Does consumption of processed foods explain disparities in the body weight of individuals? The case of Guatemala

Defining the role of processing in food classification systems-the IUFoST formulation & processing approach

The Task Force on Food Processing for Nutrition, Diet and Health established by the International Union of Food Science and Technology (IUFoST) has developed a rational approach to determine the impact of food processing on the nutritional value of processed foods, called the IUFoST Formulation and Processing Classification (IF&PC) scheme which is comprehensively reported here. The purpose of developing this scheme is (A) to address the current confusion between formulation and processing and thereby offer assistance to improve and refine the controversial NOVA classification system, and (B) to explore the potential for considering other relevant essential food attributes, such as (a) safety, (b) sustainability, (c) palatability, (d) affordability, and (e) convenience in food product classification. The authors recommend that this IUFoST initiative be further investigated and complemented based on concerted R&D interactions of food scientists, food engineers, and nutritionists.

Association between ultra-processed food consumption and inflammation: insights from the STANISLAS cohort

PURPOSE

High consumption of ultra-processed food (UPF) is associated with an increased risk of developing chronic diseases. Inflammation may be one of the underlying mechanisms behind this association. However, only a limited number of studies have investigated the association between UPF consumption and a few selected inflammation biomarkers, yielding inconsistent results. This study aimed to assess the cross-sectional association between UPF consumption (as a whole and 10 sub-categories), and 78 circulating proteins related to inflammation.

METHODS

The present study included 1594 adult participants from the STANISLAS cohort. UPF consumption was estimated using the NOVA classification, and linear regression models were used to assess their association with circulating proteins.

RESULTS

UPFs accounted for 28% of the total energy intake and 5.7 servings on average per day. In the unadjusted model, 15 circulating proteins had a significant association with UPF consumption. After adjustment, only (FGF-19) was significantly associated with UPF consumption (β =  - 0.02[- 0.03; - 0.003]).

CONCLUSION

UPF consumption was negatively associated with Fibroblast Growth Factor 19 (FGF-19) serum levels. When considering UPF sub-categories, no circulating proteins were associated with dairy products and dairy desserts. Of note, circulating proteins were differentially associated depending on the sub-category of UPF. Further studies are needed to better understand the link between UPF and inflammation.

The association between consumption of ultra-processed foods and sperm quality parameters: a cross-sectional study

BACKGROUND

While recent studies suggest a correlation between unhealthy dietary patterns, oxidative stress, inflammation, and male infertility, the potential association between ultra-processed foods (UPFs) and male infertility remains underexplored. Therefore, the aim of the present study was to investigate the association between UPF intake and male infertility by evaluating sperm quality parameters.

METHODS

The participants (n = 260) of the current cross-sectional study were recruited from an infertility center in Isfahan Province, Iran. Four semen parameters-such as total sperm motility, sperm concentration, sperm volume, and normal sperm morphology-were evaluated. Also, the participants' food intake was assessed using a validated 168-item food frequency questionnaire. Moreover, the NOVA system was employed to calculate the UPF index. The association between UPFs and sperm parameters was analyzed using logistic regression.

RESULTS

In the crude model, no significant associations were observed between the second and last tertiles of UPFs with abnormalities in sperm concentration, total motility, and morphology (p > 0.05 for all). However, after adjusting for age, marriage duration, body mass index, physical activity, depression, anxiety, stress, energy intake, cigarette history, and mineral and vitamin supplements, a significantly higher association was identified between the second tertile of UPFs and abnormalities in sperm concentration (odds ratio (OR) = 3.962, 95% confidence interval (CI): 1.345-11.670, p = 0.013).

CONCLUSIONS

In conclusion, although the analysis did not find significant associations between UPF consumption and impaired sperm motility and morphology, it revealed significant trends linking higher UPF intake with lower sperm concentration. If future studies confirm these results, they could aid in designing interventional and preventive programs aimed at addressing infertility in men of reproductive age in the field of public health.

Dynamic Progression of Hypertension and Diabetes in the Democratic Republic of Congo from 2019 to 2023

Introduction: The Democratic Republic of Congo (DRC) does not have national prevalence data for arterial hypertension (HTN) or diabetes (type I and II combined) to aid evidence-based decision-making, despite the assumption of epidemiological transition in low- and middle-income countries. The aim of this study was to estimate a proxy of prevalence for HTN and diabetes. Methodology: This study used routine monthly reported data pertaining to HTN and diabetes from the District Health Information Software 2 (DHIS2), spanning 2019-2023. Data underwent quality assessment and adjustments using standardization before analysis. Equity analyses were carried out at the national and sub-national levels. Epidemiological curves and maps were produced to analyze trends in the prevalence of HTN and diabetes among adults aged 18 and over. Permission to use the data was obtained from the regulatory authority. Results: Over five years, incidence of HTN increased from 13.23% (CI 95%: 13.22-13.24) to 15.23% (CI 95%: 15.22-15.24) (+15.1% relative increase), and diabetes rose from 2.73% (CI 95%: 2.72-2.74) to 3.345% (CI 95%: 3.34-3.35) (+16.3% relative increase), with provincial variations observed. Conclusions: In the DRC, hypertension and diabetes are advancing rapidly. Primary and preventative healthcare services and public health interventions must prioritize these diseases.

Ultra-processed foods, allergy outcomes and underlying mechanisms in children: An EAACI task force report

BACKGROUND

Consumption of ultra-processed foods [UPFs] may be associated with negative health outcomes. Limited data exist regarding the potential role of UPFs in the occurrence of allergic diseases. The underlying mechanisms underpinning any such associations are also poorly elucidated.

METHODS

We performed a systematic review and narrative evidence synthesis of the available literature to assess associations between UPF consumption and pediatric allergy outcomes (n = 26 papers), including data on the association seen with the gut microbiome (n = 16 papers) or immune system (n = 3 papers) structure and function following PRISMA guidelines.

RESULTS

Dietary exposure to fructose, carbonated soft drinks, and sugar intake was associated with an increased risk of asthma, allergic rhinitis, and food allergies in children. Commercial baby food intake was associated with childhood food allergy. Childhood intake of fructose, fruit juices, sugar-sweetened beverages, high carbohydrate UPFs, monosodium glutamate, UPFs, and advanced glycated end-products (AGEs) was associated with the occurrence of allergic diseases. Exposure to UPFs and common ingredients in UPFs seem to be associated with increased occurrence of allergic diseases such as asthma, wheezing, food allergies, atopic dermatitis, and allergic rhinitis, in many, but not all studies.

CONCLUSION

More preclinical and clinical studies are required to better define the link between UPF consumption and the risk of allergies and asthma. These observational studies ideally require supporting data with clearly defined UPF consumption, validated dietary measures, and mechanistic assessments to definitively link UPFs with the risk of allergies and asthma.

