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To describe out-of-home consumption according to the purpose and extent of industrial processing and also evaluate the association between eating out and ultra-processed food consumption, taking account of variance within and between individuals.
The study was based on the Individual Food Intake of the Brazilian Household Budget Survey, carried out with 34 003 individuals aged 10 years or more, between May 2008 and May 2009. All food items were classified according to food processing level. The habit of eating out was evaluated through the frequency of days each individual reported eating out, described according to sociodemographic characteristics. The contribution of food energy per group and subgroup was estimated according to the frequency of eating out. In addition, multilevel modelling was employed to evaluate the association between eating out and ultra-processed food consumption.
In Brazil, culinary preparations accounted for most of the energy eaten out. However, it was possible to observe a higher contribution of ultra-processed foods, especially sugary beverages and ready-to-eat meals, as the frequency of out-of-home consumption increased. Compared with food consumption exclusively at home, eating out increased the consumption of ultra-processed foods by 0·41 percentage points within and between individuals.
In Brazil, the same individual and different individuals had greater consumption of ultra-processed foods when they ate out of home compared with when they ate at home. So, it is necessary to implement public policies which discourage the out-of-home consumption of ultra-processed foods and that provide affordable and accessible less-processed food options.
To identify the energy contributions of NOVA food groups in the Mexican diet and the associations between individual sociodemographic characteristics and the energy contribution of ultra-processed foods (UPF).
We classified foods and beverages reported in a 24 h recall according to the NOVA food framework into: (i) unprocessed or minimally processed foods; (ii) processed culinary ingredients; (iii) processed foods; and (iv) UPF. We estimated the energy contribution of each food group and ran a multiple linear regression to identify the associations between sociodemographic characteristics and UPF energy contribution.
Mexican National Health and Nutrition Survey 2012.
Individuals ≥1 years old (n 10 087).
Unprocessed or minimally processed foods had the highest dietary energy contribution (54·0 % of energy), followed by UPF (29·8 %), processed culinary ingredients (10·2 %) and processed foods (6·0 %). The energy contribution of UPF was higher in: pre-school-aged children v. other age groups (3·8 to 12·5 percentage points difference (pp)); urban areas v. rural (5·6 pp); the Central and North regions v. the South (2·7 and 8·4 pp, respectively); medium and high socio-economic status v. low (4·5 pp, in both); and with higher head of household educational level v. without education (3·4 to 7·8 pp).
In 2012, about 30 % of energy in the Mexican diet came from UPF. Our results showed that younger ages, urbanization, living in the North region, high socio-economic status and high head of household educational level are sociodemographic factors related to higher consumption of UPF in Mexico.
To estimate the dietary share of ultra-processed foods and to determine its association with the overall nutritional quality of diets in Brazil.
A representative sample of 32 898 Brazilians aged ≥10 years was studied. Food intake data were collected. We calculated the average dietary content of individual nutrients and compared them across quintiles of energy share of ultra-processed foods. Then we identified nutrient-based dietary patterns, and evaluated the association between quintiles of dietary share of ultra-processed foods and the patterns’ scores.
The mean per capita daily dietary energy intake was 7933 kJ (1896 kcal), with 58·1 % from unprocessed or minimally processed foods, 10·9 % from processed culinary ingredients, 10·6 % from processed foods and 20·4 % from ultra-processed foods. Consumption of ultra-processed foods was directly associated with high consumption of free sugars and total, saturated and trans fats, and with low consumption of protein, dietary fibre, and most of the assessed vitamins and minerals. Four nutrient-based dietary patterns were identified. ‘Healthy pattern 1’ carried more protein and micronutrients, and less free sugars. ‘Healthy pattern 2’ carried more vitamins. ‘Healthy pattern 3’ carried more dietary fibre and minerals and less free sugars. ‘Unhealthy pattern’ carried more total, saturated and trans fats, and less dietary fibre. The dietary share of ultra-processed foods was inversely associated with ‘healthy pattern 1’ (−0·16; 95 % CI −0·17, −0·15) and ‘healthy pattern 3’ (−0·18; 95 % CI −0·19, −0·17), and directly associated with ‘unhealthy pattern’ (0·17; 95 % CI 0·15, 0·18).
