Article

Associations of ultra-processed food and drink products with asthma and wheezing among Brazilian adolescents

Wiley
Pediatric Allergy and Immunology
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Abstract

Background Although both consumption of ultra‐processed products and asthma are common during adolescence, the epidemiological evidence in regarding their association is unclear. We investigated the associations of ultra‐processed products consumption with asthma and wheezing in a representative sample of Brazilian adolescents. Methods We used data from a representative sample of 109,104 Brazilian adolescents enrolled in the National Survey of School Health, 2012. The consumption of ultra‐processed products was based on the weekly consumption (0‐2, 3‐4, ≥5 days/week) of sweet biscuits, salty biscuits, ultra‐processed meats, sweets/candies, soft drinks, and packaged snacks over the previous seven days. We also calculated an ultra‐processed consumption score by adding partial scores corresponding to weekly frequency intake of each ultra‐processed product. The ultra‐processed consumption score ranged from 0 to 42, the higher score, the higher the intake of these products. Presence of wheezing in the previous 12 months and asthma at any time in the past were self‐reported. Results The adjusted odds ratios of asthma comparing the extreme categories ranged from 1.08 (95% CI 1.03‐1.13) for sweets/candies to 1.30 (1.21‐1.40) for ultra‐processed meats. Similar magnitude of associations was found for wheezing outcome. The ultra‐processed consumption score was positively associated with presence of asthma and wheezing in a dose‐response manner. The adjusted OR of asthma and wheezing comparing highest to lowest quintile of ultra‐processed consumption score were 1.27 (95% CI 1.15‐1.41) and 1.42 (1.35‐1.50), respectively. Conclusions The consumption of ultra‐processed products was positively associated with the presence of asthma and wheezing in adolescents. This article is protected by copyright. All rights reserved.

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... All our included studies were published between 2007 and 2022. Six studies were performed in the USA [12,14,[21][22][23][24], and other studies were done in Europe [15,16,25] and other countries [26,27]. Both sexes were considered in all articles. ...
... The findings of 9 studies were adjusted for sex and age [12, 14-16, 21, 22, 25, 27], as well as BMI was the other adjustment factor in 6 studies [14,15,[21][22][23]25]. Most of the articles were adjusted for maternal factors like smoking [12,15,16,21,22,25,27], allergy [15,25,26], and maternal education [12,15,16,22,25,27]. Dietary factors like fruit and vegetable intake [12,15,21,25,27], or fast food intake were considered too [12]. ...
... The findings of 9 studies were adjusted for sex and age [12, 14-16, 21, 22, 25, 27], as well as BMI was the other adjustment factor in 6 studies [14,15,[21][22][23]25]. Most of the articles were adjusted for maternal factors like smoking [12,15,16,21,22,25,27], allergy [15,25,26], and maternal education [12,15,16,22,25,27]. Dietary factors like fruit and vegetable intake [12,15,21,25,27], or fast food intake were considered too [12]. ...
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Background Asthma has become the most common chronic condition among children in recent decades. Environmental factors, including food, drive its rise. Sweetened beverages are a staple of children’s diets and cause various health issues. Therefore, this research aims to evaluate the association of all types of high fructose beverages with asthma in children. Method We assessed observational studies published before November 2023, obtained from PubMed, Scopus, and Web of Science. The quality of articles was assessed by using the Newcastle-Ottawa Scale. Studies with a pediatric population under 18 years that indicate the association between all kinds of beverages containing high fructose and asthma and evaluated risk estimates with 95% confidence intervals were included. We also followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Results In the final analysis, we included eleven studies with 164,118 individuals. Twenty-one effect sizes indicated a significant positive association between sugar-sweetened beverages (SSBs) consumption and odds of asthma (OR: 1.28; 95% CI: 1.15–1.42; Pvalue < 0.001). Three effect sizes showed that total excess free fructose (tEFF) intake increases children’s asthma odds by 2.7 times (pooled OR: 2.73; 95% CI: 1.30–5.73; Pvalue =0.008). However, five effect sizes in 100% fruit juice failed to show statically association with asthma prevalence in children (pooled OR: 1.43; 95%CI: 0.91–2.23; Pvalue =0.12). Conclusion In summary, SSB and tEFF raised asthma probabilities. No relationship was found between fruit juice and asthma in children and adolescents. We need more cohort studies with correct age selection to identify the precise link.
... [82][83][84] For the clinical outcomes, the risk of bias was unclear for 1 study, 64 medium for 7 studies, 44,45,49,52,57,60,63 and low for 13 studies. [41][42][43][46][47][48]50,51,58,59,61,65,66 For the human mechanistic studies, the risk of bias was high for 1 study, 68 medium for 17 studies, 30,67,[69][70][71][72][73][74][75][76][77][78][80][81][82][83][84] and low for 1 study. 79 ...
... Seven prospective cohort studies reported on UPF intake in children and current disease. [43][44][45][46][47][48]54 Three studies reported data from Brazil. ...
... 48 reported that active asthma based on diagnosis by a physician was associated with UPF intake in the past 7 days. Melo et al. 46 reported that consumption of UPFs was positively associated with the presence of self-reported asthma and wheezing in adolescents. ...
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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.
... Two Brazilian studies involving children and adolescents evaluated the association between UPF consumption and asthma. One study reported an association in adolescents, while the other study found no association between UPF consumption in childhood and asthma in adolescence [18,19]. A study of 513 children demonstrated an 83% increase in the prevalence of wheezing respiratory diseases associated with high consumption of UPF [20]. ...
... Most studies investigating the association between the consumption of UPF and asthma have been conducted with children and adolescents, and the results are divergent [18,19]. In the study by Melo et al. [19], in which asthma was defined based on an affirmative response to the questions "Have you had wheezing or chest tightness in the last 12 months?" ...
... Most studies investigating the association between the consumption of UPF and asthma have been conducted with children and adolescents, and the results are divergent [18,19]. In the study by Melo et al. [19], in which asthma was defined based on an affirmative response to the questions "Have you had wheezing or chest tightness in the last 12 months?" and "Have you ever had asthma?" the consumption of UPF was positively associated with the presence of asthma in Brazilian adolescents. ...
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Background: Ultra-processed Food (UPF) consumption can play a role in the pathogenesis and progression of asthma. The aim of this study was to evaluate the association between the consumption of UPF and asthma. Methods: This cross-sectional study included 1857 adults aged 23-25 years from the Ribeirão Preto-SP birth cohort (1978/1979). The exposure variable was the consumption of UPF (expressed as their percentage contribution to energy intake-% total caloric value [%TCV] and their percentage contribution to the amount of food ingested-%grams), which was assessed with a food frequency questionnaire. Asthma was the outcome and was defined based on a positive methacholine challenge test and the presence of wheezing, chest tightness, or shortness of breath over the last 12 months. Poisson regression with robust variance was used to estimate the association between these variables. Unadjusted analyses and analyses adjusted for sex, age, household income, smoking, and physical activity level were performed. Results: The prevalence of asthma in the sample was 13.2%. The mean total consumption of UPF was 37.9 ± 11.2% TCV (corresponding to 35.1 ± 15.1% grams). There was no association between the consumption of UPF and asthma in adults. Conclusion: This study provides no evidence for an association between the consumption of UPF and asthma in young adults.
... Allergic symptoms such as asthma, eczema, and wheezing have been correlated with a poor diet and the excessive consumption of ultra-processed foods (UPFs) [1,[10][11][12][13]. It is hypothesized that UPFs contain more allergens than their less-processed counterparts [14]. ...
... UPFs' consumption has been adversely linked not only with allergic symptoms but with human health overall [1,[11][12][13][16][17][18][19][20][21][22][23][24]. The main mechanism linking UPFs' consumption to allergic symptoms, to date, is linked to the nutritional composition of the UPF-rich diet [10,11]. However, a more obvious mechanism would be a higher risk of exposure to allergens either as a trace or an ingredient or exposure to secondary allergens (i.e., exposure to soy for individuals diagnosed with a peanut allergy). ...
... To date, the literature has focused on the association of UPFs' consumption (usually measured through the NOVA System) with food allergies and their symptoms. Although research suggests a positive association between the two [10][11][12][13]35], it is unclear whether the mechanism of action is that of higher exposure to allergens or linked to the nutritional quality of UPFs and the nutritional adequacy of UPF-rich diets. Previous studies have suggested a positive association of UPFs' consumption with asthma and wheezing in children and adolescents; however, both the presence of additives and the positive energy balance linked to UPFs' consumption have been proposed as mediators [10,11,35,36]. ...
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Ultra-processed foods’ (UPFs’) consumption has been positively linked to the presence of allergic symptoms, but it is yet unknown whether this is linked to their nutritional composition or allergen load. This study used the ingredient lists available in the Greek Branded Food Composition Database, HelTH, to classify foods (n = 4587) into four grades of food processing (NOVA1–4) according to the NOVA System. Associations between NOVA grades and the presence of allergens (as an ingredient or trace) were studied. Overall, UPFs (NOVA4) were more likely to contain allergens than unprocessed foods, NOVA1 (76.1% vs. 58.0%). However, nested analyses among similar foods showed that in >90% of cases, processing degree was not linked to allergens’ presence. Recipe/matrix complexity was more strongly linked to allergens’ presence with NOVA4 foods declaring 1.3 allergenic ingredients vs. 0.4 allergenic ingredients in NOVA1 foods (p < 0.01). Exposure to trace allergens was more common for NOVA4 than NOVA1 foods (45.4% vs. 28.7%), but the extent of contamination was similar (2.3 vs. 2.8 trace allergens). Overall, UPFs are more complex mixtures with higher numbers of allergens per food and are more prone to cross-contamination. However, indicating a food’s degree of processing is not sufficient to help identify allergen-free choices within the same subcategory.
... These include the association between a high intake of free fructose-containing beverages and allergy (20). Additionally, studies involving UPFs have suggested that biscuits, sweets or candies, processed meats, drinks, and packaged snacks enhance the risk of asthma and wheeze among Brazilian adolescents (22). However, there is also evidence to suggest the opposite. ...
... /fpubh. . (22)] found positive associations between UPFs consumption and asthma. ...
... A high intake of UPFs represents a high intake of processed foods, saturated fat, and sugar, but fewer proteins (allergens) (10,11). It may contribute to decreased immediate-related hypersensitivity reactions (22). However, this does favor the formation of allergic immune defense in childhood (43). ...
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Design There is a strong correlation between dietary intake and allergic diseases. Ultra-processed foods (UPFs) are gradually becoming dominant worldwide and causing health problems for children and adults. We hope to determine whether links exist between UPFs and allergic symptoms. Methods We investigated data from 2,736 children (16–19 years) and 4,256 adults (≥20 years) from the National Health and Nutritional Examination Survey (NHANES) 2005–2006. The associations between the mean UPFs contribution to total energy intake and all allergic symptoms (IgE, current asthma, allergy, rash, sneeze, wheeze, eczema, and hay fever) were estimated by weighted multivariate logistic regression. Results Logistic regression analysis showed UFPs were negatively associated with IgE levels in children. Those with higher quartiles had a reduced risk from 16% (OR, 0.84, 95%CI, 0.55 to 1.28) to 34% (OR, 0.66, 95%CI, 0.49 to 0.89), p for trend = 0.006. UPFs were also positively related to current asthma in children with an increased risk of 11% (OR, 1.11, 95%CI, 0.79 to 1.56) to 76% (OR, 1.76, 95%CI, 1.10 to 2.82), p for trend = 0.0393. UPFs were also associated with eczema in girls. But there was no association observed between UPFs and allergic symptoms in adults. Conclusion Our results suggested that UPFs assessed by the NOVA system were associated with IgE, current asthma in children, and eczema in girls. These results further support the need to test the association of modern dietary patterns with allergic symptoms.