Toward a science-based classification of processed foods to support meaningful research and effective health policies

Processed foods have been part of the American diet for decades, with key roles in providing a safe, available, affordable, and nutritious food supply. The USDA Food Guides beginning in 1916 and the US Dietary Guidelines for Americans (DGA) since 1980 have included various types of commonly consumed processed foods (e.g., heated, fermented, dried) as part of their recommendations. However, there are multiple classification systems based on "level" of food processing, and additional evidence is needed to establish the specific properties of foods classified as "highly" or "ultra"-processed (HPF/UPFs). Importantly, many foods are captured under HPF/UPF definitions, ranging from ready-to-eat fortified whole grain breakfast cereals to sugar-sweetened beverages and baked goods. The consequences of implementing dietary guidance to limit all intake of foods currently classified as HPF/UPF may require additional scrutiny to evaluate the impact on consumers' ability to meet daily nutrient recommendations and to access affordable food, and ultimately, on health outcomes. Based on a meeting held by the Institute for the Advancement of Food and Nutrition Sciences in May 2023, this paper provides perspectives on the broad array of foods classified as HPF/UPFs based on processing and formulation, including contributions to nutrient intake and dietary patterns, food acceptability, and cost. Characteristics of foods classified as UPF/HPFs are considered, including the roles and safety approval of food additives and the effect of food processing on the food matrix. Finally, this paper identifies information gaps and research needs to better understand how the processing of food affects nutrition and health outcomes.

The impact of ultra-processed foods on obesity and cardiometabolic comorbidities in children and adolescents: a systematic review

CONTEXT

Over the past few decades, traditional foods have been displaced by ultra-processed foods (UPFs), with the latter being associated with health problems.

OBJECTIVE

This scoping systematic review aimed to identify the relationship between UPF intake and overweight/obesity as well as other cardiometabolic risk factors during childhood and adolescence.

DATA SOURCES

The guidance for this protocol is the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P). A systematic search was undertaken on PubMed, Scopus, and Cochrane Library electronic databases based on prespecified inclusion and exclusion criteria up to 6 February 2022.

DATA EXTRACTION

A total of 17 observational studies-9 cross-sectional, 7 cohort-longitudinal, and 1 study reporting both cross-sectional and longitudinal outcomes-among children and adolescents aged ≤18 years were eligible for inclusion in this review. Fourteen studies evaluated the consumption of UPFs in association with overweight/obesity and 9 studies examined the association of UPF consumption and cardiometabolic-related risk factors.

DATA ANALYSIS

Most studies (14/17) showed that an increase in UPFs was associated with a higher prevalence of overweight/obesity and cardiometabolic comorbidities among children and adolescents, whereas 4 of 17 studies (3 cross-sectional and 1 cohort) found no association. Most cohort and cross-sectional studies showed good quality according to the National Institutes of Health and Newcastle-Ottawa quality assessment, respectively.

CONCLUSION

The positive association found between UPFs and overweight/obesity and cardiometabolic comorbidities among children and adolescents raises concerns for future health. Further investigation is recommended to explore the role of specific types of UPFs on cardiometabolic conditions and to identify the amount of daily intake that increase risk in order to shape appropriate public health policies.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42022316432.

Does the concept of "ultra-processed foods" help inform dietary guidelines, beyond conventional classification systems? NO

The Nova classification of ultra-processed foods (UPFs) rests on poorly defined food processes and the presence of food additives from a chemically heterogeneous group, easily leading to misclassification. UPFs are claimed to promote overconsumption of energy and obesity due to high palatability, but little evidence supports effects beyond those that can be accounted for by nutrient composition, energy density, and food matrices. Observational studies link dietary intake of UPFs with obesity, but none have demonstrated independent associations after controlling for likely confounders. A highly cited randomized controlled feeding study that compared a UPF diet with an unprocessed diet showed a rapidly weaning effect on energy intake that can be entirely explained by more conventional and quantifiable dietary factors, including energy density, intrinsic fiber, glycemic load, and added sugar. Clearly, many aspects of food processing can affect health outcomes, but conflating them into the notion of ultra-processing is unnecessary, because the main determinants of chronic disease risk are already captured by existing nutrient profiling systems. In conclusion, the Nova classification adds little to existing nutrient profiling systems; characterizes several healthy, nutrient-dense foods as unhealthy; and is counterproductive to solve the major global food production challenges.

Does online food shopping boost dietary diversity? Application of an endogenous switching model with a count outcome variable

Increasingly, rural households in developing countries are shopping for food online, and the COVID-19 pandemic has accelerated this trend. In parallel, dietary guidelines worldwide recommend eating a balanced and healthy diet. With this in mind, this study explores whether online food shopping boosts dietary diversity-defined as the number of distinct food groups consumed-among rural households in China. Because people choose to shop for food online, it is important to account for the self-selection bias inherent in online food shopping. Accordingly, we estimate the treatment effects of online food shopping on dietary diversity using the endogenous switching model with a count outcome variable. The results indicate that online food shopping increases dietary diversity by 7.34%. We also find that education, asset ownership, and knowing the government's dietary guidelines are the main factors driving rural households' decisions to shop for food online.

Ultra-processed foods and human health: from epidemiological evidence to mechanistic insights

Epidemiological studies have suggested a role for ultra-processed foods in numerous chronic inflammatory diseases such as inflammatory bowel diseases and metabolic syndrome. Preclinical and clinical studies are accumulating to better decipher the effects of various aspects of food processing and formulation on the aetiology of chronic, debilitating inflammatory diseases. In this Review, we provide an overview of the current data that highlight an association between ultra-processed food consumption and various chronic diseases, with a focus on epidemiological evidence and mechanistic insights involving the intestinal microbiota.

Consumption Patterns of Processed Foods in Singapore-A Cross-Sectional Study

The consumption of processed foods is increasingly widespread and could have an impact on diet quality and health. Understanding the factors influencing people's eating habits is useful for assessing such impact. There are limited data on the consumption patterns of processed foods and associated factors influencing the dietary patterns in Singapore. This cross-sectional study based on a food frequency questionnaire aimed to examine how the consumption of processed foods among 2079 Singapore residents aged 18 to 89 years varies with sociodemographic factors. The analysis of the consumption by processed food groups showed that the studied factors, i.e., age, gender, ethnicity, housing and health status, all contributed to differences in processed food consumption to varying extents, with ethnicity being the key factor driving the variation. Such differences were also confirmed to a limited degree by determining another measure of consumption, i.e., a processed food variety score. The findings in this study could inform further work in relation to dietary risks.

Ultra-processed foods: how functional is the NOVA system?

BACKGROUND

In the NOVA classification system, descriptive criteria are used to assign foods to one of four groups based on processing-related criteria. Although NOVA is widely used, its robustness and functionality remain largely unexplored. We determined whether this system leads to consistent food assignments by users.

METHODS

French food and nutrition specialists completed an online survey in which they assigned foods to NOVA groups. The survey comprised two lists: one with 120 marketed food products with ingredient information and one with 111 generic food items without ingredient information. We quantified assignment consistency among evaluators using Fleiss' κ (range: 0-1, where 1 = 100% agreement). Hierarchical clustering on principal components identified clusters of foods with similar distributions of NOVA assignments.

