processed food and drink products and its association with the nutrient profile of the Colombian diet in 2005. Materials and methods. Food consumption based on 24-hour dietary records from 38 643 men and women was classified into four NOVA groups according to the extent and purpose of food processing. Results. Ultra-processed food and drink products represented 15.9% of the total energy daily intake, compared to 63.3% from minimally processed food, 15.8% from processed culinary ingredients, and 4.9% from processed food. Non-ultra-processed food items had a healthier nutritional profile compared to ultra-processed items in terms of contribution to total calories from protein, carbohydrates, total fat, saturated fat, free sugar, fiber and energy density. Conclusions. Ultra-processed food products have a less healthy nutrient profile than non-ultra-processed ones. An increase in the consumption of these foods must be prevented within Colombia

Correction to: Consumption of ultra-processed foods and obesity in Canada

In Table 3, there were missing values in the Physical activity and Smoking status sections. The correct version of Table 3 is displayed here.

Consumption of ultra-processed foods and obesity in Canada

OBJECTIVES

To assess the association between consumption of ultra-processed foods and obesity in the Canadian population.

METHODS

Cross-sectional study including 19,363 adults aged 18 years or more from the 2004 Canadian Community Health Survey, cycle 2.2. Ultra-processed food intake was estimated using daily relative energy intake of ultra-processed food (% of total energy intake) from data obtained by 24-h food recalls. Obesity was assessed using body mass index (BMI ≥ 30 kg/m²). Univariate and multivariate linear regressions were performed to describe ultra-processed food consumption according to socio-economic and demographic variables, and multivariate logistic regression was performed to verify the association between ultra-processed food consumption and obesity, adjusting for potential confounders, including socio-demographic factors, physical activity, smoking, immigrant status, residential location, and measured vs self-reported weight and height.

RESULTS

Ultra-processed foods make up almost half (45%) of the daily calories consumed by Canadian adults. Consumption of these foods is higher among men, younger adults, those with fewer years of formal education, smokers, those physically inactive, and Canadian-born individuals. Ultra-processed food consumption is positively associated with obesity. After adjusting for confounding factors, individuals in the highest quintile of ultra-processed food consumption were 32% more likely of having obesity compared to individuals in the first quintile (predicted OR = e^{0.005 × 56} = 1.32; 95% CI = 1.05-1.57).

CONCLUSION

Canadians would benefit from reducing consumption of ultra-processed foods and beverages and increasing consumption of freshly prepared dishes made from unprocessed or minimally processed foods.

Sociodemographic associations of the dietary proportion of ultra-processed foods in First Nations peoples in the Canadian provinces of British Columbia, Manitoba, Alberta and Ontario

We investigated the food types consumed by 3276 First Nations citizens from the First Nations Food Nutrition and Environment Study (FNFNES) living on-reserve in Canada. Data from 24-h dietary recalls were classified into NOVA categories: fresh or minimally processed foods (MPF), processed culinary ingredients, processed foods, and ultra-processed foods (UPF). Individuals were classified as traditional food (TF) eaters if they ate MPF of their First Nations culture. UPF accounted for 54.0% of energy intake; 23% of participants ate TF. Increasing age and household size, living in British Columbia and TF eating were associated with a lower intake of energy from UPF. Eating TF appeared to be protective against intake of UPF.

Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study

OBJECTIVES

To investigate the contribution of ultra-processed foods to the intake of added sugars in the USA. Ultra-processed foods were defined as industrial formulations which, besides salt, sugar, oils and fats, include substances not used in culinary preparations, in particular additives used to imitate sensorial qualities of minimally processed foods and their culinary preparations.

DESIGN

Cross-sectional study.

SETTING

National Health and Nutrition Examination Survey 2009-2010.

PARTICIPANTS

We evaluated 9317 participants aged 1+ years with at least one 24 h dietary recall.

MAIN OUTCOME MEASURES

Average dietary content of added sugars and proportion of individuals consuming more than 10% of total energy from added sugars.

