Renata Bertazzi Levy

Increasing consumption of ultra-processed foods and likely impact on human health: evidence from Brazil.

OBJECTIVE To assess time trends in the contribution of processed foods to food purchases made by Brazilian households and to explore the potential impact on the overall quality of the diet. DESIGN Application of a new classification of foodstuffs based on extent and purpose of food processing to data collected by comparable probabilistic household budget surveys. The classification assigns foodstuffs to the following groups: unprocessed/minimally processed foods (Group 1); processed culinary ingredients (Group 2); or ultra-processed ready-to-eat or ready-to-heat food products (Group 3). SETTING Eleven metropolitan areas of Brazil. SUBJECTS Households; n 13,611 in 1987-8, n 16,014 in 1995-5 and n 13,848 in 2002-3. RESULTS Over the last three decades, the household consumption of Group 1 and Group 2 foods has been steadily replaced by consumption of Group 3 ultra-processed food products, both overall and in lower- and upper-income groups. In the 2002-3 survey, Group 3 items represented more than one-quarter of total energy (more than one-third for higher-income households). The overall nutrient profile of Group 3 items, compared with that of Group 1 and Group 2 items, revealed more added sugar, more saturated fat, more sodium, less fibre and much higher energy density. CONCLUSIONS The high energy density and the unfavourable nutrition profiling of Group 3 food products, and also their potential harmful effects on eating and drinking behaviours, indicate that governments and health authorities should use all possible methods, including legislation and statutory regulation, to halt and reverse the replacement of minimally processed foods and processed culinary ingredients by ultra-processed food products.

A new classification of foods based on the extent and purpose of their processing

This paper describes a new food classification which assigns foodstuffs according to the extent and purpose of the industrial processing applied to them. Three main groups are defined: unprocessed or minimally processed foods (group 1), processed culinary and food industry ingredients (group 2), and ultra-processed food products (group 3). The use of this classification is illustrated by applying it to data collected in the Brazilian Household Budget Survey which was conducted in 2002/2003 through a probabilistic sample of 48,470 Brazilian households. The average daily food availability was 1,792 kcal/person being 42.5% from group 1 (mostly rice and beans and meat and milk), 37.5% from group 2 (mostly vegetable oils, sugar, and flours), and 20% from group 3 (mostly breads, biscuits, sweets, soft drinks, and sausages). The share of group 3 foods increased with income, and represented almost one third of all calories in higher income households. The impact of the replacement of group 1 foods and group 2 ingredients by group 3 products on the overall quality of the diet, eating patterns and health is discussed.

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.

Consumo e comportamento alimentar entre adolescentes brasileiros: Pesquisa Nacional de Saúde do Escolar (PeNSE), 2009

The objective of this article is to describe the characteristics of food consumption and eating behavior of adolescents and its association with socio-demographic factors. In 2009, a random sample of students in 9th grade of elementary education at public and private schools from 26 Brazilian state capitals and Federal District was studied. It was applied a self-administered questionnaire with socio-demographic attributes, food consumption and eating behavior, among others. Estimates of the constructed indicators were presented for the total population and by sex. The association of each indicator with socio-demographic variables was examined by logistic regression. The results showed that over half of adolescents presented frequent consumption of beans (62.6%), milk (53.6%) and sweets (50.9%), and held at least lunch or dinner with the mother or responsible (62.6%) and watching television or studying (50.9%). In general, girls were more exposed to undesirable eating habits and higher socioeconomic status was associated with a higher prevalence of the indicators studied. The results revealed regular consumption of unhealthy diet markers and consumption of less than the recommended for a healthy diet, pointing the need for strengthening health promotion activities targeting young people.

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.