RESULTS

Fleiss' κ was 0.32 and 0.34 for the marketed foods (n = 159 evaluators) and generic foods (n = 177 evaluators), respectively. There were three clusters within the marketed foods: one contained 90 foods largely assigned to NOVA4 (91% of assignments), while the two others displayed greater assignment heterogeneity. There were four clusters within the generic foods: three clusters contained foods mostly assigned to a single NOVA group (69-79% of assignments), and the fourth cluster comprised 28 foods whose assignments were more evenly distributed across the four NOVA groups.

CONCLUSIONS

Although assignments were more consistent for some foods than others, overall consistency among evaluators was low, even when ingredient information was available. These results suggest current NOVA criteria do not allow for robust and functional food assignments.

Ultra-processed foods and health: a comprehensive review

Dramatically increasing trends in consumption of ultra-processed foods have been reported across the globe. Public concern about the health consequences of ultra-processed foods is high. This manuscript provides a comprehensive review of trends in global consumption of ultra-processed foods, dietary nutrient profile of ultra-processed foods, demographic, socioeconomic, psychological, and behavioral characteristics of ultra-processed food consumers, current evidence from longitudinal studies at the population level on the association between ultra-processed foods consumption and major health outcomes (including all-cause and cause-specific mortality, cardiovascular disease, overweight and obesity, body composition and fat deposition, diabetes, cancer, and gastrointestinal and other diseases), potential mechanisms linking ultra-processed foods with these outcomes (nutrient displacement, factors that influence adiposity, and processing), and challenges and future research directions. The global trends in consumption of ultra-processed foods, the generally unfavorable nutrient profile of ultra-processed foods, the characteristics of ultra-processed food consumers, the accumulating longitudinal studies associating ultra-processed foods with major health outcomes, and the uncertainties and complexities in putative mechanisms all highlight the need for future high-quality epidemiologic and mechanistic investigations on this topic. It is critical to interpret findings in the light of the totality of evidence.

Food Processing: Comparison of Different Food Classification Systems

The substitution of minimally processed food and culinary home preparations for ready-to-eat products is increasing worldwide, which is overlooked as a cause of concern. The technological developments and the rise in highly processed food availability have introduced the concept of ultra-processed food (UPF). Food classification systems based on processing are now a new basis for epidemiological research. Different results from these classifications might influence conclusions on the population’s consumption of UPF or its association with health outcomes. The aim of this study was to compare classification systems and to find out if their results are comparable when evaluating the extent of high/UPF on the overall diet. Portuguese data from the year 2000 was extracted from the DAFNE-AnemosSoft, and 556 food/beverages items were classified according to five systems. The contribution of UPF was calculated as a percentage of total available amount and discrepancy ranges used for comparisons. Results of UPF availability contributions were: NOVA 10.2%; UNC 15.2%; IFPRI 16.7%; IFIC 17.7%; IARC 47.4%. The highest discrepancy ranges were from alcoholic beverages (97.4%), milk/milk products (94.2%), sugar/sugar products (90.1%), added lipids (74.9%), and cereals/cereal products (71.3%). Inconsistencies among classifications were huge and the contribution from highly/UPF presented high discrepancies. Caution must be taken when comparing and interpreting such data.

Hippocampal Function Is Impaired by a Short-Term High-Fat Diet in Mice: Increased Blood-Brain Barrier Permeability and Neuroinflammation as Triggering Events

Worldwide, and especially in Western civilizations, most of the staple diets contain high amounts of fat and refined carbohydrates, leading to an increasing number of obese individuals. In addition to inducing metabolic disorders, energy dense food intake has been suggested to impair brain functions such as cognition and mood control. Here we demonstrate an impaired memory function already 3 days after the start of a high-fat diet (HFD) exposure, and depressive-like behavior, in the tail suspension test, after 5 days. These changes were followed by reduced synaptic density, changes in mitochondrial function and astrocyte activation in the hippocampus. Preceding or coinciding with the behavioral changes, we found an induction of the proinflammatory cytokines TNF-α and IL-6 and an increased permeability of the blood–brain barrier (BBB), in the hippocampus. Finally, in mice treated with a TNF-α inhibitor, the behavioral and BBB alterations caused by HFD-feeding were mitigated suggesting that inflammatory signaling was critical for the changes. In summary, our findings suggest that HFD rapidly triggers hippocampal dysfunction associated with BBB disruption and neuroinflammation, promoting a progressive breakdown of synaptic and metabolic function. In addition to elucidating the link between diet and cognitive function, our results might be relevant for the comprehension of the neurodegenerative process.

Characterising percentage energy from ultra-processed foods by participant demographics, diet quality and diet cost: findings from the Seattle Obesity Study (SOS) III

Higher consumption of 'ultra-processed' (UP) foods has been linked to adverse health outcomes. The present paper aims to characterise percentage energy from UP foods by participant socio-economic status (SES), diet quality, self-reported food expenditure and energy-adjusted diet cost. Participants in the population-based Seattle Obesity Study III (n 755) conducted in WA in 2016-2017 completed socio-demographic and food expenditure surveys and the FFQ. Education and residential property values were measures of SES. Retail prices of FFQ component foods (n 378) were used to estimate individual-level diet cost. Healthy Eating Index (HEI-2015) and Nutrient Rich Food Index 9.3 (NRF9.3) were measures of diet quality. UP foods were identified following NOVA classification. Multivariable linear regressions were used to test associations between UP foods energy, socio-demographics, two estimates of food spending and diet quality measures. Higher percentage energy from UP foods was associated with higher energy density, lower HEI-2015 and NRF9.3 scores. The bottom decile of diet cost ($216·4/month) was associated with 67·5 % energy from UP foods; the top decile ($369·9/month) was associated with only 48·7 % energy from UP foods. Percentage energy from UP foods was inversely linked to lower food expenditures and diet cost. In multivariate analysis, percentage energy from UP foods was predicted by lower food expenditures, diet cost and education, adjusting for covariates. Percentage energy from UP foods was linked to lower food spending and lower SES. Efforts to reduce UP foods consumption, an increasingly common policy measure, need to take affordability, food expenditures and diet costs into account.

Ultra-Processed Food Availability and Noncommunicable Diseases: A Systematic Review

Ultra-processed food (UPF) can be harmful to the population's health. To establish associations between UPF and health outcomes, food consumption can be assessed using availability data, such as purchase lists or household budget surveys. The aim of this systematic review was to search studies that related UPF availability with noncommunicable diseases or their risk factors. PRISMA guidelines were used. Searches were performed in PubMed, EBSCO, Scopus and Web of Science in February 2021. The search strategy included terms related to exposure (UPF) and outcomes (noncommunicable diseases and their risk factors). Studies that assessed only food consumption at an individual level and did not present health outcomes were excluded. Two reviewers conducted the selection process, and a third helped when disagreement occurred. The Newcastle-Ottawa Scale was used to assess the studies' quality; 998 records were analyzed. All 11 eligible studies were ecological and assessed overweight and obesity as a health outcome, only one showed no positive association with UPF availability. Two studies included the prevalence of diabetes as an outcome, however no significant association was found with UPF availability. Studies relating UPF availability and health outcomes are focused on overweight and obesity. It is necessary to further explore the relationship between other health outcomes and UPF availability using purchase or sales data.