... Moreover, concerns have also been raised about the presence of additives and chemicals entering the food supply inadvertently (e.g., pesticides, among others). There is evidence reporting that additives and excess weight are the main possible mediators of the association between ultra-processed products and asthma [66]. However, emerging evidence highlights that UPFs included in the dietary pattern provide environmental factors that influence the diversity and functionality of the gut microbiota with direct action on their homeostasis. ...
... Diets rich in ultra-processed foods are linked with poor health outcomes, including asthma [66]. It is well known that UPFs contain high amounts of saturated and trans fats, refined carbohydrates, sodium, and a low presence of monounsaturated and polyunsaturated fatty acids (MUFA and PUFA, respectively), vitamins, minerals, antioxidants, and fibre [89]. ...
Article
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Obesity is considered an important risk factor for the onset of asthma, playing a key role in enhancing the disease’s severity. However, there is increasing evidence linking not only obesity but also overweight with a higher risk of asthma. Although the correlation between obesity and asthma has already been reported, several aspects are still not fully elucidated, mainly about the inflammatory processes underlying both diseases. It is well known that Western-type calorically rich diets and overfeeding can act as triggers of chronic metabolic inflammation, but few studies have examined associations between ultra-processed foods (UPFs) intake, despite its positive correlation with obesity, and biomarkers of inflammation. In addition to their nutrient composition, UPF may have chemical additives and contaminants from packaging, whose effects on health and food addiction are still under research. In this review, we provide an overview of the current data that identify the associations between the obese asthma phenotype and UPF consumption, highlighting the potential central role played by the intestinal microbiota.
... 271of endocrine hormone-disrupting chemicals, such as bisphenol A (BPA), which are 272 associated with diabetes(84).273 Regarding respiratory health, previously published studies investigating the association 274 between UPF and wheezing in children and adolescents showed inconsistent results, 275 while our updated meta-analyses revealed a significant association with convincing 276 evidence(85,86). Food additives widely used in industrial processing might mediate the associations between UPFs and respiratory disease. ...
... Food additives widely used in industrial processing might mediate the associations between UPFs and respiratory disease. Certain food additives like 278 tartrazine and carmine (E-120), might induce pro-inflammatory cytokines and 279 hypersensitivity reactions, which can play a key role in the development of asthma and 280 wheezing(85,87,88). Human studies have also found an association between food 281 additives, such as sodium benzoate, an important antiseptic agent, and augmented 282 histamine release from basophils, which is one of the substances that triggers allergic283 symptoms (89, 90). ...
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Background & aims Ultra-processed food (UPF) intake has increased sharply over the last few decades and has been consistently asserted to be implicated in the development of non-communicable diseases. We aimed to evaluate and update the existing observational evidence for associations between ultra-processed food (UPF) consumption and human health. Methods We searched Medline and Embase from inception to March 2023 to identify and update meta-analyses of observational studies examining the associations between UPF consumption, as defined by the NOVA classification, and a wide spectrum of health outcomes. For each health outcome, we estimated the summary effect size, 95% confidence interval (CI), between-study heterogeneity, evidence of small-study effects, and evidence of excess-significance bias. These metrics were used to evaluate evidence credibility of the identified associations. Results This umbrella review identified 39 meta-analyses on the associations between UPF consumption and health outcomes. We updated all meta-analyses by including 122 individual articles on 49 unique health outcomes. The majority of the included studies divided UPF consumption into quartiles, with the lowest quartile being the reference group. We identified 25 health outcomes associated with UPF consumption. For observational studies, 2 health outcomes, including renal function decline (OR: 1.25; 95% CI: 1.18, 1.33) and wheezing in children and adolescents (OR: 1.42; 95% CI: 1.34, 1.49), showed convincing evidence (Class I); and five outcomes were reported with highly suggestive evidence (Class II), including diabetes mellitus, overweight, obesity, depression, and common mental disorders. Conclusions High UPF consumption is associated with an increased risk of a variety of chronic diseases and mental health disorders. At present, not a single study reported an association between UPF intake and a beneficial health outcome. These findings suggest that dietary patterns with low consumption of UPFs may render broad public health benefits.
... However, the study was underpowered due to relatively lower numbers of respiratory mortality (793 CRDs deaths) [18]. Other cross-sectional studies from Brazil have reported that a higher consumption of UPF was associated with increased risk of asthma and wheezing in paediatric and adolescent population [19,20]. As a result of this limited evidence on the relationship between UPF consumption and CRDs, further studies have been recommended which focus on greater characterization of UPF, relationships and the potential mechanisms linked with risk of CRDs [17]. ...
... A recent study from the UK Biobank suggested that a higher UPF intake increases the risk of respiratory diseases/incidence by 4% but the risk of respiratory mortality increased by 12%, a non-statistically significant association. Two studies in Brazil (one cross-sectional study with small samples (n = 513) and one national survey) showed a positive relationship of UPF consumption and respiratory diseases (asthma and wheezing) in adolescents and risk of wheezing in children [19,20]. In line with these findings, the current study revealed higher UPF intake is responsible for at least a 10% increase in the risk of overall CRDs mortality and a 26% higher risk of COPD mortality in older adults in the USA. ...
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Purpose The purpose of the study was to determine the relationships between ultra-processed food (UPF) consumption and risk of mortality due to chronic respiratory diseases (CRDs) overall, chronic obstructive pulmonary disease (COPD), and lung cancer. Methods A total of 96,607 participants aged 55 years and over were included from the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer trial. Dietary intake was measured using food frequency questionnaire. Cox regression was fitted to estimate the risk of all-cause mortality and mortality due to CRDs overall, COPD and lung cancer associated with UPF intake. Competing risk regression was used to account for deaths from other causes and censoring. Results During the follow-up of 1,379,655.5 person-years (median 16.8 years), 28,700 all-cause, 4092 CRDs, 2015 lung cancer and 1,536 COPD mortality occurred. A higher intake of UPF increased the risk of mortality from CRDs overall by 10% (HR 1.10; 95% CI 1.01, 1.22) and COPD by 26% (HR 1.26; 95% CI 1.06, 1.49) but not associated with lung cancer mortality risk (HR 0.97; 95% CI 0.84, 1.12). However, the risk of lung cancer increased by 16% (HR 1.16; 95% CI 1.01, 1.34) in the highest UPF intake after multiple imputation. Dose–response relationships existed for CRDs and COPD mortality but not lung cancer. Conclusion UPF consumption was associated with an increased risk of CRD mortality. The association between UPF consumption and lung cancer mortality is inconclusive and only significant when multiple imputation was applied.
... Of the 63 articles included, 8 33,34,59-62,69,81 were cohort studies and 55 22,[27][28][29][30][31][32][63][64][65][66][67][68][70][71][72][73][74][75][76][77][78][79][80][82][83][84][85][86][88][89][90] were crosssectional studies. Regarding the geographical area, one article 83 originated from Africa, one article 51 was international, 13 articles [30][31][32]35,36,41,47,64,73,74,76,77,80 were published in Asia, 27 articles 22,27,29,33,34,[37][38][39][43][44][45][46]48,49,[55][56][57]59,62,69,70,72,81,82,86,88,90 originated from Europe, 7 articles 50,53,54,63,68,84,89 from North America, 4 articles 28,40,60,61 from Oceania and 10 articles 42,52,[65][66][67]71,75,78,79,85 were published in South America. ...
... Of the 63 articles included, 8 33,34,59-62,69,81 were cohort studies and 55 22,[27][28][29][30][31][32][63][64][65][66][67][68][70][71][72][73][74][75][76][77][78][79][80][82][83][84][85][86][88][89][90] were crosssectional studies. Regarding the geographical area, one article 83 originated from Africa, one article 51 was international, 13 articles [30][31][32]35,36,41,47,64,73,74,76,77,80 were published in Asia, 27 articles 22,27,29,33,34,[37][38][39][43][44][45][46]48,49,[55][56][57]59,62,69,70,72,81,82,86,88,90 originated from Europe, 7 articles 50,53,54,63,68,84,89 from North America, 4 articles 28,40,60,61 from Oceania and 10 articles 42,52,[65][66][67]71,75,78,79,85 were published in South America. ...
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Background Asthma is a public health problem requiring focused attention. This study aimed to systematically evaluate the association between dietary structure and asthma or wheezing in children. Methods The study protocol of this meta-analysis has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the registration code CRD42023390191. A total of 8397 articles were retrieved, searching PubMed, Medline, Embase, Web of Science, and Scopus databases as of November 21, 2022. Two independent authors were responsible for independently conducting the literature screening process. Effect-size estimates were expressed as odds ratio (OR) in cross-sectional studies and risk ratio (RR) in cohort studies with a 95% confidence interval (CI). Summary effect estimates were evaluated with random-effect models. Meanwhile, subgroup and sensitivity analyses were performed to assess the potential sources of heterogeneity and the robustness of the pooled estimation. Results A total of 65 studies, including 567,426 subjects had been analyzed. Overall analyses of cross-sectional studies revealed that a healthy diet was protective against asthma (adjusted OR=0.85, 95% CI: 0.80–0.89, P <0.001, I²=69.8%, Tau²=0.026) and wheezing (adjusted OR=0.85, 95% CI: 0.81–0.89, P <0.001, I²=66.8%, Tau²=0.015) in children and adolescents. Conversely, unhealthy diets can exacerbate asthma (adjusted OR=1.28, 95% CI: 1.20–1.36, P <0.001, I²=64.9%, Tau²=0.019) and wheeze (adjusted OR=1.09, 95% CI: 1.02–1.16, P =0.006, I²=75.2%, Tau²=0.023) in children and adolescents. The same trend was found in cohort studies (adjusted RR=0.72, 95% CI: 0.58–0.90, P =0.003, I²=83.5%, Tau²=0.105). A clear trend was observed between high-frequency healthy diets (OR=0.80; 95% CI: 0.71–0.89; P <0.001) is more protective against asthma than low-frequency healthy diets (OR=0.81; 95% CI: 0.70–0.94; P =0.007). Conclusion Our findings highlight the protective effects of a healthy diet on asthma and wheezing in children, including fruit, seafood, cereals, and the Mediterranean diet.
... However, numerous studies have revealed a correlation between poor diets and a higher risk of developing chronic diseases. Inflammation in the body can be increased by poor-quality diets [45]. When regularly consumed, certain food additives found in ultra-processed meals (such as emulsifiers and artificial sweeteners) can also exacerbate gut inflammation by altering the gut microbiome [46]. ...