Vigilância de fatores de risco para doenças não transmissíveis entre adolescentes: a experiência da cidade do Rio de Janeiro, Brasil

This paper presents the methodology and results of the implementation of a Surveillance System for Non-Communicable Disease Risk Factors in Adolescents. A random sample of 8th-grade students (n = 1,684) enrolled in municipal schools in Rio de Janeiro, Brazil, was studied. Students were asked to complete a confidential questionnaire on food consumption, physical activity, sedentary leisure-time activities, and tobacco consumption. Prevalence estimates of risk factors were calculated for the entire sample and by gender. Non-response rates ranged from 1.1 to 8.9%. The findings included low consumption of fruits (45.8%) and vegetables (20.0% and 16.5% for salads and cooked vegetables, respectively), regular consumption of soft drinks (36.7%) and candies (46.7%), extensive time on TV, computer, and videogames (71.7% spend at least 4h/day at these activities), low frequency of regular physical activity (40%), and 6.4% prevalence of smoking. Girls showed less physical activity and more smoking. The system appeared to be feasible and indicated high prevalence of risk factors for non-communicable diseases.

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.

Estimativa de consumo de sódio pela população brasileira, 2002-2003

OBJETIVO: Estimar a magnitude e a distribuicao regional e socioeconomica do consumo de sodio no Brasil e identificar as fontes alimentares que mais contribuem para esse consumo. METODOS: As estimativas foram baseadas nos dados da Pesquisa de Orcamentos Familiares, realizada no Brasil entre julho de 2002 e junho de 2003. Foram analisados 969.989 registros de aquisicao de alimentos efetuados por uma amostra probabilistica de 48.470 domicilios localizados em 3.984 setores censitarios do Pais. Realizou-se conversao dos registros das aquisicoes de alimentos em nutrientes por meio de tabelas de composicao de alimentos. Foram calculadas a disponibilidade media de sodio por pessoa e por dia e a disponibilidade media ajustada para um consumo energetico equivalente a 2.000 kcal. Calculou-se a contribuicao de grupos de alimentos selecionados para o total de sodio disponivel para consumo no domicilio. As estimativas sao apresentadas segundo regioes, situacao urbana ou rural do domicilio, e estratos de renda. RESULTADOS: A quantidade diaria de sodio disponivel para consumo nos domicilios brasileiros foi de 4,5 g por pessoa (ou 4,7 g para uma ingestao diaria de 2.000 Kcal), excedendo, assim, em mais de duas vezes o limite recomendado de ingestao desse nutriente. Embora a maior parte do sodio disponivel para consumo em todas classes de renda provenha do sal de cozinha e de condimentos a base desse sal (76,2%), a fracao proveniente de alimentos processados com adicao de sal aumenta linear e intensamente com o poder aquisitivo domiciliar, representando 9,7% do total de sodio no quinto inferior da distribuicao da renda per capita e 25,0% no quinto superior. CONCLUSOES: Os resultados indicam que o consumo de sodio no Brasil excede largamente a recomendacao maxima para esse nutriente em todas as macrorregioes brasileiras e em todas as classes de renda.OBJECTIVE To estimate the magnitude and distribution of sodium intake in Brazil and to identify major dietary sources contributing to this intake. METHODS Estimates were based on data from a Brazilian household budget survey carried between July 2002 and June 2003. A total of 969,989 food purchase records from a probabilistic sample of 48,470 households located in 3,984 census tracts across the country were analyzed. Purchase records were converted into nutrients using food composition charts. Mean sodium availability per person per day and mean adjusted availability considering a 2,000 kcal daily energy intake were calculated, as well as the contribution of selected food groups to total household sodium availability. Estimates are presented according to geographical region, urban or rural status of the household, and income stratum. RESULTS Mean daily sodium availability in Brazilian households was 4.5 g per person (or 4.7 g considering a daily calorie intake of 2,000 kcal), thus exceeding by more than two times the recommended levels of intake for this nutrient. Although most of the sodium available for intake across all income strata was derived from kitchen salt or salt-based condiments (76.2%), the fraction derived from processed foods with added salt showed a strong linear increase as household purchasing power increased, representing 9.7% of total sodium intake in the lower quintile of the per capita income distribution and 25.0% in the upper quintile. CONCLUSIONS Results indicate that sodium intake in Brazil widely exceeds the maximum recommended intake level for this nutrient in all of the countrys macro regions and across all income strata.

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.