DATA ANALYSIS

Gaussian and Poisson regressions estimated the association between consumption of ultra-processed foods and intake of added sugars. All models incorporated survey sample weights and adjusted for age, sex, race/ethnicity, family income and educational attainment.

RESULTS

Ultra-processed foods comprised 57.9% of energy intake, and contributed 89.7% of the energy intake from added sugars. The content of added sugars in ultra-processed foods (21.1% of calories) was eightfold higher than in processed foods (2.4%) and fivefold higher than in unprocessed or minimally processed foods and processed culinary ingredients grouped together (3.7%). Both in unadjusted and adjusted models, each increase of 5 percentage points in proportional energy intake from ultra-processed foods increased the proportional energy intake from added sugars by 1 percentage point. Consumption of added sugars increased linearly across quintiles of ultra-processed food consumption: from 7.5% of total energy in the lowest quintile to 19.5% in the highest. A total of 82.1% of Americans in the highest quintile exceeded the recommended limit of 10% energy from added sugars, compared with 26.4% in the lowest.

CONCLUSIONS

Decreasing the consumption of ultra-processed foods could be an effective way of reducing the excessive intake of added sugars in the USA.

Consumption of ultra-processed foods and obesity in Brazilian adolescents and adults

OBJECTIVES

The aim of this study was to evaluate the relationship between the consumption of ultra-processed foods and obesity indicators among Brazilian adults and adolescents.

METHODS

We used cross-sectional data on 30,243 individuals aged ≥10 years from the 2008-2009 Brazilian Dietary Survey. Food consumption data were collected through 24-h food records. We classified food items according to characteristics of food processing. Ultra-processed foods were defined as formulations made by the food industry mostly from substances extracted from foods or obtained with the further processing of constituents of foods or through chemical synthesis, with little if any whole food. Examples included candies, cookies, sugar-sweetened beverages, and ready-to-eat dishes. Regression models were fitted to evaluate the association of the consumption of ultra-processed foods (% of energy intake) with body-mass-index, excess weight, and obesity status, controlling for socio-demographic characteristics, smoking, and physical activity.

RESULTS

Ultra-processed foods represented 30% of the total energy intake. Those in the highest quintile of consumption of ultra-processed foods had significantly higher body-mass-index (0.94 kg/m(2); 95% CI: 0.42,1.47) and higher odds of being obese (OR=1.98; 95% CI: 1.26,3.12) and excess weight (OR=1.26; 95% CI: 0.95,1.69) compared with those in the lowest quintile of consumption.

CONCLUSION

Our findings support the role of ultra-processed foods in the obesity epidemic in Brazil.

Current food classifications in epidemiological studies do not enable solid nutritional recommendations for preventing diet-related chronic diseases: the impact of food processing

To date, observational studies in nutrition have categorized foods into groups such as dairy, cereals, fruits, and vegetables. However, the strength of the association between food groups and chronic diseases is far from convincing. In most international expert surveys, risks are most commonly scored as probable, limited, or insufficient rather than convincing. In this position paper, we hypothesize that current food classifications based on botanical or animal origins can be improved to yield solid recommendations. We propose using a food classification that employs food processes to rank foods in epidemiological studies. Indeed, food health potential results from both nutrient density and food structure (i.e., the matrix effect), both of which can potentially be positively or negatively modified by processing. For example, cereal-based foods may be more or less refined, fractionated, and recombined with added salt, sugars, and fats, yielding a panoply of products with very different nutritional values. The same is true for other food groups. Finally, we propose that from a nutritional perspective, food processing will be an important issue to consider in the coming years, particularly in terms of strengthening the links between food and health and for proposing improved nutritional recommendations or actions.