... Studies on human subjects have also discovered a link between histamine generated by human basophils and food additives like tartrazine and sodium benzoate. One of the molecules that sets off allergy symptoms like wheezing in the chest and shortness of breath is histamine [45]. In response, the body instructs our immune cells, including white blood cells, to combat any invasive infections (such as bacteria or viruses). ...
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Changes in behavior, lifestyle, and nutritional patterns have influenced many potential risk variables globally. In recent decades, food allergies (FAs) have been elevated to a severe public health issue both in developed countries and developing countries (third-world countries). This study aims to evaluate the effects caused by certain factors such as lifestyle and dietary habits on food allergies, review the association of lifestyle and dietary habit status with FAs, and outline why more people are allergic to food sources as a result of lifestyle changes and dietary habits. We searched electronic international databases including Scopus, PubMed, Google Scholar, and Web of Science using combinations of keywords. Utilizing Excel, the relevant studies were included and the irrelevant studies were excluded, and Mendeley was used for referencing and also to remove duplicates. The framework proposed by Arksey and O’Malley was used for this scoping review. The papers published in the databases from 2016 to 2020 were extracted. A total of eight studies were extracted, and this scoping review was carried out according to the risk factors. In our review, we found that some lifestyle choices (Caesarean section and antibiotics) and dietary habits (n-3 PUFA, fast food, duration of dietary intervention, and vitamin D), were important contributing factors for FA.
... A associação entre o consumo de alimentos ultraprocessados e asma ou chiado foi examinada em adolescentes de um estudo de coorte (qualidade metodológica alta) 73 e dois transversais com amostras nacionais representativas (ambos com qualidade média) 74,75 . ...
... Os dois estudos transversais foram realizados com amostra representativa de adolescentes brasileiros do 9 o ano do Ensino Fundamental. Após ajuste para possíveis confundidores, eles encontraram associações dose-resposta entre um escore de consumo de alimentos ultraprocessados e a ocorrência de asma e chiado no peito 74,75 . ...
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The aim of this study was to conduct a literature scope review of the association between the consumption of ultra-processed foods and health outcomes. The search was carried out in the PubMed, Web of Science and LILACS databases. Studies that assessed the association between the consumption of ultra-processed foods, identified on the NOVA classification, and health outcomes were eligible. The review process resulted in the selection of 63 studies, which were analyzed in terms of quality using a tool from the National Institutes of Health. The outcomes found included obesity, metabolic risk markers, diabetes, cardiovascular diseases, cancer, asthma, depression, frailty, gastrointestinal diseases and mortality indicators. The evidence was particularly consistent for obesity (or indicators related to it) in adults, whose association with the consumption of ultra-processed foods was demonstrated, with dose-response effect, in cross-sectional studies with representative samples from five countries, in four large cohort studies and in a randomized clinical trial. Large cohort studies have also found a significant association between the consumption of ultra-processed foods and the risk of cardiovascular diseases, diabetes and cancer - even after adjusting for obesity. Two cohort studies have shown an association of ultra-processed foods consumption with depression and four cohort studies with all-cause mortality. This review summarized the studies' results that described the association between the consumption of ultra-processed foods and various non-communicable diseases and their risk factors, which has important implications for public health.
... For children, lipid profile changes (Rauber et al., 2015) and increased abdominal circumference have been reported (Costa, Rauber, et al., 2019). Moreover the occurrence of Metabolic Syndrome (Tavares et al., 2012) and asthma have been reported in adolescents (Melo et al., 2018). Finally, there are reports of increased risk of obesity (Mendonça et al., 2016) and other chronic diseases in adults (Fiolet et al., 2018;Mendonça et al., 2017;Srour et al., 2020). ...
... We emphasize that eating habits once formed in childhood are generally tracked through adulthood (Movassagh et al., 2017). This is even more relevant if we consider that increases in UPF dietary share is linked to deterioration of the overall diet nutritional quality Rauber et al., 2018) and negative health outcomes (Costa, Rauber, et al., 2019;Leffa et al., 2020;Melo et al., 2018;Rauber et al., 2015). Thus, understanding the eating occasion-specific opportunities early could help to identify potential aspects to reduce the UPF consumption among UK children. ...
Article
This study aimed to investigate the patterns of eating context and its association with ultra-processed food consumption by British children. This cross-sectional study was conducted with a representative sample of UK children aged 4–10 years old (n = 1772) from the National Diet and Nutrition Survey 2008/2014. Data on food consumption, meal context and ultra-processed food consumption were assessed through a four-day food diary. Exploratory factor analysis was used to identify the patterns of eating context and these patterns’ association with the daily consumption of ultra-processed food was verified by linear regression analyses. Ultra-processed foods comprised 65.4% of the total daily energy intake. At lunch, higher ultra-processed food consumption was associated with the patterns “Eating with family while watching TV” (64.9% in the lowest tertile to 68.1% in the highest tertile) and “Eating away from home” (65.2%–67.7%, respectively), while the eating pattern “Eating at school with friends” was associated with lower ultra-processed food consumption (66.6%–64.7%, respectively). At dinner, higher ultra-processed food consumption was associated with the patterns “Eating with family while watching TV” (64.6%–67.1%, respectively) and “Eating alone in the bedroom” (63.9%–66.5%, respectively). Eating alone, eating whilst watching TV, and eating away from home stood out as patterns of eating context associated with the increased consumption of ultra-processed food.
... 15 According to one study, eating a lot of ultra processed food was positively correlated with wheezing and asthma among teenage Brazilians. 16 Another study discovered that eating more than four servings of processed meat per week, as opposed to fewer than one, is linked to worsening symptoms of asthma. 17 ...
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Modernization, a stressful lifestyle, attachment to a Western diet, and the use of preserved and processed foods lead to a loss of homeostasis of intestinal microbial diversity. The use of refined flour and refined sugar, which lack of micro biota-accessible carbohydrates (MAC), means dietary fiber high salt consumption, and saturated fats in fried and packaged foods cause gut microbiota dysbiosis. Microbial dysbiosis caused by high fat, salt, and lack of fiber causes several metabolic diseases, including asthma. The objective of the study is to develop a hypothetic model that “Ancient Indian diet” which is inspired by thousands of years of Indian science, including Yoga, Ayurveda, and Naturopathy may maintain the diversity of the gut microbiota and may inhibits the asthmatic symptoms by enhancing the growth of antiasthmatic bacteria. A keyword search utilizing the phrases "western diet, beneficial microbiota, asthma, gut microbial dysbiosis, Ancient Indian diet" was conducted electronically search through the SCOPUS ,Science Direct ,PubMed, Web of Science, and PsycINFO databases. Search criteria are divided into two arms the first one includes different full-text research papers including how Indian diet altered gut microbial composition. The second one, we included the full text including how presence of certain gut microbiota can prevents the asthmatic attack. To find publications that met the eligibility requirements, the first and third authors separately reviewed each publication's title and abstract using the previously described inclusion criteria. We have included 124 research articles, which is published between 1989 to 2024. A plant-based ancient Indian diet increases the diversity of Bacteroidetes, Actinobacteria, Prevotella, Bifidobacterium, Lactobacillus, Ruminococcus, Roseburia, Lactobacillus, Lachnospira, Akkermansia and shows inhibitory effects against Clostridium, E. coli, Staphylococcus, Haemophilus, Moraxella and Neisseria. The ancient Indian diet a low-fat lacto-vegetarian diet maintains gut microbiota homeostasis, and suppresses the growth of pathogenic asthmatic bacteria and promotes the growth of beneficial asthmatic bacteria.
... 2019), cardiovascular diseases, coronary heart disease, cerebrovascular disease , asthma and wheezing (Melo et al., 2018), irritable bowel syndrome and functional dyspepsia (Schnabel et al., 2018), depression (Adjibade et al., 2019), and double burden of disease due to eating errors (Rivera et al., 2014;De -Deus-Mendonca et al., 2016). On a broader scale, the general consumption pattern of undergraduate students has been correlated with their health status. ...
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This study builds on an earlier investigation of the ultra-processed foods (UPF) consumption and general consumption patterns of undergraduate students in Ondo City of Ondo State, Nigeria. It sought to assess the relationship between health statuses. One question and two null hypotheses guided the study. A quantitative survey research design was adopted in the study, and the Adeyemi Federal University of Education was the sampled area for the study in the city. The sample size for the survey comprised 2% of the estimated population (240 respondents). Data was collected from 240 respondents using the Ultra-Processed Foods Consumption Pattern and Effects on Students' Health Questionnaire (UCPESHQ) and analysed statistically (using frequency count, percentage, simple ranking and Pearson Product-Moment Correlation). The significant findings were that the most everyday self-reported ailment, medically diagnosed ailment and worrisome clinical features are sleeping disorder (41.9%), ulcer (11.4%) and dandruff (19.1%), respectively. The students are averagely average in weight (58.5%). It was also found that UPF consumption is significantly associated with self-reported ailments (r = 0.160, ρ = 0.014) and worrisome clinical features (r = 0.185; ρ = 0.004). It was recommended that management teams of universities should work with appropriate stakeholders to facilitate sustainable feeding and healthcare programs for undergraduate students.
... The AAP recommends that sugar sweetened drinks, the addition of salt to foods, or the consumption of nutrient-poor discretionary foods with high levels of saturated fat, added sugars, and/or added salt should not be included during the transition to solid foods [104]. UPFs have been linked to allergic conditions such as asthma, eczema, and wheezing [119,120]. It has been hypothesized that UPFs can contribute to food allergy development, either due to their poor nutritional composition or as a result of higher levels of food processing [119]. ...
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Pediatric food allergy remains commonplace, despite the advancement in our understanding of risk factors and prevention modalities for the condition. Early allergen introduction, a dietary intervention, has been endorsed by professional societies globally as an effective primary preventive measure, yet awareness among medical professionals and parents is lacking. Alongside food allergen introduction, overall nutrition, such as diet diversity, also plays an important role in allergy prevention. To address both food allergen introduction and overall nutrition, dietitians play a pivotal role in the dissemination and education of current guidelines to caregivers. This review addresses the particular role of the dietitian in food allergy prevention consultations, providing up-to-date information on food allergies, their development and prevalence, risk factors, dietary factors and an overview of the current guidelines in the United States. This has not been addressed in any of the current food allergy or nutrition guidelines.
... Por otro lado, el asma es una enfermedad no transmisible de mayor impacto en la adolescencia. A pesar de ello, existen pocos estudios sobre el consumo de AUP y su conexión con las enfermedades respiratorias en la infancia (35). ...
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Este artículo propone considerar a la alimentación en general y a los ultraprocesados y bebidas azucaradas en lo particular, como un tema que atañe a la bioética global. La primera sección explica la relación entre el consumo de los alimentos ultraprocesados y la salud, la segunda, relaciona a las llamadas enfermedades no transmisibles y la salud mental con la alimentación y la tercera sección, argumenta el papel que debe jugar la bioética, en especial la global, en materia de alimentación.