Ultra-processed food consumption and adult obesity risk: a systematic review and dose-response meta-analysis

We performed this systematic review and meta-analysis to evaluate observational studies assessing the association between ultra-processed food (UPF) consumption and the risk of overweight, obesity, and abdominal obesity in the general population. We searched the databases PubMed/MEDLINE, Scopus, Embase, and ISI Web of Science from inception until December 2020. Data were extracted from 12 studies (nine cross-sectional and three cohort studies). Odds ratio (OR) were pooled using a random-effects model. UPF consumption was associated with an increased risk of obesity (OR = 1.55; 95% CI: 1.36, 1.77; I² = 55%), overweight (OR = 1.36; 95% CI: 1.14, 1.63; I² = 73%), and abdominal obesity (OR = 1.41; 95% CI: 1.18, 1.68; I² = 62%). Furthermore, every 10% increase of UPF consumption in daily calorie intake was associated with a 7%, a 6%, and a 5% higher risk of overweight, obesity, and abdominal obesity, respectively. Dose-response meta-analysis of cross-sectional studies showed a positive linear association between UPF consumption and abdominal obesity. There was also a positive linear association between UPF consumption and risk of overweight/obesity in the analysis of cross-sectional studies and a positive monotonic association in the analysis of cohort studies. Our study suggests that UPF consumption is associated with an increased risk of excess weight or abdominal obesity.

Ultra-processed foods, changes in blood pressure and incidence of hypertension: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Objective:

To estimate changes in blood pressure and the incidence of hypertension associated with consumption of ultra-processed foods (UPF) by Brazilian civil servants at a 4-year follow-up.

Design:

Longitudinal analysis of the ELSA-Brasil with non-hypertensive individuals at baseline. We applied the FFQ at the baseline and categorised energy intake by degree of processing, using the NOVA classification. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured at baseline (2008–2010) and again at first follow-up (2012–2014). Incidence of arterial hypertension was defined as SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or antihypertensive medication during the previous 2 weeks. A mixed-effect linear regression model and mixed-effect logistic regression model were used to estimate associations between UPF consumption and, respectively, changes in blood pressure and incidence of hypertension.

Setting:

Brazil.

Participants:

Civil servants of Brazilian public academic institutions in six cities (n 8754), aged 35–74 years at baseline (2008–2010).

Results:

UPF consumption contributed 25·2 % (sd = 9·6) of total energies consumed. After adjustment, participants with high UPF consumption presented a 23 % greater risk of developing hypertension (OR = 1·23, 95 % CI 1·06, 1·44) than those with low UPF consumption. We did not find association between UPF consumption and changes in blood pressure over time.

Conclusions:

The higher the UPF consumption, the higher the risk of hypertension in adults. Reducing UPF consumption is thus important to promote health and prevent hypertension.

Role of ultra-processed food in fat mass index between 6 and 11 years of age: a cohort study

BACKGROUND

Ultra-processed food consumption and obesity have been highlighted as an important relationship to public health. We aimed to evaluate the association between ultra-processed food consumption and body fat from 6 to 11 years of age.

METHODS

We assessed the association between ultra-processed food consumption (from food frequency questionnaires) and body fat (measured by air displacement plethysmography) between 6 and 11 years of age among participants of the Pelotas-Brazil 2004 Birth Cohort. The NOVA classification was used to classify foods according to the processing degree. Body fat was evaluated relative to the height using fat mass index (FMI). Generalized estimating equations were used to answer the main research question and mediation analyses were run to assess the direct and indirect effect of ultra-processed food in body fat.

RESULTS

At fully adjusted analysis, an increase of 100 g in contribution from ultra-processed food to daily food intake at between 6 and 11 years of age was associated with a gain of 0.14 kg/m² in FMI in the same period; 58% of the total effect of ultra-processed food intake at 6 years (in grams) over the change in FMI from 6 to 11 years was mediated by its calorie content.

CONCLUSIONS

Ultra-processed food consumption was associated with an increase in body fat from childhood to early adolescence, and this association was not just due to the effect of ultra-processed food on calorie content.

Extent and nutritional quality of foods and beverages to which children are exposed in Colombian TV food advertising

OBJECTIVE

To examine children's exposure to food and beverage advertising across a year of Colombian television based on whether products exceed Pan-American Health Organization (PAHO)-defined nutrient thresholds.

DESIGN

Nutritional information was obtained for all foods and beverages advertised and used to categorise each product according to the product category (e.g. beverage, snack food) and nutritional quality based on the PAHO model for identifying products in excess of free sugars, Na or saturated fat or containing non-caloric sweeteners or trans-fat. Television audience ratings data were used to derive the average child audience (unique child viewers) per ad and the number of times ads were seen by children in a single week (weekly impressions) based on product category and nutritional quality.

SETTING

All food and beverage ads on cable and over-the-air TV in Colombia in 2017.

PARTICIPANTS

N/A.

RESULTS

Of all instances of TV ads, 89·3 % were of unhealthy products. A larger proportion of male and female children, as well as children from low (88·01 %), mid (89·10 %) and high (89·10 %) socio-economic status, are exposed to advertising of unhealthy products, but no significant difference was found between these proportions.

CONCLUSION

The majority of foods and beverages advertised to Colombian children are unhealthy. These findings highlight a need to implement statutory measures to reduce children's exposure to unhealthy food advertising in Colombia, as obesity and overweight have been increasing among school-age children in Colombia, and exposure to television advertising of unhealthy foods is a known contributor to children's food intake and obesity.

Development of MacroPics: A novel food picture set to dissociate the effects of carbohydrate and fat on eating behaviors

Emerging evidence suggests that fat and carbohydrate interact to potentiate the reward value of food (DiFeliceantonio et al., 2018). The primary goal of the current study was to develop a novel picture set to facilitate research into the effects of macronutrient composition on food choice and eating behavior. Toward this aim, we developed "MacroPics." In Experiment 1, we photographed 120-kcal portions of 60 snack foods falling into one of the three macronutrient categories: (1) mostly carbohydrate, (2) mostly fat, or (3) a combination of fat and carbohydrate. Sixty-one participants rated the images for liking, familiarity, frequency of consumption, healthiness, estimated energy content (in kcal), and expected satiation. A subset of these images consisting of 36 items was then selected in an iterative process to minimize differences in ratings between the macronutrient categories while simultaneously ensuring similar within-category variability on a number of food characteristics (e.g., energy density, portion size, retail price) and visual properties (e.g., color, complexity, visual area). In Experiment 2, an independent sample of 67 participants rated the pictures of the final 36-item MacroPics. Both experiments reveal similar participant ratings across categories for item liking, familiarity, frequency, healthiness, and estimated energy content. Protein content was higher in the fat compared to the carbohydrate and combination categories, leading to higher ratings of estimated satiety and energy density for fatty foods. Item and macronutrient category characteristics of the final MacroPics set are reported.

