Ana Paula Bortoletto Martins

Consumption of ultra-processed foods and likely impact on human health. Evidence from Canada

OBJECTIVE To investigate consumption of ultra-processed products in Canada and to assess their association with dietary quality. DESIGN Application of a classification of foodstuffs based on the nature, extent and purpose of food processing to data from a national household food budget survey. Foods are classified as unprocessed/minimally processed foods (Group 1), processed culinary ingredients (Group 2) or ultra-processed products (Group 3). SETTING All provinces and territories of Canada, 2001. SUBJECTS Households (n 5643). RESULTS Food purchases provided a mean per capita energy availability of 8908 (se 81) kJ/d (2129 (se 19) kcal/d). Over 61·7 % of dietary energy came from ultra-processed products (Group 3), 25·6 % from Group 1 and 12·7 % from Group 2. The overall diet exceeded WHO upper limits for fat, saturated fat, free sugars and Na density, with less fibre than recommended. It also exceeded the average energy density target of the World Cancer Research Fund/American Institute for Cancer Research. Group 3 products taken together are more fatty, sugary, salty and energy-dense than a combination of Group 1 and Group 2 items. Only the 20 % lowest consumers of ultra-processed products (who consumed 33·2 % of energy from these products) were anywhere near reaching all nutrient goals for the prevention of obesity and chronic non-communicable diseases. CONCLUSIONS The 2001 Canadian diet was dominated by ultra-processed products. As a group, these products are unhealthy. The present analysis indicates that any substantial improvement of the diet would involve much lower consumption of ultra-processed products and much higher consumption of meals and dishes prepared from minimally processed foods and processed culinary ingredients.

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.

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.

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.

Participacao crescente de produtos ultraprocessados na dieta brasileira (1987-2009)

OBJETIVO Estimar tendencias temporais do consumo domiciliar de itens alimenticios no Brasil, levando em conta a extensao e o proposito do seu processamento industrial. METODOS Os dados analisados sao provenientes de Pesquisa de Orcamentos Familiares realizadas no Brasil em 1987-1988, 1995-1996, 2002-2003 e 2008-2009. Foram analisadas amostras probabilisticas dos domicilios das areas metropolitanas em todos os periodos mencionados e, nas duas amostras mais recentes, a abrangencia foi nacional. As unidades de analise foram registros de aquisicoes de agregados de domicilios. Os itens alimenticios foram divididos segundo extensao e proposito de seu processamento industrial em: alimentos in natura ou minimamente processados, ingredientes culinarios processados e produtos alimenticios prontos para consumo, processados ou ultraprocessados. A quantidade adquirida de cada item foi convertida em energia. Estimaram-se a disponibilidade diaria total per capita de calorias e a contribuicao dos grupos de alimentos em cada pesquisa. Calcularam-se estimativas por quintos de renda para as pesquisas nacionais. Variacoes temporais foram testadas por teste de diferenca de medias e modelos de regressao linear. RESULTADOS Houve aumento significativo da participacao de produtos prontos para o consumo (de 23,0% para 27,8% das calorias), gracas ao aumento no consumo de produtos ultraprocessados (de 20,8% para 25,4%) entre 2002-2003 e 2008-2009. Houve reducao significativa na participacao de alimentos e de ingredientes culinarios nesse periodo. O aumento da participacao de produtos ultraprocessados ocorreu em todos os estratos de renda. Observou-se aumento uniforme da participacao calorica de produtos prontos para o consumo em areas metropolitanas, novamente a custa de produtos ultraprocessados e acompanhada por reducoes na participacao de alimentos in natura ou minimamente processados quanto de ingredientes culinarios. CONCLUSOES Produtos ultraprocessados apresentam participacao crescente na dieta brasileira, evidenciada desde a decada de 1980 nas areas metropolitanas e confirmada para todo o Pais na decada de 2000.

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.

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.

Increased contribution of ultra-processed food products in the Brazilian diet (1987-2009)