... Furthermore, there is evidence that the consumption of ultraprocessed foods has been inversely associated with the adoption of healthy patterns [7]. Among adolescents, specifically, there is a growing body of evidence indicating that the consumption of ultra-processed foods is a risk factor for increased body fat [8], as well as the development of obesity [4], metabolic diseases [4], asthma [9], and sleep disorders [10]. ...
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Background: Considering its deleterious effects on health, as well as the importance of information to support actions, strategies, and public policies, the present study was developed, aiming at identifying and classifying the main variables associated with ultra-processed foods consumption in Brazilian adolescents. Data sources: Targeting observational studies involving samples of Brazilian adolescents (11 to 19 years old), which evaluated possible associations between the consumption of ultra-processed foods and individual, interpersonal, environmental, and public policy variables, in October 2022, a systematic review was conducted, consulting electronic databases (Lilacs, Pubmed, Scielo, Scopus, and Web of Science), Google Scholar, and the reference lists of included articles. Data synthesis: The descriptive synthesis consisted of 11 papers, representing nine original studies. The main variables identified were: sedentary behavior (specially screen time), studying at a private school, having a higher body mass index, and being female. Conclusions: Based on this evidence, it is important to direct actions, strategies, and public policies aimed at confronting the consumption of ultra-processed foods for these groups.
... Epidemiological studies, conducted with different populations, suggest that as greater the presence of ultra-processed foods in the dietary pattern, increases the energy density of the diet and the concentration of critical nutrients for the development of distinct diseases, in different life cycles [3][4][5][6]. Among adolescents, specifically, there is a growing body of evidence indicating that the consumption of ultra-processed foods is a risk factor for increased body fat [7], as well as the development of obesity [4], metabolic diseases [4], asthma [8] and sleep disorders [9,10]. ...
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Background: Considering its deleterious effects on health, as well as the importance of information to support actions, strategies and public policies, this study was aimed to identify and classify the risk factors for consumption of ultra-processed foods among Brazilian adolescents. Data sources: targeting observational studies involving samples of Brazilian adolescents (11 to 19 years old), which evaluated possible associations between the consumption of ultra-processed foods and individual, interpersonal, environmental and public policies variables, in October 2022, a systematic review was conducted, consulting electronic databases (Lilacs, Pubmed, Scielo, Scopus and Web of Science), Google Scholar and the reference lists of included articles. Data synthesis: The descriptive synthesis consisted of 11 papers, representing nine original studies. In general, the consumption of ultra-processed foods was associated with different individual, interpersonal and environmental variables. More specifically, the following variables can be highlighted: sedentary behavior (specially screen time), studying at a private school, having a higher Body Mass Index and being female. Conclusions: Based on this evidence, it is important to direct actions, strategies and public policies aimed at confronting the consumption of ultra-processed foods for these groups.
... Studies using the NOVA classification system have found associations between the high consumption of UPF and gestational weight gain, newborn fat mass, and maternal diet quality and gestational weight gain [15][16][17][18], besides excess weight, obesity, inadequate intake of micronutrients and chronic diseases in late life stages [19][20][21][22][23][24][25], but there is a gap in the literature about the relationship of UPF on SGA and LGA. Scientific studies are necessary to evaluate the association between the degree of food processing and the adequation of birth weight for the age and sex. ...
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Objective To assess the association between the maternal diet, according to the degree of processing of food consumption, and birth weight for gestational age and sex. Methods A cross-sectional study with 300 women was conducted from February 2009 to 2011 from a maternity ward in Mesquita, Rio de Janeiro. The outcome was based on sex-specific birth weight for gestational age: small, adequate, or large. A validated food frequency questionnaire was used to estimate the food consumption during the 2nd and 3rd trimesters of pregnancy. The food intake was classified into three groups according to the degree of processing: 1) unprocessed or minimally processed foods and culinary ingredients (oil, fats, salt, and sugar), 2) processed foods, and 3) ultra-processed foods. Descriptive analyses were made to assess the tertiles of the percentage of energy intake of each food group on the outcome and on maternal and infant characteristics. Multinomial logistic regressions were used to test the association of the tertiles of food according to the degree of processing on the outcome (adequate, small, or large birth weight for gestational age and sex). Results The analysis of the food frequency questionnaire from the 300 women indicated that the mean percentage of kcal consumed from unprocessed and minimally processed food and culinary ingredients was 54.0%, while the percentages of energy from processed foods and ultra-processed foods were 2.0% and 44.0%, respectively. The highest tertile of consumption of unprocessed and minimally processed food and culinary ingredients had a protective effect on the prevalence of newborn large for gestational weight in relation to the lowest (OR: 0.13; 95% IC: 0.02 to 0.89; p=0.04). Conclusion High consumption of unprocessed and minimally processed food and culinary ingredients during the last six months of pregnancy might be a protective factor against having a newborn large for gestational weight when compared to mothers with the lowest consumption. Keywords Eating; Healthy eating; Newborn; Ultra-processed food
... Compared with culinary preparations and processed foods, ultra-processed foods have, on average, a higher content of free sugar, fat, sodium, calories, flavorings, dyes, and texturizers, as well as a lower density of proteins, fibers and micronutrients 2,3,4 . They are products that can affect the control of satiety and glycemic responses of the body 5 , and their excessive consumption is a risk factor for negative health outcomes in adolescents, such as metabolic syndrome 6 , overweight 7 and asthma and wheezing 8 . According to data from the Brazilian National Survey of School Health (PeNSE), the frequent consumption of ultra-processed foods among Brazilian school adolescents increased between 2009 and 2015 9 , when it reached 60.6% 10 . ...
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Alimentos ultraprocessados são marcadores de padrões alimentares não saudáveis e seu consumo é elevado entre os adolescentes. Características do ambiente alimentar escolar se associam a práticas alimentares de estudantes. O objetivo do estudo foi investigar a associação entre a presença de cantinas e a disponibilidade de alimentos ultraprocessados nas cantinas com o consumo destes alimentos, dentro da escola, entre adolescentes do 9º ano do Ensino Fundamental das redes pública e particular do Município de São Paulo, Brasil. Foi realizado um estudo transversal com dados do SP-Proso, em amostra de 2.680 adolescentes. Foram feitos modelos de regressão linear multinível para avaliar as associações entre as exposições presença de cantinas nas escolas e disponibilidade de alimentos ultraprocessados com desfechos de frequência de consumo de ultraprocessados na escola. A presença de cantinas esteve associada à maior frequência de consumo de embutidos (0,46; IC95%: 0,24; 0,68), salgadinhos de pacote (0,50; IC95%: 0,19; 0,80), guloseimas (0,82; IC95%: 0,55; 1,09) e bebidas açucaradas (0,34; IC95%: 0,06; 0,62), bem como um escore de frequência de consumo de ultraprocessados (2,37; IC95%: 1,25; 3,48). A disponibilidade de salgadinhos de pacote, guloseimas e bebidas açucaradas nas cantinas aumentou a frequência de consumo desses alimentos. Foi observado um efeito dose/resposta entre a diversidade de ultraprocessados nas cantinas e a frequência de consumo destes alimentos. Um ambiente alimentar escolar com maior disponibilidade de ultraprocessados está associado ao maior consumo dos mesmos na escola, o que aponta para a necessidade de regulamentar o comércio de alimentos dentro destas instituições.
... Indeed, the assessment of the toxicology of co-exposure to multiple compounds or the entire food exposome is a very challenging task 41 . It should be noted that HPFs have been linked to a wide range of NCCDs with markedly different pathologies, including heart disease 42 , cancers 4 , gut disorders 43 , frailty 44 , depression 45 , bone health 46 , dental caries 47 , hypertension 48 , asthma 49 , redox status and inflammation 50,51 , obesity 52 and macular degeneration 53 . It will be challenging to propose a biological link between an individual additive or groups of additives to such a range of complex pathologies. ...
Article
Existing highly processed food (HPF) classification systems show large differences in the impact of these foods on biochemical risk factors for disease. If public health nutrition is to consider the degree of food processing as an important element of the link between food and health, certain gaps in research must be acknowledged. Quantifying the food additive exposure derived from HPFs is a task made challenging by the lack of data available on the occurrence and concentration of additives in food and the degree to which the natural occurrence of additives in unprocessed foods confounds exposure estimates. The proposed role of HPFs in health outcomes could also be associated with altered nutrient profiles. Differences exist within and between HPF classification systems in this regard and there are conflicting data on the impact of controlling for nutrient intake. Furthermore, research is needed on how the sensory aspects of HPFs contribute to energy intake. Current data suggest that high energy intake rate may be the mechanism linking HPFs and increased energy intake. A high priority now is to clarify the basis of definitions used to categorize foods as highly processed and, in a constructive sense, to distinguish between the contributions of nutrients, additives and sensory properties to health. Systems used to categorize processed foods display variation in the impact of highly processed food on risk factors for non-communicable disease. Clarity is needed on the contribution of nutrients, additives and sensory properties of foods categorized as highly processed to health and disease.
... UPF consumption has been related to several adverse health outcomes, such as overweight/obesity, abdominal obesity, dyslipidaemia, metabolic syndrome, depression, cardiovascular and cerebrovascular disease, as well as total mortality, in adults [8]. Among children and adolescents, UPF consumption has been associated with some outcomes such as increased body fatness [9], the occurrence of asthma or wheezing [10], and changes in serum lipid profile [11]. These associations may be explained by the impact of ultraprocessed foods on diet quality, which has been seen among Portuguese adults and the elderly population [12] and also in other national representative samples which included children and adolescents [13][14][15][16][17]. ...
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Considering the nature, extent, and purpose of food processing, this study aims to identify dietary patterns (DPs) and their associations with sociodemographic factors and diet quality in Portuguese children and adolescents. Cross-sectional data were obtained from the National Food, Nutrition and Physical Activity Survey (2015–2016) of the Portuguese population. Dietary intake was obtained from two non-consecutive days and food items were classified according to the NOVA system. The proportion (in grams) of foods in the total daily diet was considered to identify DPs by latent class analysis, with age and sex as concomitant variables. Associations of DPs with sociodemographic characteristics were assessed using multinomial logistic regression. Linear regressions adjusted by sociodemographic characteristics tested associations of DPs with diet quality. DPs identified were: “Unhealthy” (higher sugar-sweetened beverages, industrial breads, and sausages intake), “Traditional” (higher vegetables, fish, olive oil, breads, ultra-processed yogurts, and sausages intake), and “Dairy” (higher intake of milk, yogurt, and milk-based beverages). “Unhealthy” was associated with older ages and lower intake of dietary fibre and vitamins and the highest free sugars and ultra-processed foods (UPF), although all DPs presented significant consumption of UPF. These findings should be considered for the design of food-based interventions and school-feeding policies in Portugal.
... of a negative impact of UPF on functional gastrointestinal disorders (7) , asthma in adolescents (8) , obesity (9) , hypertension (10) , metabolic disorders in adolescents (11) and cancer (12) . ...