Ultra-processed food and the risk of overweight and obesity: a systematic review and meta-analysis of observational studies

BACKGROUND

Numerous studies have reported the association of ultra-processed foods with excess body weight; however, the nature and extent of this relation has not been clearly established. This systematic review was conducted to analyze the currently documented evidence regarding the association between ultra-processed food with overweight and obesity.

METHODS

A literature search was performed using multiple literature databases for relevant articles published prior to November 2019. Random effects model, namely the DerSimonian-Laird method, was applied to pool effect sizes. The potential sources of heterogeneity across studies were explored using the Cochrane Q test.

RESULTS

Fourteen studies (one cohort study and thirteen cross-sectional studies) were included in this review. A significant association was identified between ultra-processed food intake and overweight (pooled effect size: 1.02; 95% confidence interval (95% CI): 1.01, 1.03, p < 0.001) and obesity (pooled effect size: 1.26; 95% CI: 1.13, 1.41, p < 0.001).

CONCLUSION

Our findings revealed a positive association between ultra-processed foods and excess body weight. Future studies with longitudinal designs and adequate control for confounding factors are required to clarify whether ultra-processed food intake alters anthropometric parameters and leads to obesity.

Organizing for thoughtful food: a meshwork approach

This paper provides an alternative narrative for organizing food systems. It introduces meshwork as a novel theoretical lens to examine the ontological assumptions underlying the shadow and informal dynamics of organizing food. Through a longitudinal qualitative case study, we place relationality and becoming at the centre of organizing food and food systems, demonstrating how entangled relationships can create a complex ontology through the meshwork knots, threads and weave. We show how issues of collective concern come together to form dynamic knots of interactions, how the threads within the meshwork indicate processes of movement, and how the weave suggests degrees of food system resilience-but always in flow. This theoretical approach thus provides a platform for addressing thoughtful concerns about "food matters" including the integrity of our global food system, the negative health and environmental impacts of industrialized food production, and food safety issues.

Addressing Challenges with the Categorization of Foods Processed at Home: A Pilot Methodology to Inform Consumer-Facing Guidance

The objective of this study was to inform consumer-facing dietary guidance by (1) adapting the current University of North Carolina at Chapel Hill (UNC) food processing framework to include a home processing (HP) component and (2) pilot testing the adapted version using a nationally representative sample of foods consumed in the U.S. The UNC framework was adapted to include guidelines for categorizing home-prepared (HP) foods. The original UNC and adapted HP frameworks were used to code dietary recalls from a random sample of National Health and Nutrition Examination Survey (2015–2016 cycle) participants (n = 100; ages 2–80 years). Percent changes between the UNC and HP adapted frameworks for each processing category were calculated using Microsoft Excel, version 16.23. Participants were 56% female, 35% non-Hispanic white (mean age = 31.3 ± 23.8). There were 1,376 foods with 651 unique foods reported. Using the HP compared to the UNC framework, unprocessed/minimally processed foods declined by 11.7% (UNC: 31.0% vs. HP: 27.4%); basic processed foods increased by 116.8% (UNC: 8.2% vs. HP: 17.8%); moderately processed foods increased by 16.3% (UNC: 14.2% vs. HP: 16.6%); and highly processed foods decreased by 17.8% (UNC: 46.5% vs. HP: 38.2%). Home-prepared foods should be considered as distinct from industrially produced foods when coding dietary data by processing category. This has implications for consumer-facing dietary guidance that incorporates processing level as an indicator of diet quality.

Impact of Poultry Farmers' Participation in Modern Food Retail Markets on Household Dietary Diversity: Lessons from Southeast Nigeria

Simple Summary

Developing countries’ food systems are experiencing rapid transformations led by modern food retail market (MFRM) channels such as supermarkets, fast food firms, hotels, and convenience stores. This paper analyzes the impact of these channels on farm households’ dietary diversity with survey data from Southeast Nigeria. Estimates from the instrumental variable model show that participation in MFRM is associated with a significant increase in dietary diversity. Furthermore, the linkages through which MFRM participation impacts dietary diversity are analyzed using seemingly unrelated regression. Poultry farm income, consumption of poultry products produced by the farmer, and area of vegetable cultivated using poultry droppings have positive association with dietary diversity, while male controlled poultry farm revenue has negative association with dietary quality. Our study provides useful insights that poultry farm managers would find helpful. It also serves as a potential source of information for policymakers for planning as it links smallholder poultry farmers’ participation in modern food retail markets to improved nutrition.

Abstract

This study analyzed the interrelationships between participation in MFRMs and dietary diversity of poultry farming households in Southeast Nigeria. We used cross-sectional data from poultry farmers in Southeast Nigeria and employed instrumental variable and seemingly unrelated regression models to estimate the impact of MFRM participation and major linkages to poultry farm households’ dietary diversity. The results show that participating in MFRMs, relative to traditional markets, improved poultry farmers’ dietary diversity. Moreover, dietary diversity was positively related to higher poultry farm incomes, higher value of own poultry products consumed, and larger area of vegetable cultivated using poultry droppings as manure. Furthermore, increased poultry farm income, higher value of own poultry products consumed, and larger area of vegetable land cultivated using poultry droppings as manure increased the dietary diversity of the farm households. In contrast, a higher share of poultry production revenue controlled by men reduced household dietary diversity. These findings make clear the potential of improving farming households’ nutrition outcomes by promoting participation in MFRMs and the major impact pathways.

Snack food and beverage consumption and young child nutrition in low- and middle-income countries: A systematic review

Although snacks can provide important nutrients for young children during the complementary feeding period, the increasing availability of snack foods and sugar‐sweetened beverages (SSB), often energy‐dense and nutrient‐poor, in low‐ and middle‐income countries (LMIC) is a concern. Such foods may displace consumption of nutritious foods in contexts where diets are often nutritionally inadequate and the burden of childhood malnutrition is high. This systematic review summarizes literature on the contribution of snack food/SSB consumption to total energy intakes (TEI) of children below 23 months of age in LMIC and associations between this consumption and nutritional outcomes. It also identifies areas where further research is needed. A systematic search of Embase, Global Health, and MEDLINE for literature published in January 1990–July 2018 was conducted. This search yielded 8,299 studies, 13 of which met inclusion criteria: Nine studies assessed % TEI from snack foods/SSB, and four studies assessed associations between snack food/SSB consumption and nutritional outcomes. Average % TEI from snack foods/SSB ranged from 13% to 38%. Findings regarding associations with growth were inconclusive, and no studies assessed associations with nutrient intakes. Variation in measurement of consumption and definitions of snack foods and SSB limited study comparisons. Further research is needed to understand how consumption of energy‐dense, nutrient‐poor snack foods and SSB influences undernutrition and overnutrition among young children during the complementary feeding period in settings that are experiencing dietary transitions and the double burden of malnutrition.