OBJETIVO Estimar tendencias temporais do consumo domiciliar de itens alimenticios no Brasil, levando em conta a extensao e o proposito do seu processamento industrial. METODOS Os dados analisados sao provenientes de Pesquisa de Orcamentos Familiares realizadas no Brasil em 1987-1988, 1995-1996, 2002-2003 e 2008-2009. Foram analisadas amostras probabilisticas dos domicilios das areas metropolitanas em todos os periodos mencionados e, nas duas amostras mais recentes, a abrangencia foi nacional. As unidades de analise foram registros de aquisicoes de agregados de domicilios. Os itens alimenticios foram divididos segundo extensao e proposito de seu processamento industrial em: alimentos in natura ou minimamente processados, ingredientes culinarios processados e produtos alimenticios prontos para consumo, processados ou ultraprocessados. A quantidade adquirida de cada item foi convertida em energia. Estimaram-se a disponibilidade diaria total per capita de calorias e a contribuicao dos grupos de alimentos em cada pesquisa. Calcularam-se estimativas por quintos de renda para as pesquisas nacionais. Variacoes temporais foram testadas por teste de diferenca de medias e modelos de regressao linear. RESULTADOS Houve aumento significativo da participacao de produtos prontos para o consumo (de 23,0% para 27,8% das calorias), gracas ao aumento no consumo de produtos ultraprocessados (de 20,8% para 25,4%) entre 2002-2003 e 2008-2009. Houve reducao significativa na participacao de alimentos e de ingredientes culinarios nesse periodo. O aumento da participacao de produtos ultraprocessados ocorreu em todos os estratos de renda. Observou-se aumento uniforme da participacao calorica de produtos prontos para o consumo em areas metropolitanas, novamente a custa de produtos ultraprocessados e acompanhada por reducoes na participacao de alimentos in natura ou minimamente processados quanto de ingredientes culinarios. CONCLUSOES Produtos ultraprocessados apresentam participacao crescente na dieta brasileira, evidenciada desde a decada de 1980 nas areas metropolitanas e confirmada para todo o Pais na decada de 2000.

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 (R2=0.38, p<0.01).

Disponibilidad de productos alimentarios listos para el consumo en los hogares de Chile y su impacto sobre la calidad de la dieta (2006-2007)

Background: Processed foodstuff may have a lower nutritional value than natural products. Aim: To analyze the impact of ready-to-consume products on diet quality of Chilean households. Material and methods: A national representative sample of 10,096 households, based on the 6th Survey on Household Budget and Expenses (VI Encuesta de Presupuestos y Gastos Familiares, 2006-2007), was studied. Foodstuff were classified as follows: 1) Unprocessed foods or minimally processed foods (G1); 2) Processed culinary ingredients (G2); and 3) Ready-to-consume products (G3). Calorie contribution and energy availability of each household food group, was calculated. The nutritional profile of the national food basket was calculated and compared with two simulated baskets (G3vsG1+G2), based on international nutritional recommendations. Results: Overall energy availability was of 1,885 kcal per capita/ day; 24% derived from unprocessed foods (G1), 21% from processed culinary ingredients (G2) and 55% from ready-to-consume products (G3), whose proportion increased along with income level. The 2007 national food basket contained an excess of total fat (34% vs 30%), free sugars (16% vs 10%), energy density (2.1 vs 1.3 kcal/ gram) and a low amount of fiber (8.4 vs 12.5 grams/1000 kcal). The basket consisting in ready-to-consume products (G3) had a higher percentage of carbohydrates (61% vs 46%) than the basket consisting in unprocessed foods and ingredients (G1+G2). It also had a higher percentage of free sugars (17% vs 15%), less dietary fiber (7 vs. 10 grams/1000 kcal) and, above all, a higher energy density (2.6 vs 1.6 kcal/g). Conclusions: The Chilean dietary pattern, based on ready-to-consume products (G3), is affecting the nutritional quality of the diet.BACKGROUND Processed foodstuff may have a lower nutritional value than natural products. AIM To analyze the impact of ready-to-consume products on diet quality of Chilean households. MATERIAL AND METHODS A national representative sample of 10,096 households, based on the 6th Survey on Household Budget and Expenses (VI Encuesta de Presupuestos y Gastos Familiares, 2006-2007), was studied. Foodstuffs were classified as follows: 1) Unprocessed foods or minimally processed foods (G1); 2) Processed culinary ingredients (G2); and 3) Ready-to-consume products (G3). Calorie contribution and energy availability of each household food group, was calculated. The nutritional profile of the national food basket was calculated and compared with two simulated baskets (G3 vs G1+G2), based on international nutritional recommendations. RESULTS Overall energy availability was of 1,885 kcal per capita/ day; 24% derived from unprocessed foods (G1), 21% from processed culinary ingredients (G2) and 55% from ready-to-consume products (G3), whose proportion increased along with income level. The 2007 national food basket contained an excess of total fat (34% vs 30%), free sugars (16% vs 10%), energy density (2.1 vs 1.3 kcal/gram) and a low amount of fiber (8.4 vs 12.5 g/1,000 kcal). The basket consisting in ready-to-consume products (G3) had a higher percentage of carbohydrates (61% vs 46%) than the basket consisting in unprocessed foods and ingredients (G1+G2). It also had a higher percentage of free sugars (17% vs 15%), less dietary fiber (7 vs. 10 g/1,000 kcal) and, above all, a higher energy density (2.6 vs 1.6 kcal/g). CONCLUSIONS The Chilean dietary pattern, based on ready-to-consume products (G3), is affecting the nutritional quality of the diet.