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Objective To investigate the association between ultra-processed food (UPF) consumption and Internalizing Symptoms (IS) among adolescents. Design It is a cross-sectional study. Paper-pencil survey was completed in classroom with information on UPF consumption, IS and selected covariates. IS were assessed with the Internalizing Symptoms sub-scale from the Social Behaviour Questionnaire (ISs-SBQ). UPF was evaluated with a food frequency questionnaire extracted from the Brazilian National School Health Survey. Crude and adjusted association between UPF and IS was investigated with Structural Equation Models. Setting São Paulo, SP, Brazil. Participants n= 2,680 students, M age = 14.85; CI95% 14.81-14.88. Results UPF consumption was associated with higher scores in IS in the crude (ß=0.14; p<0.001) and adjusted (ß=0.12; p<0.001) models. The higher the consumption of UPF, the higher the IS score. The following variables were associated with a lower risk of UPF consumption: male gender, public school and having more meals with parents. The change in the magnitude of the standardized score was almost negligible, but the model was significantly improved with the inclusion of covariates. Conclusions Our results provide evidence about the positive association between UPF consumption and IS among adolescents. The association, despite its low magnitude, remained significant after adjusting for potential confounders. These results are relevant considering the increase in UPF consumption worldwide and in low- and middle-income countries. Also, our study emphasizes the importance of a healthy diet with a reduction in UPF consumption among adolescents.
... Par ailleurs, les profils lipidiques et dyslipidémies, d'une part, [23,72,73], et l'hypertension, d'autre part, [22,[74][75][76], ont été étudiés à plusieurs reprises dans des études prospectives en lien avec la consommation d'AUT. L'asthme chez les enfants et les adolescents [77,78] a également été investigué (résultats non significatifs au sein de la cohorte Pelotas Birth mais associations positives au Brésil, dans la National Survey of School Health) ainsi que le diabète gestationnel (Espagne) [79], la fonction rénale [80] et la fragilité [81] chez les personnes âgées (cohorte Seniors-ENRICA). ...
Article
Résumé Au cours des dernières décennies, l’offre agro-alimentaire s’est considérablement étoffée en matière d’aliments dits « ultra-transformés » (AUT). Il s’agit de produits ayant subi d’importants procédés de transformation impactant fortement la matrice alimentaire et/ou contenant des additifs alimentaires ou autres substances d’origine industrielle (huiles hydrogénées, maltodextrine, sirop de glucose, etc.). Dans la cohorte NutriNet-Santé (2009-en cours), sept études ont été réalisées, sur des sous-échantillons allant de 26 000 à plus de 100 000 participants. Ces travaux ont mis en évidence des associations entre consommation d’AUT et incidences de cancers, maladies cardiovasculaires, mortalité, diabète de type 2, symptômes dépressifs, surpoids et obésité, et présence de troubles fonctionnels digestifs. Les analyses tenaient compte de nombreux facteurs de confusion potentiels, y compris nutritionnels. Au-delà des aspects de qualité nutritionnelle, d’autres facteurs pourraient donc être impliqués, tels que certains additifs alimentaires, des composés néoformés lors des procédés de transformation, ou des contaminants issus des emballages. Ces résultats sont en cohérence avec un nombre croissant d’études épidémiologiques et expérimentales récentes à travers le monde qui suggèrent un rôle étiologique des AUT dans la survenue de différentes maladies. Sur la base de ces travaux, les autorités de santé publique en France et dans divers pays recommandent aujourd’hui d’en limiter la consommation.
... Higher intake of ultra-processed foods is associated with a concomitant decrease in disease-preventing vegetable intake [26,45] and increased risk of wheezing or asthma in teens [46,47], depression [48,49], mortality [50][51][52][53] and chronic diet-related diseases such as metabolic syndrome [54][55][56][57], obesity [23,[58][59][60][61][62], type 2 diabetes [63,64], hypertension [65], heart disease [66], stroke [66] and cancer [67][68][69] in adults. A meta-analysis of 43 studies on ultra-processed foods and chronic disease risk found consumption of ultra-processed food was associated with an increased risk of overweight, obesity, abdominal obesity, all-cause mortality, metabolic syndrome and depression in adults [47]. ...
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The organic food market’s recent rapid global growth reflects the public’s interest in buying certified organic foods, including packaged products. Our analysis shows that packaged foods containing fewer ingredients associated with negative public health outcomes are more likely to be labeled organic. Previous studies comparing organic and conventional foods focused primarily on nutrient composition. We expanded this research by additionally examining ingredient characteristics, including processing and functional use. Our dataset included nutrition and ingredient data for 8240 organic and 72,205 conventional food products sold in the U.S. from 2019 to 2020. Compared to conventional foods, organic foods in this dataset had lower total sugar, added sugar, saturated fat and sodium content. Using a mixed effects logistic regression, we found that likelihood of classification as organic increased as sodium content, added sugar content and the number of ultra-processed ingredients and cosmetic additives on the product label decreased. Products containing no trans-fat ingredients were more likely to be labeled organic. A product was more likely to be classified “organic” the more potassium it contained. These features of organic foods sold in the U.S. are significant because lower dietary ingestion of ultra-processed foods, added sugar, sodium and trans-fats is associated with improved public health outcomes.
... UPFs now amount to around half of the total dietary energy consumed in highly developed market Fig. 1 A schematic conceptualisation of different pathways in the food value chain based on the level of processing of end-products economies, and their sales in less developed market economies are increasing rapidly [34]. Studies have shown that a greater contribution of UPFs to total energy intake are associated with poorer diet quality [39][40][41], higher risks of all-cause mortality [42,43], obesity [44,45], and a range of diet-related chronic diseases, including depression [46][47][48][49][50][51][52]. ...
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Background The public health community has become increasingly critical of the role that powerful corporations play in driving unhealthy diets, one of the leading contributors to the global burden of disease. While a substantial amount of work has examined the political strategies used by dominant processed food manufacturers that undermine public health, less attention has been paid to their use of market strategies to build and consolidate power. In this light, this paper aimed to systematically review and synthesise the market strategies deployed by dominant processed food manufacturers to increase and consolidate their power. Methods A systematic review and document analysis of public health, business, legal and media content databases (Scopus, Medline, ABI Inform, Business Source Complete, Thomas Reuters Westlaw, Lexis Advance, Factiva, NewsBank), and grey literature were conducted. Data extracted were analysed thematically using an approach informed by Porter’s ‘Five Forces’ framework. Results 213 documents met inclusion criteria. The market strategies ( n =21) and related practices of dominant processed food manufacturers identified in the documents were categorised into a typological framework consisting of six interconnected strategic objectives: i) reduce intense competition with equivalent sized rivals and maintaining dominance over smaller rivals; ii) raise barriers to market entry by new competitors; iii) counter the threat of market disruptors and drive dietary displacement in favour of their products; iv) increase firm buyer power over suppliers; v) increase firm seller power over retailers and distributors; and vi) leverage informational power asymmetries in relations with consumers. Conclusions The typological framework is well-placed to inform general and jurisdiction-specific market strategy analyses of dominant processed food manufacturers, and has the potential to assist in identifying countervailing public policies, such as those related to merger control, unfair trading practices, and public procurement, that could be used to address market-power imbalances as part of efforts to improve population diets.
... 2,6 Consumption of ultra-processed foods is related to increased overweight/obesity, dyslipidemias, hypertension, diabetes mellitus and allergies in children, adolescents and adults. [6][7][8][9][10][11] Adequate and healthy eating, on the other hand, is an important health promotion factor, which is fundamental for satisfactory growth and child development, especially in the first two years of life. Therefore, exclusive breastfeeding is recommended in the first 6 months, and then complemented with other foods -fresh or minimally processed -up to 2 years or over. 2 The positive impacts of breastfeeding include reduction of the infant mortality rate, protection against infections, decreased risk of chronic diseases, improvement of oral cavity performance and intelligence levels. ...
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Resumo Objetivo: Analisar a associação entre aleitamento materno exclusivo (AME) e a introdução de alimentos ultraprocessados em crianças menores de 12 meses. Métodos: Estudo de coorte, realizado com crianças de Vitória da Conquista, Bahia, Brasil. A exposição principal foi o AME (em dias: <120; 120-179; ≥180). A variável-desfecho do estudo foi a introdução de quatro ou mais tipos de ultraprocessados no primeiro ano de vida. Utilizou-se análise de regressão de Poisson. Resultados: Foram avaliadas 286 crianças, das quais 40,2% receberam quatro ou mais ultraprocessados e 48,9% receberam AME por menos de 120 dias. O AME por menos de 120 dias (RR=2,94 - IC95% 1,51;5,71) e por 120-179 dias (RR=2,17 - IC95% 1,09;4,30) associou-se ao desfecho após ajuste pelas variáveis socioeconômicas, maternas, paternas e da criança. Conclusão: O AME por menos de 180 dias aumentou o risco de introdução de quatro ou mais alimentos ultraprocessados no primeiro ano de vida.
... Due to the set of intrinsic characteristics of ultra-processed foods (i.e. high energy density, sugar content, unhealthy fats and salt, and low content of fibers, proteins, vitamins, and minerals), its excessive consumption is already negatively impacting on the diet quality and health of Brazilian children (Costa et al., 2019;Filgueiras et al., 2019;Melo, Rezende, Machado, Gouveia, & Levy, 2018;Rauber et al., 2015). Also, a recent systematic review (Elizabeth, Machado, Zinöcker, Baker, & Lawrence, 2020) shows that of 43 studies, 37 (86%) showed an association between ultra-processed food exposure and at least one adverse health outcome. ...
... El consumo energético medio de nuestros participantes se encuentra por encima del rango de normalidad establecido para ese grupo de edad, sin embargo, no se trata de una población obesa y el consumo de UP es similar al referido en poblaciones pediátricas de países en vías de desarrollo. Un estudio con adolescentes brasileños, utilizando también datos autorreferidos, reportó datos similares, demostrando que el consumo de UP se asociaba con la presencia de L. Moreno-Galarraga et al. asma y sibilancias, con un gradiente dosis-respuesta (OR en el quintil de mayor consumo de productos UP) de 1,27 (IC 95% 1,15-1,41) para asma y de 1,42 (IC 95% 1,35-1,50) para sibilancias 27 . En nuestro estudio, los datos orientan a la misma asociación y similar magnitud de asociación en las bronquitis/sibilancias de repetición, y la falta de resultados estadísticamente significativos para el asma posiblemente se deba al tamaño muestral limitado. ...