Commercial Snack Food and Beverage Consumption Prevalence among Children 6-59 Months in West Africa

Consumption of commercial snack food and beverage products among infants, young, and school-aged children may have negative effects on child nutritional outcomes, as these foods are typically dense in energy but not in micronutrients. However, there is limited information available about the consumption of such snacks in low-income settings, particularly in Africa. We contribute to filling this gap using data from 11,537 children aged 6-59.9 months from four West African countries (i.e., Burkina Faso, Cote d'Ivoire, Mali, and Niger). We estimated the prevalence of commercial snack food and drink consumption and explored variations within the sample by age group, urban or rural residence, household wealth status, and caregiver educational attainment. The results show that 25.7% of children in Niger, 31.5% in Burkina Faso, 42.9% in Mali, and 45.4% in Cote d'Ivoire ate at least one commercial snack food or beverage in the prior 24 h. Consumption prevalence was significantly higher in urban areas than rural areas, among older children (ages 2-5 y) than those in the complementary feeding period (6-23.9 months), and among children in wealthier households. These relationships were confirmed via logistic regression. Our results confirm the widespread consumption of commercial snack foods and drinks by young children in West Africa, a finding with relevance for nutrition policy and programming.

Assessing effectiveness of a novel mid-upper arm circumference Z-score tape in a community setting in Guatemala

Background

Mid-Upper Arm Circumference (MUAC) is an independent anthropometric measurement used to identify malnutrition in children. While much research has been dedicated to applying fixed estimates of MUAC to identify cases of malnutrition in children under 5 years of age, far less has been done with age-specific MUAC Z-score values across the continuum of age from birth through adolescence.

Methods

The present study examined the effectiveness of a novel MUAC Z-score tape, in the hands of community health volunteers, to identify children over the age of 5 who would benefit from nutritional rehabilitation. In January of 2019, 112 community health volunteers working within Children International in Guatemala were trained to use the MUAC Z-score tape and asked to collect measurements on children or youth in their communities.

Results

Of the 818 MUAC Z-score tape measurements obtained by volunteers, 88.26% (722/818) were concordant with nutritional risk status as predicted by BMI Z-score, and 90.95% (744/818) were concordant with MUAC Z-score tape measurements made by field medical staff. MUAC Z-scores identified 87.10% (27/31) of the severely or moderately undernourished children as determined by the BMI Z-score who would be candidates for the nutrition rehabilitation program (Z-score ≤ − 2) along with an additional six children that would not have been classified as such with BMI Z-score. A qualitative survey distributed to the volunteers showed moderate rates of understanding of nutritional risk using the tape, and 62.50% reported the tape was easy to use.

Conclusions

These quantitative and qualitative findings suggest that with more in-depth training and education the MUAC Z-score tape is a viable, low-cost, low-burden alternative for community-level nutritional status assessment among the population served by Children International in Guatemala.

Supplementary information

Supplementary information accompanies this paper at (10.1186/s13690-019-0370-0).

Analysis of dietary patterns and cross-sectional and longitudinal associations with hypertension, high BMI and type 2 diabetes in Peru

OBJECTIVE

To determine if specific dietary patterns are associated with risk of hypertension, type 2 diabetes mellitus (T2DM) and high BMI in four sites in Peru.

DESIGN

We analysed dietary patterns from a cohort of Peruvian adults in four geographical settings using latent class analysis. Associations with prevalence and incidence of hypertension, T2DM and high BMI were assessed using Poisson regression and generalised linear models, adjusted for potential confounders.

SETTING

Four sites in Peru varying in degree of urbanisation.

PARTICIPANTS

Adults aged ≥35 years (n 3280).

RESULTS

We identified four distinct dietary patterns corresponding to different stages of the Peruvian nutrition transition, reflected by the foods frequently consumed in each pattern. Participants consuming the 'stage 3' diet, characterised by high proportional consumption of processed foods, animal products and low consumption of vegetables, mostly consumed in the semi-urban setting, showed the highest prevalence of all health outcomes (hypertension 32·1 %; T2DM 10·7 %; high BMI 75·1 %). Those with a more traditional 'stage 1' diet characterised by potato and vegetables, mostly consumed in the rural setting, had lower prevalence of hypertension (prevalence ratio; 95 CI: 0·57; 0·43, 0·75), T2DM (0·36; 0·16, 0·86) and high BMI (0·55; 0·48, 0·63) compared with the 'stage 3' diet. Incidence of hypertension was highest among individuals consuming the 'stage 3' diet (63·75 per 1000 person-years; 95 % CI 52·40, 77·55).

CONCLUSIONS

The study found more traditional diets were associated with a lower prevalence of three common chronic diseases, while prevalence of these diseases was higher with a diet high in processed foods and low in vegetables.

Modernization of African Food Retailing and (Un)healthy Food Consumption

Food environments in Africa are changing rapidly, with modern retailers—such as supermarkets, hypermarkets, and fast-food restaurants—gaining in importance. Changing food environments can influence consumers’ food choices and dietary patterns. Recent research has suggested that the growth of supermarkets leads to more consumption of processed foods, less healthy diets, and rising obesity. However, relatively little is known about what type of consumers actually use modern supermarkets and to what extent. Moreover, focusing only on supermarkets may be misleading, as most consumers obtain their food from various modern and traditional retailers. We add to the literature by examining relationships between consumers’ socioeconomic status, use of different modern and traditional retailers, and dietary patterns. The analysis uses household survey data from urban Zambia. Results show that two-thirds of the households use modern and traditional retailers simultaneously, but that richer households are more likely than poorer ones to use supermarkets and hypermarkets. Use of modern retailers is positively associated with higher consumption of ultra-processed foods, after also controlling for income and other socioeconomic factors. However, the use of traditional stores and kiosks is also positively associated with the consumption of ultra-processed foods, suggesting that modern retailers are not the only drivers of dietary transitions.