Impact of ultra-processed foods on micronutrient content in the Brazilian diet

OBJECTIVE To evaluate the impact of consuming ultra-processed foods on the micronutrient content of the Brazilian population's diet. METHODS This cross-sectional study was performed using data on individual food consumption from a module of the 2008-2009 Brazilian Household Budget Survey. A representative sample of the Brazilian population aged 10 years or over was assessed (n = 32,898). Food consumption data were collected through two 24-hour food records. Linear regression models were used to assess the association between the nutrient content of the diet and the quintiles of ultra-processed food consumption - crude and adjusted for family income per capita. RESULTS Mean daily energy intake per capita was 1,866 kcal, with 69.5% coming from natural or minimally processed foods, 9.0% from processed foods and 21.5% from ultra-processed foods. For sixteen out of the seventeen evaluated micronutrients, their content was lower in the fraction of the diet composed of ultra-processed foods compared with the fraction of the diet composed of natural or minimally processed foods. The content of 10 micronutrients in ultra-processed foods did not reach half the content level observed in the natural or minimally processed foods. The higher consumption of ultra-processed foods was inversely and significantly associated with the content of vitamins B12, vitamin D, vitamin E, niacin, pyridoxine, copper, iron, phosphorus, magnesium, selenium and zinc. The reverse situation was only observed for calcium, thiamin and riboflavin. CONCLUSIONS The findings of this study highlight that reducing the consumption of ultra-processed foods is a natural way to promote healthy eating in Brazil and, therefore, is in line with the recommendations made by the Guia Alimentar para a População Brasileira (Dietary Guidelines for the Brazilian Population) to avoid these foods.

Ultra-processed foods and the nutritional dietary profile in Brazil

OBJECTIVE To assess the impact of consuming ultra-processed foods on the nutritional dietary profile in Brazil. METHODS Cross-sectional study conducted with data from the module on individual food consumption from the 2008-2009 Pesquisa de Orçamentos Familiares (POF - Brazilian Family Budgets Survey). The sample, which represented the section of the Brazilian population aged 10 years or over, involved 32,898 individuals. Food consumption was evaluated by two 24-hour food records. The consumed food items were classified into three groups: natural or minimally processed, including culinary preparations with these foods used as a base; processed; and ultra-processed. RESULTS The average daily energy consumption per capita was 1,866 kcal, with 69.5% being provided by natural or minimally processed foods, 9.0% by processed foods and 21.5% by ultra-processed food. The nutritional profile of the fraction of ultra-processed food consumption showed higher energy density, higher overall fat content, higher saturated and trans fat, higher levels of free sugar and less fiber, protein, sodium and potassium, when compared to the fraction of consumption related to natural or minimally processed foods. Ultra-processed foods presented generally unfavorable characteristics when compared to processed foods. Greater inclusion of ultra-processed foods in the diet resulted in a general deterioration in the dietary nutritional profile. The indicators of the nutritional dietary profile of Brazilians who consumed less ultra-processed foods, with the exception of sodium, are the stratum of the population closer to international recommendations for a healthy diet. CONCLUSIONS The results from this study highlight the damage to health that is arising based on the observed trend in Brazil of replacing traditional meals, based on natural or minimally processed foods, with ultra-processed foods. These results also support the recommendation of avoiding the consumption of these kinds of foods.

A nutrition/health mindset on commercial Big Data and drivers of food demand in modern and traditional systems

Building greater reciprocity between traditional and modern food systems and better convergence of human and economic development outcomes may enable the production and consumption of accessible, affordable, and appealing nutritious food for all. Information being key to such transformations, this roadmap paper offers a strategy that capitalizes on Big Data and advanced analytics, setting the foundation for an integrative intersectoral knowledge platform to better inform and monitor behavioral change and ecosystem transformation. Building upon the four P's of marketing (product, price, promotion, placement), we examine digital commercial marketing data through the lenses of the four A's of food security (availability, accessibility, affordability, appeal) using advanced consumer choice analytics for archetypal traditional (fresh fruits and vegetables) and modern (soft drinks) product categories. We demonstrate that business practices typically associated with the latter also have an important, if not more important, impact on purchases of the former category. Implications and limitations of the approach are discussed.