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Resumen Introducción El consumo de productos ultraprocesados (UP) se relaciona con múltiples enfermedades en el adulto, como hipertensión arterial, diabetes o asma. Objetivo estudiar si el consumo de UP en niños se asocia con enfermedades respiratorias sibilantes (asma o bronquitis/sibilancias de repetición). Material y métodos Estudio transversal dentro del proyecto SEguimiento del Niño para un Desarrollo Óptimo (SENDO), una cohorte abierta, multidisciplinar y multipropósito de niños españoles. El consumo de UP se calculó mediante cuestionarios semicuantitativos de frecuencia de consumo de alimentos. Los alimentos se agruparon según la clasificación NOVA y se estimó el consumo diario y el porcentaje de kilocalorías procedentes de UP. Dividimos la exposición en «alto» y «bajo» a partir de la mediana de consumo. Se calcularon las odds ratio y los intervalos de confianza al 95% para las enfermedades respiratorias sibilantes asociadas al consumo alto de UP, usando como referencia el bajo consumo. Se calcularon estimadores brutos y multiajustados y se utilizaron modelos de regresión mixtos para tener en cuenta la correlación entre hermanos. Resultados En los 513 niños estudiados (51,8% varones, edad media de 5,2 años), el consumo medio de UP fue de 446,76 g/día, representando un 39,9% de la ingesta calórica total. Un alto consumo de UP se asoció a un incremento del 87% de la prevalencia de enfermedades respiratorias sibilantes (OR 1,87; IC 95% 1,01-3,45). Encontramos que un mayor consumo de UP multiplica por 2,12 (IC 95% 1,10-4,05) la prevalencia de bronquitis/sibilancias de repetición. Conclusiones Nuestros resultados muestran una asociación directa entre el consumo de UP y la prevalencia de enfermedades sibilantes en niños.
... Due to the set of intrinsic characteristics of ultra-processed foods (i.e. high energy density, sugar content, unhealthy fats and salt, and low content of fibers, proteins, vitamins, and minerals), its excessive consumption is already negatively impacting on the diet quality and health of Brazilian children (Costa et al., 2019;Filgueiras et al., 2019;Melo, Rezende, Machado, Gouveia, & Levy, 2018;Rauber et al., 2015). Also, a recent systematic review (Elizabeth, Machado, Zinöcker, Baker, & Lawrence, 2020) shows that of 43 studies, 37 (86%) showed an association between ultra-processed food exposure and at least one adverse health outcome. ...
Article
This study identified adults' cooking practices patterns and tested their associations with children's consumption of ultra-processed foods. Cross-sectional study conducted with 551 adult-child pairs from São Paulo, Brazil. Children's food consumption was collected through dietary recalls. Adults' cooking practices were identified using a questionnaire developed for the Brazilian's context. Principal Component Analysis has been employed to identify cooking patterns and linear regression models (crude and adjusted for sociodemographic variables) have been used to test associations between pattern's scores and contribution of ultra-processed foods to total energy at dinners. Three cooking patterns were identified: “Healthy”, “Usual” and “Convenience”. The first two patterns reflected behaviors of people who mostly cook “from scratch”. Only the Healthy pattern (confidence to cook several meals using fresh foods and natural seasonings; healthier cooking techniques) was inversely associated with ultra-processed food consumption (β = −4.1; p = 0.002), whereas the Convenience pattern (less frequency and time to cook, using microwave and ready-to-heat meals) was positively associated with (β = 3.6; p = 0.008). Our results suggest that cooking at home, as an isolated action, is not enough to protect the consumption of ultra-processed foods. To promote healthy eating among children, the adults' cooking practices should be aligned with the preparation of meals made “from scratch”, taking into account the healthiness of what is being cooked.
... Two cross-sectional studies (N = 111,294) that investigated the association between consumption of ultraprocessed food and asthma and wheezing were included in a meta-analysis (see Table S5 for study characteristics). 37 ...
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This systematic review and meta‐analysis investigated the association between consumption of ultraprocessed food and noncommunicable disease risk, morbidity and mortality. Forty‐three observational studies were included (N = 891,723): 21 cross‐sectional, 19 prospective, two case‐control and one conducted both a prospective and cross‐sectional analysis. Meta‐analysis demonstrated consumption of ultraprocessed food was associated with increased risk of overweight (odds ratio: 1.36; 95% confidence interval [CI], 1.23‐1.51; P < 0.001), obesity (odds ratio: 1.51; 95% CI, 1.34‐1.70; P < 0.001), abdominal obesity (odds ratio: 1.49; 95% CI, 1.34‐1.66; P < 0.0001), all‐cause mortality (hazard ratio: 1.28; 95% CI, 1.11‐1.48; P = 0.001), metabolic syndrome (odds ratio: 1.81; 95% CI, 1.12‐2.93; P = 0.015) and depression in adults (hazard ratio: 1.22; 95% CI, 1.16‐1.28, P < 0.001) as well as wheezing (odds ratio: 1.40; 95% CI, 1.27‐1.55; P < 0.001) but not asthma in adolescents (odds ratio: 1.20; 95% CI, 0.99‐1.46; P = 0.065). In addition, consumption of ultraprocessed food was associated with cardiometabolic diseases, frailty, irritable bowel syndrome, functional dyspepsia and cancer (breast and overall) in adults while also being associated with metabolic syndrome in adolescents and dyslipidaemia in children. Although links between ultraprocessed food consumption and some intermediate risk factors in adults were also highlighted, further studies are required to more clearly define associations in children and adolescents. Study registration Prospero ID: CRD42020176752.
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Introduction University students experienced significant changes in their routines with the implementation of remote learning during Covid‐19 pandemic, including increase in sedentary behavior (SB) time and ultra‐processed foods (UPF's) consumption, which may have influenced changes in body mass index (BMI). Objective To evaluate the association between the variation in SB time and UPF's consumption with the variation in BMI, before and during the pandemic, in university students. Methods This is a cross‐sectional study, conducted between November 2020 and February 2021, with students from a public university of Southeast of Brazil, who answered an online questionnaire with questions regarding to the period before and during the pandemic. SB was assessed through questions about time spent on TV and electronic devices. A score of the frequency of UPF's consumption was estimated based on the Brazilian Food Guide. Self‐reported information on height and body mass was used to calculate BMI. Results The sample comprised 3390 university students, with an average age of 28.7 (± 10.0) years. Among them, 65.4% were undergraduates, and 66.9% were women. SB time, UPF score, and BMI increased significantly during the pandemic, compared to the previous period. In this population, there was a significant association between increased SB time ( β = 0.06; SE = 0.01; p < 0.001) and UPF score ( β = 0.08; SE = 0.01; p < 0.001) with an increase in BMI. Conclusion Changes in SB time and UPF score were associated with an increase in BMI before and during the COVID‐19 pandemic in students from a Brazilian University.
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Tarih boyunca besinlerin daha uzun süre saklanabilmesi amacıyla çeşitli besin işleme yöntemleri (ateş, tuz ve havanın kullanılması, fermantasyon ve tütsüleme vb.) kullanılmıştır. Sanayileşme ile birlikte bu işleme yöntemlerinin amacı ve kapsamı da değişiklik göstermiştir. İşlenmiş besinler, gıdalardan/gıda substratlarından elde edilen veya sentezlenen bileşikler yoluyla üretilen endüstriyel formülasyonlar olarak tanımlanmakta ve NOVA sınıflandırılması ile karakterize edilmektedir. NOVA olarak adlandırılan bu sınıflandırmada besinler 'endüstriyel işlemenin kapsamı ve amacı' temelinde işlenmemiş/minimum düzeyde işlenmiş besinler, işlenmiş yemeklik katkılar, işlenmiş besinler ve ultra işlenmiş besinler olmak üzere dört gruba ayrılmıştır. Ultra-işlenmiş besinlerin tüketimi geçmişte yüksek gelirli ülkelerde, günümüzde ise orta ve düşük gelirli ülkelerde giderek artmaktadır. Bu besinler karakteristik olarak yüksek enerji yoğunluğu, yağ, şeker ve tuz içeriğine sahip; aşırı lezzetli, ucuz, çekici, tüketime hazır ve genellikle obezojenik ürünlerdir. Bu tür besinlerin tüketiminin artması ile obezite başta olmak üzere bulaşıcı olmayan hastalıkların prevalansı artış göstermektedir. Ultra işlenmiş besinlerin tüketimi, yetişkinlerde beden kütle indeksi, bel çevresi, vücut yağ yüzdesi ve visseral yağ dokusu artışına, çocuklarda bel çevresi artışı ve dislipidemiye, adölesanlarda ise metabolik sendroma yol açmaktadır. Ultra işlenmiş besinlerin daha fazla tüketilmesini sağlayacak biçimde paketlenmeleri ve agresif reklam stratejileri, beyin tepkisini manipüle ederek bireylerde yoğun uyarıya maruziyet sonucu aşırı tüketime yol açabilmektedir. Bu derlemede ultra işlenmiş besinlerin sağlık üzerine etkileri ve bu besinlerin alımını teşvik eden faktörlerin incelenmesi amaçlanmıştır.
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Scientific research shows that on average, human adults consume daily 1.5-2.5 of food. The daily amount of food intake can vary depending on factors such as age, body weight, activity level, and dietary requirements. Generally, the recommended daily calorie intake is 2,000 calories a day for women and 2,500 for men. The unprocessed or minimally processed foods include fruit, vegetables, milk, fish, fresh meat, pulses, eggs, nuts and seeds that have no added ingredients and have been little altered from their natural state. Processed ingredients that are added to other foods to make them palatable are salt, sugar and fats-oils. Ultra-processed foods (UPF) tend to include many additives and extra ingredients, such as preservatives, emulsifiers, sweeteners, and artificial colours and flavours. The products undergo multiple industrial processes to make them tasty and shelf-stable, and contain additives like emulsifiers, colouring agents and chemical flavours. Ultra-processed foods now account for up to 58% of total daily energy intake in some high income-countries. These highly processed foods contain loads of sugar, salt and saturated fat, as well as other ingredients that can be harmful to many organ and systems within the human body. Scientific epidemiological and clinical research results in the last decades have accumulated evidence linking ultra-processed foods with a 21% greater risk of death from any cause, a 55% increased risk of obesity, a 40% increased risk of type 2 diabetes, a 41% increased risk of sleep problems and a 22% increased risk of depression. A recent review (2022) collected data from 48 prospective studies investigating the associations between UPF consumption and health status, chronic diseases, or mortality. Reviewers concluded that UPF consumption is associated with several adverse health effects and pathologies given the prevalence of UPFs in diets globally. Numerous research efforts have focused on better understanding the mechanisms behind UPF's effects on health. These efforts have brought to light the potential central role played by the intestinal microbiota in connecting UPF and host health. The human intestinal microbiota has co-evolved with their host for millennia and now perform core functions, such as food digestion and maturation of host immunity and metabolism. A combination of laboratory-based preclinical research, epidemiological studies, and clinical trials suggest that UPFs affect human health. Research on UPF showed that is directly linked to 32 harmful effects to health, including a higher risk of heart disease, cancer, type 2 diabetes, adverse mental health and early death, according to the world's largest review of its kind. The findings from the first comprehensive umbrella review (2024) of evidence come amid rapidly rising global consumption of UPF. In the UK and US, more than50% the average diet now consists of ultra-processed food. For some, especially people who are younger, poorer or from disadvantaged areas, a diet comprising as much as 80% UPF is typical. The review presents all these research studies. 2
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The social and economic constructs of the United Kingdom (UK) provide a fertile food environment for the dramatic expansion in the ultra‐processed food (UPF) market, driving increased UPF consumption. This has coincided with the significant increase in the incidence and prevalence of non‐communicable diseases (NCDs) such as obesity, type 2 diabetes, cardiovascular disease, and cancer, with an inherent impact on morbidity and mortality. Our review aims to assess the current epidemiological and public health trends in the United Kingdom, specifically examining consumption of UPFs and subsequent development of NCDs, summarizing existing meta‐analytical and experimental approaches. First, we address important socioeconomic and psychosocial domains that may contribute to increased availability and consumption of UPF. Additionally, we explore the putative mechanistic basis for the association between UPFs and NCDs: partly attributable to their energy density , the macro‐ and micronutrient composition (including high refined carbohydrate, saturated, and trans fats composition, in addition to low fiber and protein content), and artificially engineered additives and other compounds that adversely affect health in inadequately researched pathophysiological pathways. This review highlights the importance of promoting minimally processed diets to both clinical and political decision makers.