Obesity and the food system transformation in Latin America

The Latin America and the Caribbean (LAC) region faces a major diet-related health problem accompanied by enormous economic and social costs. The shifts in diet are profound: major shifts in intake of less-healthful low-nutrient-density foods and sugary beverages, changes in away-from-home eating and snacking and rapid shifts towards very high levels of overweight and obesity among all ages along with, in some countries, high burdens of stunting. Diet changes have occurred in parallel to, and in two-way causality with, changes in the broad food system - the set of supply chains from farms, through midstream segments of processing, wholesale and logistics, to downstream segments of retail and food service (restaurants and fast food chains). An essential contribution of this piece is to marry and integrate the nutrition transition literature with the literature on the economics of food system transformation. These two literatures and debates have been to date largely 'two ships passing in the night'. This review documents in-depth the recent history of rapid growth and transformation of that broad food system in LAC, with the rapid rise of supermarkets, large processors, fast food chains and food logistics firms. The transformation is the story of a 'double-edged sword', showing its links to various negative diet side trends, e.g. the rise of consumption of fast food and highly processed food, as well as in parallel, to various positive trends, e.g. the reduction of the cost of food, de-seasonalization, increase of convenience of food preparation reducing women's time associated with that and increase of availability of some nutritious foods like meat and dairy. We view the transformation of the food system, as well as certain aspects of diet change linked to long-run changes in employment and demographics (e.g. the quest for convenience), as broad parameters that will endure for the next decades without truly major regulatory and fiscal changes. We then focus in on what are the steps that are being and can be taken to curb the negative effects on diet of these changes. We show that countries in LAC are already among the global leaders in initiating demand-related solutions via taxation and marketing controls. But we also show that this is only a small step forward. To shift LAC's food supply towards prices that incentivize consumption of healthier diets and demand away from the less healthy component is not simple and will not happen immediately. We must be cognizant that ultimately, food industry firms must be incentivized to market the components of healthy diets. This will primarily need to be via selective taxes and subsidies, marketing controls, as well as food quality regulations, consumer education and, in the medium term, consumers' desires to combine healthier foods with their ongoing quest for convenience in the face of busy lives. In the end, the food industry in LAC will orient itself towards profitable solutions, ie those demanded by the broad mass of consumers.

Rango Cards, a digital game designed to promote a healthy diet: a randomized study protocol

BACKGROUND

Several food and nutrition education actions have been described in the literature, with emphasis on the recommended use of innovative methods when addressing a young audience. Digital games are an attractive, dynamic, and motivating resource for teaching and learning practices, and adolescents form the group that readily accepts and adopts new technologies. Adapting dietary and nutritional guidelines to change dietary behavior is a challenge, and game-based learning has several benefits that can be used in this sense. Thus, this study aims to outline a nutritional intervention for school-aged adolescents from the Federal District, Brazil, whose object is a digital card game aimed at promoting healthy dietary practices.

METHODS

In this randomized study with intervention and control groups, we propose a nutritional intervention for adolescents studying in Federal District private schools. The intervention group will be introduced to Rango Cards, a digital game specifically developed for this study. The purpose of the game is to present the concept of an adequate and healthy diet using simple information in a playful context. This game features cards for foods/meals, characters, and healthy habits. The players' choices may lead them to winning or losing. Theme selection and phase order were designed to provide a learning experience. The control group will not receive any material during the study. Both groups will complete questionnaires before and after the intervention. The game is expected to improve food knowledge and self-efficacy in the adoption of healthy practices, thus contributing to appropriate dietary consumption.

DISCUSSION

The game was designed as a food and nutrition education tool based on Brazilian dietary guidelines. We believe that Rango Cards will provide a comprehensive experience on the topic, improving the students' autonomy, motivation, and pleasure of learning.

TRIAL REGISTRATION

RBR-72zvxv June 29, 2018; Retrospectively registered.

A Community-Driven Approach to Generate Urban Policy Recommendations for Obesity Prevention

There is an increasing research interest in targeting interventions at the neighborhood level to prevent obesity. Healthy urban environments require including residents’ perspectives to help understanding how urban environments relate to residents’ food choices and physical activity levels. We describe an innovative community-driven process aimed to develop environmental recommendations for obesity prevention. We conducted this study in a low-income area in Madrid (Spain), using a collaborative citizen science approach. First, 36 participants of two previous Photovoice projects translated their findings into policy recommendations, using an adapted logical framework approach. Second, the research team grouped these recommendations into strategies for obesity prevention, using the deductive analytical strategy of successive approximation. Third, through a nominal group session including participants, researchers, public health practitioners and local policy-makers, we discussed and prioritized the obesity prevention recommendations. Participants identified 12 policy recommendations related to their food choices and 18 related to their physical activity. The research team grouped these into 11 concrete recommendations for obesity prevention. The ‘top-three’ ranked recommendations were: (1) to adequate and increase the number of public open spaces; (2) to improve the access and cost of existing sports facilities and (3) to reduce the cost of gluten-free and diabetic products.

Neighborhood social and economic change and retail food environment change in Madrid (Spain): The heart healthy hoods study

This study explores the association between neighborhood social and economic change from 2009 to 2013 and changes in the retail food environment from 2013 to 2017 in Madrid (Spain). We classified neighborhoods into four types: decreasing SES, new housing/gentrifying, increasing SES, and aging (population and housing). Food store data was obtained from a retail spaces census and classified as supermarket, specialized small store, or fruit and vegetable store. Compared to aging areas, new housing/gentrifying and areas with increasing SES had a higher baseline presence and proportion of supermarkets and a lower proportion of specialized stores and fruit and vegetable stores. Areas with decreasing SES had an initially higher presence and proportion of fruit and vegetable stores but showed a declining trend in both presence and proportion of fruit and vegetable stores.

Consumption of ultra-processed foods and socioeconomic position: a cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health

The objective of the study was to estimate the contribution of ultra-processed foods to total caloric intake and investigate whether it differs according to socioeconomic position. We analyzed baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil 2008-2010; N = 14.378) and data on dietary intake using a food frequency questionnaire, assigning it into three categories: unprocessed or minimally processed foods and processed culinary ingredients, processed foods, and ultra-processed foods. We measured the associations between socioeconomic position (education, per capita household income, and occupational social class) and the percentage of caloric contribution of ultra-processed foods, using generalized linear regression models adjusted for age and sex. Unprocessed or minimally processed foods and processed culinary ingredients contributed to 65.7% of the total caloric intake, followed by ultra-processed foods (22.7%). After adjustments, the percentage of caloric contribution of ultra-processed foods was 20% lower among participants with incomplete elementary school when compared to postgraduates. Compared to individuals from upper income classes, the caloric contribution of ultra-processed foods was 10%, 15% and 20% lower among the ones from the three lowest income, respectively. The caloric contribution of ultra-processed foods was also 7%, 12%, 12%, and 17% lower among participants in the lowest occupational social class compared to those from high social classes. Results suggest that the caloric contribution of ultra-processed foods is higher among individuals from high socioeconomic positions with a dose-response relationship for the associations.

Pathways of the association between maternal employment and weight status among women and children: Qualitative findings from Guatemala

The double burden of malnutrition, defined by the coexistence of undernutrition and overweight, is well documented in low- and middle-income countries. However, the mechanisms by which employment may be related to maternal and child weight status in low- and middle-income countries are not well understood. We conducted in-depth interviews among 20 mothers who participated in Project MIEL, a contemporary trial which evaluated the effects of an integrated micronutrient supplement and parenting intervention in rural Guatemala. We utilized semi-structured interviews to explore the pathways by which maternal employment might influence bodyweight. Interviews were structured to explore the factors that mothers considered when deciding whether or not to participate in the labor force and how mothers perceived the influence of employment on determinants of their own bodyweight and that of their children. Themes were used to develop a conceptual framework. Mothers described four pathways through which employment could lead to changes in weight status: changes in food purchasing; improved household well-being; changes in time allocation; and psychological effects. Mothers described purchasing increased quantities and more varied types of food, as well as the purchase of energy-dense foods. Less time to devote to food preparation resulted in mothers preparing quicker meals and relying on substitute childcare. Mothers also expressed feelings of worry and neglect in relation to being employed, and perceived that these feelings would affect weight. A better understanding of these mechanisms is important for developing policies and programs to support women in the workplace and also reducing maternal and child overweight in Guatemala.