Food Classification Systems Based on Food Processing: Significance and Implications for Policies and Actions: A Systematic Literature Review and Assessment

This paper is the first to make a systematic review and assessment of the literature that attempts methodically to incorporate food processing into classification of diets. The review identified 1276 papers, of which 110 were screened and 21 studied, derived from five classification systems. This paper analyses and assesses the five systems, one of which has been devised and developed by a research team that includes co-authors of this paper. The quality of the five systems is assessed and scored according to how specific, coherent, clear, comprehensive and workable they are. Their relevance to food, nutrition and health, and their use in various settings, is described. The paper shows that the significance of industrial food processing in shaping global food systems and supplies and thus dietary patterns worldwide, and its role in the pandemic of overweight and obesity, remains overlooked and underestimated. Once food processing is systematically incorporated into food classifications, they will be more useful in assessing and monitoring dietary patterns. Food classification systems that emphasize industrial food processing, and that define and distinguish relevant different types of processing, will improve understanding of how to prevent and control overweight, obesity and related chronic non-communicable diseases, and also malnutrition. They will also be a firmer basis for rational policies and effective actions designed to protect and improve public health at all levels from global to local.

Ultra-processed food products and obesity in Brazilian households (2008-2009)

Background

Production and consumption of industrially processed food and drink products have risen in parallel with the global increase in overweight and obesity and related chronic non-communicable diseases. The objective of this study was to analyze the relationship between household availability of processed and ultra-processed products and the prevalence of excess weight (overweight plus obesity) and obesity in Brazil.

Methods

The study was based on data from the 2008–2009 Household Budget Survey involving a probabilistic sample of 55,970 Brazilian households. The units of study were household aggregates (strata), geographically and socioeconomically homogeneous. Multiple linear regression models were used to assess the relationship between the availability of processed and ultra-processed products and the average of Body Mass Index (BMI) and the percentage of individuals with excess weight and obesity in the strata, controlling for potential confounders (socio-demographic characteristics, percentage of expenditure on eating out of home, and dietary energy other than that provided by processed and ultra-processed products). Predictive values for prevalence of excess weight and obesity were estimated according to quartiles of the household availability of dietary energy from processed and ultra-processed products.

Results

The mean contribution of processed and ultra-processed products to total dietary energy availability ranged from 15.4% (lower quartile) to 39.4% (upper quartile). Adjusted linear regression coefficients indicated that household availability of ultra-processed products was positively associated with both the average BMI and the prevalence of excess weight and obesity, whereas processed products were not associated with these outcomes. In addition, people in the upper quartile of household consumption of ultra-processed products, compared with those in the lower quartile, were 37% more likely to be obese.

Conclusion

Greater household availability of ultra-processed food products in Brazil is positively and independently associated with higher prevalence of excess weight and obesity in all age groups in this cross-sectional study.

Processed and Ultra-processed Food Products: Consumption Trends in Canada from 1938 to 2011

Purpose

A classification of foods based on the nature, extent, and purpose of industrial food processing was used to assess changes in household food expenditures and dietary energy availability between 1938 and 2011 in Canada.

Methods

Food acquisitions from six household food budget surveys (1938/1939 , 1953, 1969, 1984, 2001, and 2011) were classified into unprocessed or minimally processed foods, processed culinary ingredients, and ready-to-consume processed or ultra-processed products. Contributions of each group to household food expenditures, and to dietary energy availability (kcal per capita) were calculated.

Results

During the period studied, household expenditures and dietary energy availability fell for both unprocessed or minimally processed foods and culinary ingredients, and rose for ready-to-consume products. The caloric share of foods fell from 34.3% to 25.6% and from 37% to 12.7% for culinary ingredients. The share of ready-to-consume products rose from 28.7% to 61.7%, and the increase was especially noteworthy for those that were ultra-processed.

Conclusions

The most important factor that has driven changes in Canadian dietary patterns between 1938 and 2011 is the replacement of unprocessed or minimally processed foods and culinary ingredients used in the preparation of dishes and meals; these have been displaced by ready-to-consume ultra-processed products. Nutrition research and practice should incorporate information about food processing into dietary assessments.

Consumption patterns of sweetened food and drink products in a Catholic Middle Eastern Canadian community

OBJECTIVE

The present study describes the consumption patterns of sweetened food and drink products in a Catholic Middle Eastern Canadian community and examines its associations with physical activity, sedentary behaviours and BMI.