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Inflammatory status is one of the main drivers in the development of non-communicable diseases (NCDs). Specific unhealthy dietary patterns and the growing consumption of ultra-processed foods (UPFs) may influence the inflammation process, which negatively modulates the gut microbiota and increases the risk of NCDs. Moreover, several chronic health conditions require special long-term dietary treatment, characterized by altered ratios of the intake of nutrients or by the consumption of disease-specific foods. In this narrative review, we aimed to collect the latest evidence on the pro-inflammatory potential of dietary patterns, foods, and nutrients in children affected by multifactorial diseases but also on the dietetic approaches used as treatment for specific diseases. Considering multifactorial diet-related diseases, the triggering effect of pro-inflammatory diets has been addressed for metabolic syndrome and inflammatory bowel diseases, and the latter for adults only. Future research is required on multiple sclerosis, type 1 diabetes, and pediatric cancer, in which the role of inflammation is emerging. For diseases requiring special diets, the role of single or multiple foods, possibly associated with inflammation, was assessed, but more studies are needed. The evidence collected highlighted the need for health professionals to consider the entire dietary pattern, providing balanced and healthy diets not only to permit the metabolic control of the disease itself, but also to prevent the development of NCDs in adolescence and adulthood. Personalized nutritional approaches, in close collaboration between the hospital, country, and families, must always be promoted together with the development of new methods for the assessment of pro-inflammatory dietary habits in pediatric age and the implementation of telemedicine.
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Scope: Evidence suggests a positive association between ultra-processed food (UPF) consumption and the incidence of cardiovascular disease (CVD). We aimed to investigate associations between UPF intake and respiratory disease, CVD, and their multimorbidity in a large prospective cohort. Methods and results: Within the UK Biobank, participants who were free from respiratory disease or CVD at baseline and completed at least two times 24-h dietary records were included in this study. After adjusting for socioeconomic status and lifestyle factors, the hazard ratios (95% confidence interval) for each ten percent increase in UPF were 1.06 (1.04, 1.09) for CVD, 1.04 (1.02, 1.06) for respiratory disease, 1.15 (1.08, 1.22) for CVD mortality, and 1.06 (1.01, 1.12) for their multimorbidity, respectively. In addition, replacing 20% of UPF weight in diet with an equivalent proportion of unprocessed or minimally processed foods was estimated to be associated with 11% lower risk of CVD, 7% lower risk of respiratory disease, 25% lower risk of CVD mortality and 11% lower risk of CVD and respiratory disease multimorbidity. Conclusion: In this prospective cohort study, higher consumption of UPF was associated with higher risks of CVD and respiratory disease multimorbidity. Further longitudinal studies are needed to confirm our findings. This article is protected by copyright. All rights reserved.
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Objective: To verify the prevalence of the offer of ultra-processed foods (UPFs), and to analyze their associated factors in the child's first year of life. Methods: Cross-sectional study with 119 mother-infant pairs. At 5.5 months of the child, the mothers received guidance on complementary feeding (CF) according to three methods: Parent-Led Weaning (PLW), Baby-Led Introduction to Solids (BLISS), or mixed (a combination of PLW and BLISS). At nine and 12 months, the mothers answered a questionnaire about the offer of UPFs. The NOVA classification, which classifies foods according to the nature, extent, and purposes of the industrial processes to which they are subjected, was used to list the UPFs. Descriptive statistics and multivariate Poisson regression, following a multilevel hierarchical model according to the proximity to the outcome, were used to estimate the association between dependent and independent variables. Results: The prevalence of UPF consumption was 63 % (n = 75) in the first year of life. Receiving guidance on healthy CF in the BLISS method showed to be a protective factor for offering UPFs (RR 0.72; CI95 0.52-0.99). Attending less than six prenatal consultations was a risk factor for the UPFs provision (RR 1.39; CI95 1.07-1.80). Conclusion: The prevalence of UPFs offered in the first year of life in this study can be considered high, and future interventions aimed at avoiding UPFs offered in this population should consider the CF method.
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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.
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CHAPTER NINE DEVELOPMENT OF SPORTS SPONSORSHIP IN TURKEY AND COMPARISON BY EUROPEAN LEAGUES (FOOTBALL EXAMPLE) Özlem EKİZOĞLU1, Mehmet ACET2 Abstract: Football is undoubtedly all other sports with its audience and viewing rates. differs significantly from its branches. Knowing this, sponsors concentrate mostly on football. International sports sponsorship has proven important as online digital technologies have the capacity to interact with customers on a global scale through multiple digital platforms. This change of sport has made it a great place in the world economy. So much so that the income of a club in Europe is more than the national income of many small countries. The aim of our study; Considering sports sponsorship in Turkey with the example of football; is to examine the developmental stages and the latest status according to the European Leagues. Keywords: Sports, Sponsorship, Football.
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Gebelik ve doğum kadının hayatını fiziksel, zihinsel, duygusal ve ruhsal olarak değiştiren bir süreçtir. Doğum süreci daha önce dene�yimlenmeyen şiddetli bir ağrı, bebeğin doğumuyla gerçekleşen rahat�lama ve yeni bebeği ile tanışmanın vermiş olduğu mutluluk gibi birçok duygunun aynı zamanda yaşandığı, doğum gücü, doğum kanalı, fetüs, maternal zihinsel ve psikolojik faktörlerden etkilenen dinamik bir süreç�tir. Doğumda hissedilen kontraksiyonlar her gebe tarafından farklı bo�yutlarda algılanan bir ağrıdır. Doğum ağrısı ile baş etmede farmakolojik ya da nonfarmakolojik yöntemler kullanılabilir. Yoga yaparak gebelik dönemini konforlu ve rahat geçirmenin yanı sıra, kolay ve en az müda�hale ile doğumu gerçekleştiren kadının, doğum sonu döneme de daha uyumlu olduğu yapılan birçok çalışma ile desteklenmektedir. Yoga, bi�reyin fiziksel, zihinsel, duygusal ve ruhsal boyutlarına denge ve sağlık getirmek için tasarlanmış eski bir disiplindir. Sonuç olarak yoga eğitimli kişiler tarafından yönlendirilerek gözetim altında uygulandığında her�hangi bir yan etkisi olmaksızın gebeliğe çok uygundur. Yoganın invaziv olmayan, öğrenmesi kolay zihin-beden uygulaması olduğu, doğum ağ�rısını hafifletmede ve muhtemelen doğum sonucunu iyileştirmede etkili olduğu birçok çalışmada vurgulanmaktadır. Anahtar Kelimeler: Gebelik, Doğum, Doğum Sancısı, Yoga
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Background Ultra-processed foods (UPF) are associated with poor diet quality and chronic diseases. UPF falls into one of the four groups classified according to the extent and purpose of processing: Group 1 includes unprocessed and minimally processed foods (MPF); group 2 refers to processed culinary ingredients (PCI); group 3, processed foods (PF); and group 4, UPF. Objective The aim of this study was to evaluate the relative validity of a semi-quantitative food frequency questionnaire (SFFQ) compared to two 24-hour dietary recalls to estimate dietary intake per NOVA food group in Mexican children and adolescents. Design This study is a secondary analysis of dietary data from a subsample of children and adolescents who participated in the 2012 Mexican National Health and Nutrition Survey Participants/setting The study participants were 217 children (5 to 11 years) and 165 adolescents (12 to 19 years) with complete information for the SFFQ and two 24 hour-dietary recalls (24DRs). Main outcome measures Daily averages of energy intake and % of energy intake for each NOVA category were calculated using the SFFQ and two 24DRs. Statistical analysis To assess relative validity, the SFFQ was compared with two 24DRs to estimate dietary intake per NOVA food group. Mean differences, Spearman correlations and intra-class correlations coefficients (ICC) and Bland–Altman plots for continuous variables and weighted kappa for ordinal variables were calculated. Results For percentage of energy intake, ICC in children and adolescents were moderate for MPF (ICC=0.47, ICC=0.56, respectively) and UPF (ICC=0.53, ICC=0.57, respectively). Bland–Altman plots indicated reasonably consistent agreement for UPF and MPF groups in children and adolescents. Classification by quintiles was acceptable in all groups. Conclusions Data from this study indicated reasonable relative validity of the SFFQ to rank the percentage of energy intake from MPF and UPF in Mexican children and adolescents.
Article
Introduction The consumption of ultra-processed products (UP) is associated with many diseases in the adult, such as arterial hypertension, diabetes, or asthma. Objective To determine whether the consumption of UP in children is associated with wheezing respiratory diseases (asthma or bronchitis/recurrent wheezing). Material and methods A cross-sectional study was conducted within the Follow-up of the Child for Optimal Development (SENDO) project (an open, multidisciplinary and multiple outcome study of Spanish children). The consumption of UP was calculated using semi-quantitative questionnaires on the frequency of food consumption. The foods were grouped according to the NOVA classification, and the daily consumption was estimated along with the percentage of Kilocalories from the UP. The exposure was grouped into “high” and “low” from the median consumption. Odds Ratios and 95% confidence intervals were calculated for wheezing respiratory diseases associated with the high consumption UP, using low consumption as a reference. Crude and multi-adjusted estimators were calculated, and mixed regression models were used to take into account the correlation between siblings. Results In the 513 children studied (51.8% males, mean age 5.2 years), the mean consumption of UP was 446.76 g/day, representing 39.9% of the total calories ingested. A high consumption of UP was associated with an increase of 87% in the prevalence of wheezing respiratory diseases (OR: 1.87, 95% CI: 1.01–3.45). It was found that a higher consumption of UP multiplied by 2.12 (95% CI: 1.10–4.05) the prevalence of bronchitis/recurrent wheezing. Conclusions The results of this study show a direct relationship between UP consumption and the prevalence of wheezing diseases in children.
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Background The detrimental impact of dominant corporations active in health-harming commodity industries is well recognised. However, to date, existing analyses of the ways in which corporations influence health have paid limited attention to corporate market power. Accordingly, the public health implications of concentrated market structures, the use of anti-competitive market strategies, and the ways in which market power mediates the allocation and distribution of resources via market systems, remain relatively unexplored. To address this gap, this paper aimed to identify and explore key literature that could inform a comprehensive framework to examine corporate market power from a public health perspective. The ultra-processed food (UPF) industry was used to provide illustrative examples. Methods A scoping review of a diverse range of literature, including Industrial Organization, welfare economics, global political economy and antitrust policy, was conducted to identify important concepts and metrics that could be drawn upon within the field of public health to understand and explore market power. The Structure-Conduct-Performance (SCP) model, a guiding principle of antitrust policy and the regulation of market power, was used as an organising framework. Results We described each of the components of the traditional SCP model and how they have historically been used to assess market power through examining the interrelations between the structure of industries and markets, the conduct of dominant firms, and the overall ability of markets and firms to efficiently allocate and distribute the scarce resources. Conclusion We argue that the SCP model is well-placed to broaden public health research into the ways in which corporations influence health. In addition, the development of a comprehensive framework based on the key findings of this paper could help the public health community to better engage with a set of policy and regulatory tools that have the potential to curb the concentration of corporate power for the betterment of population health.