Ultra-processed Food Intake and Obesity: What Really Matters for Health-Processing or Nutrient Content?

PURPOSE OF REVIEW

The aim of this narrative review was to summarize and critique recent evidence evaluating the association between ultra-processed food intake and obesity.

RECENT FINDINGS

Four of five studies found that higher purchases or consumption of ultra-processed food was associated with overweight/obesity. Additional studies reported relationships between ultra-processed food intake and higher fasting glucose, metabolic syndrome, increases in total and LDL cholesterol, and risk of hypertension. It remains unclear whether associations can be attributed to processing itself or the nutrient content of ultra-processed foods. Only three of nine studies used a prospective design, and the potential for residual confounding was high. Recent research provides fairly consistent support for the association of ultra-processed food intake with obesity and related cardiometabolic outcomes. There is a clear need for further studies, particularly those using longitudinal designs and with sufficient control for confounding, to potentially confirm these findings in different populations and to determine whether ultra-processed food consumption is associated with obesity independent of nutrient content.

Supermarket purchase contributes to nutrition-related non-communicable diseases in urban Kenya

BACKGROUND

While undernutrition and related infectious diseases are still pervasive in many developing countries, the prevalence of non-communicable diseases (NCD), typically associated with high body mass index (BMI), is rapidly rising. The fast spread of supermarkets and related shifts in diets were identified as possible factors contributing to overweight and obesity in developing countries. Potential effects of supermarkets on people's health have not been analyzed up till now.

OBJECTIVE

This study investigates the effects of purchasing food in supermarkets on people's BMI, as well as on health indicators such as fasting blood glucose (FBG), blood pressure (BP), and the metabolic syndrome.

DESIGN

This study uses cross-section observational data from urban Kenya. Demographic, anthropometric, and bio-medical data were collected from 550 randomly selected adults. Purchasing food in supermarkets is defined as a binary variable that takes a value of one if any food was purchased in supermarkets during the last 30 days. In a robustness check, the share of food purchased in supermarkets is defined as a continuous variable. Instrumental variable regressions are applied to control for confounding factors and establish causality.

RESULTS

Purchasing food in supermarkets contributes to higher BMI (+ 1.8 kg/m2) (P<0.01) and an increased probability (+ 20 percentage points) of being overweight or obese (P<0.01). Purchasing food in supermarkets also contributes to higher levels of FBG (+ 0.3 mmol/L) (P<0.01) and a higher likelihood (+ 16 percentage points) of suffering from pre-diabetes (P<0.01) and the metabolic syndrome (+ 7 percentage points) (P<0.01). Effects on BP could not be observed.

CONCLUSIONS

Supermarkets and their food sales strategies seem to have direct effects on people's health. In addition to increasing overweight and obesity, supermarkets contribute to nutrition-related NCDs. Effects of supermarkets on nutrition and health can mainly be ascribed to changes in the composition of people's food choices.

Childhood obesity among the poor in Peru: Are there implications for cognitive outcomes?

This paper exploits three rounds of panel data provided by the Peruvian dataset of the Young Lives study to investigate the relationship between child cognition and obesity status among the poor. Child weight status is measured by a full distribution of child weight, from severely thin to obese, using data from a z-score for body mass index and cognition is measured by the Spanish version of the Picture Peabody Vocabulary Test (PPVT). This relationship is studied at age five and age eight (school age), and disaggregated across socioeconomic factors of gender, urban/rural setting and indigenous/nonindigenous status. The initial results suggests that obese children have higher cognitive scores and that this result is driven by those who are female, non-indigenous and live in an urban region. However, after correcting for possible bias due to unobservable heterogeneity, there is little evidence of this relationship. The one exception is for a weakly significant relationship between obese female children and higher cognition, a relationship which tends to weaken between the ages of five and eight. On the other end of the weight distribution, indigenous children who are severely thin or thin have significantly lower cognitive scores, a relationship that holds after correcting for possible bias and appears to strengthen between ages of five and eight. This paper contributes to a very small set of literature on child cognition and obesity, points to the importance of controlling for unobserved heterogeneity in estimation, and is the first of its kind to study this relationship in a developing country.

Nutrition status of children in Latin America

The prevalence of overweight and obesity is rapidly increasing among Latin American children, posing challenges for current healthcare systems and increasing the risk for a wide range of diseases. To understand the factors contributing to childhood obesity in Latin America, this paper reviews the current nutrition status and physical activity situation, the disparities between and within countries and the potential challenges for ensuring adequate nutrition and physical activity. Across the region, children face a dual burden of undernutrition and excess weight. While efforts to address undernutrition have made marked improvements, childhood obesity is on the rise as a result of diets that favour energy-dense, nutrient-poor foods and the adoption of a sedentary lifestyle. Over the last decade, changes in socioeconomic conditions, urbanization, retail foods and public transportation have all contributed to childhood obesity in the region. Additional research and research capacity are needed to address this growing epidemic, particularly with respect to designing, implementing and evaluating the impact of evidence-based obesity prevention interventions.

CONSUMO ENERGÉTICO PROVENIENTE DE ALIMENTOS ULTRAPROCESSADOS POR ADOLESCENTES

Objective:

To evaluate the consumption of ultra-processed foods and related factors in adolescents.

Methods:

This is a cross-sectional study conducted with 784 adolescents (both sexes and aged between 12 and 19 years) from public and private schools in the municipality of Palmeira das Missões, Brazil. Food consumption was recorded by the semiquantitative questionnaire of frequency of food consumption and converted to energy (kcal/day). Foods were classified as minimally processed, group 1 (G1); processed foods, group 2 (G2); and ultra-processed foods, group 3 (G3). The variables evaluated were sex, socioeconomic class, color, physical activity, body mass index, and blood pressure levels. In the comparison of quantitative variables, the Mann-Whitney test and the Kruskal-Wallis H test were used. To adjust the differences between the groups, considering the effects of total calories, the covariance analysis test (ANCOVA) was applied.

Results:

The median of the total energy consumption was 3,039.8 kcal, and that of ultra-processed foods was 1,496.5 kcal/day (49.23%). The caloric intake from foods in G1, G2, and G3 did not differ according to the skin color of the adolescents. Those belonging to socioeconomic classes C and D are the most frequent consumers of calories from G2 and G3 (p<0.001). Underactive teens consume fewer calories from minimally processed foods. Eutrophic adolescents present higher consumption of G3 foods (p<0.001) when compared to those who are overweight.

Conclusions:

The consumption of ultra-processed foods was associated with socioeconomic level, physical activity level, and nutritional status.