DESIGN

A two-stage cross-sectional design was used. In Stage 1 (n 42), 24 h recalls enabled the identification of sweetened products. In Stage 2 (n 192), an FFQ was administered to measure the daily consumption of these products and to collect sociodemographic and behavioural data. Sweetened products were defined as processed culinary ingredients and ultra-processed products for which total sugar content exceeded 20% of total energy.

SETTING

Three Catholic Middle Eastern churches located in Montreal, Canada.

SUBJECTS

Normoglycaemic men and women (18-60 years old).

RESULTS

Twenty-six sweetened products represented an average consumption of 75·4 g total sugars/d or 15·1% of daily energy intake (n 190, 56% women). Soft drinks, juices, sweetened coffee, chocolate, cookies, cakes and muffins were the main sources of consumption and mostly consumed between meals. Age (exp (β) = 0·99; P < 0·01), physical activity (exp (β) = 1·08; P < 0·01) and recreational computer use (exp (β) = 1·17; P < 0·01) were independently associated with sweetened product consumption. The association between sweetened product consumption and physical activity was U-shaped. BMI was not significantly associated with sweetened product consumption but all participants regardless of BMI were above the WHO recommendation for free sugars.

CONCLUSIONS

Being physically active and spending less time using a computer may favour a reduced consumption of sweetened products. Very active individuals may, however, overconsume such products.

Persisting problems related to race and ethnicity in public health and epidemiology research

A recent and comprehensive review of the use of race and ethnicity in research that address health disparities in epidemiology and public health is provided. First it is described the theoretical basis upon which race and ethnicity differ drawing from previous work in anthropology, social science and public health. Second, it is presented a review of 280 articles published in high impacts factor journals in regards to public health and epidemiology from 2009-2011. An analytical grid enabled the examination of conceptual, theoretical and methodological questions related to the use of both concepts. The majority of articles reviewed were grounded in a theoretical framework and provided interpretations from various models. However, key problems identified include a) a failure from researchers to differentiate between the concepts of race and ethnicity; b) an inappropriate use of racial categories to ascribe ethnicity; c) a lack of transparency in the methods used to assess both concepts; and d) failure to address limits associated with the construction of racial or ethnic taxonomies and their use. In conclusion, future studies examining health disparities should clearly establish the distinction between race and ethnicity, develop theoretically driven research and address specific questions about the relationships between race, ethnicity and health. One argue that one way to think about ethnicity, race and health is to dichotomize research into two sets of questions about the relationship between human diversity and health.

International differences in cost and consumption of ready-to-consume food and drink products: United Kingdom and Brazil, 2008-2009

This paper tests the hypothesis that one important factor determining household availability of ready-to-consume products is their cost relative to the rest of the diet. National food expenditure surveys in the UK (2008) and Brazil (2008-09) were used. Purchased food quantities were converted into dietary energy (calories) and classified into three groups: (1) foods that are unprocessed or minimally processed; (2) processed culinary ingredients; and (3) ready-to-consume products, either processed or ultra-processed. The contribution of these groups to diets in each country was calculated as a percentage of total energy. Relative cost of ready-to-consume products in each country was calculated by dividing their cost by the cost of the rest of the diet (foods plus culinary ingredients). Linear regression analysis was used to test the association between the UK to Brazil ratios of the caloric share of different ready-to-consume products, and of the relative cost of these products. The caloric share of ready-to-consume products in the UK (63.4%) was well over double that of Brazil (27.7%), whereas their cost relative to the rest of the diet was 43% lower. The lower the relative cost of ready-to-consume products in the UK (compared with Brazil), the higher their relative consumption (R(2)=0.38, p<0.01).

Psychological distress mediates the association between daytime sleepiness and consumption of sweetened products: cross-sectional findings in a Catholic Middle-Eastern Canadian community

OBJECTIVE

To examine the associations between consumption of sweetened products, daytime sleepiness (DS) and psychological distress (PD) in a Catholic Middle-Eastern Canadian community, and to test the hypothesis that the association between DS and consumption of sweetened products is mediated by PD.