Dietary share of ultra-processed foods determines the overall nutritional quality of diets in Brazil.
To assess household availability of NOVA food groups in nineteen European countries and to analyse the association between availability of ultra-processed foods and prevalence of obesity.
Ecological, cross-sectional study.
Estimates of ultra-processed foods calculated from national household budget surveys conducted between 1991 and 2008. Estimates of obesity prevalence obtained from national surveys undertaken near the budget survey time.
Across the nineteen countries, median average household availability amounted to 33·9 % of total purchased dietary energy for unprocessed or minimally processed foods, 20·3 % for processed culinary ingredients, 19·6 % for processed foods and 26·4 % for ultra-processed foods. The average household availability of ultra-processed foods ranged from 10·2 % in Portugal and 13·4 % in Italy to 46·2 % in Germany and 50·4 % in the UK. A significant positive association was found between national household availability of ultra-processed foods and national prevalence of obesity among adults. After adjustment for national income, prevalence of physical inactivity, prevalence of smoking, measured or self-reported prevalence of obesity, and time lag between estimates on household food availability and obesity, each percentage point increase in the household availability of ultra-processed foods resulted in an increase of 0·25 percentage points in obesity prevalence.
The study contributes to a growing literature showing that the consumption of ultra-processed foods is associated with an increased risk of diet-related non-communicable diseases. Its findings reinforce the need for public policies and actions that promote consumption of unprocessed or minimally processed foods and make ultra-processed foods less available and affordable.
To assess the consumption of ultra-processed foods and analyse its association with the content of added sugars in the Chilean diet.
Cross-sectional study of national dietary data obtained through 24 h recalls and classified into food groups according to the extent and purpose of food processing (NOVA classification).
A probabilistic sample of 4920 individuals (aged 2 years or above) studied in 2010 by a national dietary survey (Encuesta Nacional de Consumo Alimentario).
Ultra-processed foods represented 28·6 (se 0·5) % of total energy intake and 58·6 (se 0·9) % of added sugars intake. The mean percentage of energy from added sugars increased from 7·7 (se 0·3) to 19·7 (se 0·5) % across quintiles of the dietary share of ultra-processed foods. After adjusting for several potential sociodemographic confounders, a 5 percentage point increase in the dietary share of ultra-processed foods determined a 1 percentage point increase in the dietary content of added sugars. Individuals in the highest quintile were three times more likely (OR=2·9; 95 % CI 2·4, 3·4) to exceed the 10 % upper limit for added sugars recommended by the WHO compared with those in the lowest quintile, after adjusting for sociodemographic variables. This association was strongest among individuals aged 2–19 years (OR=3·9; 95 % CI 2·7, 5·9).
In Chile, ultra-processed foods are important contributors to total energy intake and to the consumption of added sugars. Actions aimed at limiting consumption of ultra-processed foods are being implemented as effective ways to achieve WHO dietary recommendations to limit added sugars and processed foods, especially for children and adolescents.
To present and discuss the dietary guidelines issued by the Brazilian government in 2014.
The present paper describes the aims of the guidelines, their shaping principles and the approach used in the development of recommendations. The main recommendations are outlined, their significance for the cultural, socio-economic and environmental aspects of sustainability is discussed, and their application to other countries is considered.
Brazil in the twenty-first century.
All people in Brazil, now and in future.
The food- and meal-based Brazilian Dietary Guidelines address dietary patterns as a whole and so are different from nutrient-based guidelines, even those with some recommendations on specific foods or food groups. The guidelines are based on explicit principles. They take mental and emotional well-being into account, as well as physical health and disease prevention. They identify diet as having cultural, socio-economic and environmental as well as biological and behavioural dimensions. They emphasize the benefits of dietary patterns based on a variety of natural or minimally processed foods, mostly plants, and freshly prepared meals eaten in company, for health, well-being and all relevant aspects of sustainability, as well as the multiple negative effects of ready-to-consume ultra-processed food and drink products.
The guidelines’ recommendations are designed to be sustainable personally, culturally, socially, economically and environmentally, and thus fit to face this century. They are for foods, meals and dietary patterns of types that are already established in Brazil, which can be adapted to suit the climate, terrain and customs of all countries.
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