DESIGN

A cross-sectional study.

SETTING

A Catholic Middle-Eastern Canadian community.

PARTICIPANTS

186 men and women aged between 18 and 60 years.

PRIMARY AND SECONDARY OUTCOME MEASURES

Sweetened product consumption was measured using a food frequency questionnaire (total sugars/day). DS and PD were measured using standardised questionnaires. The generalised linear model was used to estimate associations between sweetened product consumption, age, sex, self-reported body mass index, DS and PD. Baron and Kenny's four-step approach in addition to the Sobel test were used to establish mediation.

RESULTS

Average DS score was 8.2 (SD=4.5) with 19.5% having excessive scores (>12). Mean PD score was 20.8 (SD=6.2) with 11.8% having high distress scores. Average consumption of sweetened products was 15.5 g/day (SD=13.9). Baron and Kenny's three steps to establish partial mediation were confirmed. First, DS was associated with consumption of sweetened products (p<0.03). Second, DS and PD were correlated (r=0.197; p<0.04). Third, PD was associated with consumption of sweetened products (p<0.01) when both PD and DS were entered as predictors in a multivariate regression. However, Baron and Kenny's fourth step to establish complete mediation was not met. The effect of DS on consumption of sweetened products controlling for PD was reduced, but it was not zero. Finally, the Sobel test was significant (2.14; p<0.03).

CONCLUSIONS

The association between DS and consumption of sweetened products in the Catholic Middle-Eastern Canadian community is partially mediated by psychological distress. Further work should test this mediation relationship in larger samples and verify the potential effects of other sleep variables in this relationship.

Describing the situational contexts of sweetened product consumption in a Middle Eastern Canadian community: application of a mixed method design

Little is known about the situational contexts in which individuals consume processed sources of dietary sugars. This study aimed to describe the situational contexts associated with the consumption of sweetened food and drink products in a Catholic Middle Eastern Canadian community. A two-stage exploratory sequential mixed-method design was employed with a rationale of triangulation. In stage 1 (n = 62), items and themes describing the situational contexts of sweetened food and drink product consumption were identified from semi-structured interviews and were used to develop the content for the Situational Context Instrument for Sweetened Product Consumption (SCISPC). Face validity, readability and cultural relevance of the instrument were assessed. In stage 2 (n = 192), a cross-sectional study was conducted and exploratory factor analysis was used to examine the structure of themes that emerged from the qualitative analysis as a means of furthering construct validation. The SCISPC reliability and predictive validity on the daily consumption of sweetened products were also assessed. In stage 1, six themes and 40-items describing the situational contexts of sweetened product consumption emerged from the qualitative analysis and were used to construct the first draft of the SCISPC. In stage 2, factor analysis enabled the clarification and/or expansion of the instrument's initial thematic structure. The revised SCISPC has seven factors and 31 items describing the situational contexts of sweetened product consumption. Initial validation of the instrument indicated it has excellent internal consistency and adequate test-retest reliability. Two factors of the SCISPC had predictive validity for the daily consumption of total sugar from sweetened products (Snacking and Energy demands) while the other factors (Socialization, Indulgence, Constraints, Visual Stimuli and Emotional needs) were rather associated to occasional consumption of these products.

Bingo playing and problem gambling: A review of our current knowledge

Bingo has a long history as a popular gambling game. Previous research on bingo has been almost exclusively limited to qualitative research. Consequently, little is known about the prevalence of bingo playing, the potential risks associated with regular bingo playing, and its possible influence on the development of problem gambling. The present paper provides a review of the literature on bingo in Western countries using published articles focused on bingo and reports of broad-based gambling surveys containing data on bingo participation. Available data show relatively high rates of past-year bingo participation among adolescents. Within the adult population, females and individuals in poor health reported the highest bingo participation rates. Three general groups of bingo players were identified: low-income individuals, seniors, and young adults. It is argued that although bingo is generally viewed by the public as a "soft" form of gambling, it has the potential to lead to significant problems.