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Background: Increasing consumption of highly processed foods has been associated with adverse health outcomes among children. In the US, children consume up to half of their daily energy intake at school. Objectives: We sought to characterize foods that children bring from home to school according to processing level and to evaluate the effectiveness of a school-based intervention, Great Taste Less Waste (GTLW), in reducing the proportion of energy brought from highly processed foods from home compared with control. Design: Secondary data analysis of a 7-month school-based, cluster-randomized trial. Participants/setting: Third- and fourth-grade students (n = 502, mean age: 9.0 ± 0.62 years) at 10 public elementary schools in Eastern Massachusetts (school year 2012-2013). Intervention: GTLW included a 22-lesson classroom curriculum, homework activities, monthly parent newsletters, a food shopping and packing guide for parents, food demonstrations, school-wide announcements, and a poster contest. Main outcome measures: The energy content of foods brought to school was estimated from digital photographs, and foods were assigned to 1 of 3 processing levels (less processed or unprocessed, moderately processed, or highly processed) based on an established classification system. Statistical analyses performed: The percentage of energy brought from foods categorized into each processing level was calculated and compared pre- and postintervention using hierarchical linear models. Results: Most of the food brought from home to school was highly processed (70% of food energy brought). Foods categorized as snack foods and desserts contributed the greatest percentage of total energy to the highly processed category at baseline and follow-up (72% and 69%, respectively). Energy from foods brought for snack tended to be more highly processed than those brought for lunch. No significant differences were observed from pre- to postintervention in the GTLW group compared with control for the percentage of energy brought from highly processed foods in adjusted models (β: -1.1, standard error: 2.2, P = .6) or any other processing level. Conclusions: Highly processed foods were prevalent in home-packed lunches and snacks, and these patterns persisted after a targeted intervention. Further research is needed to identify strategies to improve the healthfulness of foods brought from home to school.
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Background and aim: The burden of childhood asthma and its risk factors is an important but neglected public health challenge in Latin America. We investigated the association between allergic symptoms and dietary intake in children from this region. Methods: As part of the International Study of Asthma and Allergies in Childhood (ISAAC) Phase III, questionnaire collected dietary intake was investigated in relation to risk of parental/child reported current wheeze (primary outcome) and rhino-conjunctivitis and eczema. Per-country adjusted logistic regressions were performed, and combined effect sizes were calculated with meta-analyses. Results: 143,967 children from 11 countries had complete data. In children aged 6-7 years, current wheeze was negatively associated with higher fruit intake (adjusted odds ratio [aOR] 0.65; 95% CI 0.74, 0.97). Current rhino-conjunctivitis and eczema were statistically negatively associated with fruit intake (aOR 0.72; 95% CI 0.64, 0.82; and OR 0.64, 95% CI 0.56, 0.74, respectively). Vegetable intake was negatively associated with risk of symptoms in younger children, but these associations were attenuated in the 13-14 years old group. Fastfood/burger intake was positively associated with all three outcomes in the older children. Conclusion: A higher intake of fruits and vegetables was associated with a lower prevalence of allergic symptoms in Latin American children. Conversely, intake of fastfood was positively associated with a higher prevalence of wheeze in adolescents. Improved dietary habits in children might help reduce the epidemic of allergic symptoms in Latin America. Food interventions in asthmatic children are needed to evaluate the possible public health impact of a better diet on respiratory health.
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Given evident multiple threats to food systems and supplies, food security, human health and welfare, the living and physical world and the biosphere, the years 2016–2025 are now designated by the UN as the Decade of Nutrition, in support of the UN Sustainable Development Goals. For these initiatives to succeed, it is necessary to know which foods contribute to health and well-being, and which are unhealthy. The present commentary outlines the NOVA system of food classification based on the nature, extent and purpose of food processing. Evidence that NOVA effectively addresses the quality of diets and their impact on all forms of malnutrition, and also the sustainability of food systems, has now accumulated in a number of countries, as shown here. A singular feature of NOVA is its identification of ultra-processed food and drink products. These are not modified foods, but formulations mostly of cheap industrial sources of dietary energy and nutrients plus additives, using a series of processes (hence ‘ultra-processed’). All together, they are energy-dense, high in unhealthy types of fat, refined starches, free sugars and salt, and poor sources of protein, dietary fibre and micronutrients. Ultra-processed products are made to be hyper-palatable and attractive, with long shelf-life, and able to be consumed anywhere, any time. Their formulation, presentation and marketing often promote overconsumption. Studies based on NOVA show that ultra-processed products now dominate the food supplies of various high-income countries and are increasingly pervasive in lower middle- and upper-middle-income countries. The evidence so far shows that displacement of minimally processed foods and freshly prepared dishes and meals by ultra-processed products is associated with unhealthy dietary nutrient profiles and several diet-related non-communicable diseases. Ultra-processed products are also troublesome from social, cultural, economic, political and environmental points of view. We conclude that the ever-increasing production and consumption of these products is a world crisis, to be confronted, checked and reversed as part of the work of the UN Sustainable Development Goals and its Decade of Nutrition. (NOVA, Ultra-processing)
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The burden of obesity-related asthma among children, particularly among ethnic minorities, necessitates an improved understanding of the underlying disease mechanisms. Although obesity is an independent risk factor for asthma, not all obese children develop asthma. Several recent studies have elucidated mechanisms, including the role of diet, sedentary lifestyle, mechanical fat load, and adiposity-mediated inflammation that may underlie the obese asthma pathophysiology. Here, we review these recent studies and emerging scientific evidence that suggest metabolic dysregulation may play a role in pediatric obesity-related asthma. We also review the genetic and epigenetic factors that may underlie susceptibility to metabolic dysregulation and associated pulmonary morbidity among children. Lastly, we identify knowledge gaps that need further exploration to better define pathways that will allow development of primary preventive strategies for obesity-related asthma in children.
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Epidemiological research on the relationship between diet and asthma has increased in the last decade. Several components found in foods have been proposed to have a series of antioxidant, anti-allergic and anti-inflammatory properties, which can have a protective effect against asthma risk. Several literature reviews and critical appraisals have been published to summarise the existing evidence in this field. In the context of this EAACI Lifestyle and asthma Task Force, we summarise the evidence from existing systematic reviews on dietary intake and asthma, using the PRISMA guidelines. We therefore report the quality of eligible systematic reviews and summarise the results of those with an AMSTAR score ≥32. The GRADE approach is used to assess the overall quality of the existing evidence. This overview is centred on systematic reviews of nutritional components provided in the diet only, as a way to establish what type of advice can be given in clinical practice and to the general population on dietary habits and asthma. This article is protected by copyright. All rights reserved.
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OBJECTIVE To evaluate the impact of consuming ultra-processed foods on the micronutrient content of the Brazilian population’s diet. METHODS This cross-sectional study was performed using data on individual food consumption from a module of the 2008-2009 Brazilian Household Budget Survey. A representative sample of the Brazilian population aged 10 years or over was assessed (n = 32,898). Food consumption data were collected through two 24-hour food records. Linear regression models were used to assess the association between the nutrient content of the diet and the quintiles of ultra-processed food consumption – crude and adjusted for family income per capita. RESULTS Mean daily energy intake per capita was 1,866 kcal, with 69.5% coming from natural or minimally processed foods, 9.0% from processed foods and 21.5% from ultra-processed foods. For sixteen out of the seventeen evaluated micronutrients, their content was lower in the fraction of the diet composed of ultra-processed foods compared with the fraction of the diet composed of natural or minimally processed foods. The content of 10 micronutrients in ultra-processed foods did not reach half the content level observed in the natural or minimally processed foods. The higher consumption of ultra-processed foods was inversely and significantly associated with the content of vitamins B12, vitamin D, vitamin E, niacin, pyridoxine, copper, iron, phosphorus, magnesium, selenium and zinc. The reverse situation was only observed for calcium, thiamin and riboflavin. CONCLUSIONS The findings of this study highlight that reducing the consumption of ultra-processed foods is a natural way to promote healthy eating in Brazil and, therefore, is in line with the recommendations made by the Guia Alimentar para a População Brasileira (Dietary Guidelines for the Brazilian Population) to avoid these foods.
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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 ≥10years 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 (0.94kg/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.
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to evaluate the relationship between the consumption of ultra-processed foods and obesity indicators among Brazilian adults and adolescents. 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-hour 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. 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. Our findings support the role of ultra-processed foods in the obesity epidemic in Brazil. Copyright © 2015. Published by Elsevier Inc.
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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.
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BACKGROUND: The increased asthma prevalence in westernized societies has been suggested to be related to environment exposures and lifestyle changes, particularly diet. We aimed to explore the association between dietary patterns and asthma prevalence, incidence and control in a nationally representative population. METHODS: Data from 32 644 adults, 53% female, from the 4th Portuguese National Health Survey were analysed. Prevalence of asthma was 5.3%; 'current asthma', defined by asthma symptoms within previous year, 3.5%; 'current medicated asthma' defined by use of asthma medication within previous year, 3.0%; 'current severe asthma' defined by emergency visit because of asthma within previous year, 1.4%; and 'incident asthma', 0.2%. Dietary patterns (DP) were identified by latent trait models based on dietary intake. Unconditional logistic regression models were performed to analyse association between DP and asthma. Age, gender, education, family income, proxy reporting information, smoking, body mass index and physical activity level were analysed as confounders. RESULTS: Two of the five identified DP were associated with asthma: 'high fat, sugar and salt' DP (positively correlated with pastry, chocolate and sweet desserts, candies, salty snacks, chips, fruit juices, soft drinks and alcoholic beverages consumption at snacks) was associated with asthma prevalence (OR = 1.13, 95% CI = 1.03, 1.24) and current severe asthma (OR = 1.23, 95% CI = 1.03, 1.48), while 'fish, fruit and vegetables' DP (positively correlated with fish, vegetables and fruit intake at meals) was negatively associated with current (OR = 0.84, 95% CI = 0.73, 0.98), and current medicated asthma (OR = 0.84, 95% CI = 0.72, 0.98), after adjustment for confounders. CONCLUSION & CLINICAL RELEVANCE: Our results suggest a protective association between 'fish, vegetables and fruit' DP and current asthma and current medicated asthma, and a detrimental association between 'high fat, sugar and salt' DP and severe asthma prevalence, further supporting the rational for diet and lifestyle intervention studies in asthma based on whole dietary patterns and physical activity.
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Objective: This study aims to describe the prevalence rates of asthma symptoms in Brazil, its Regions and State capitals, according to data from the National Adolescent School-based Health Survey, 2012. Furthermore, it aims to compare the prevalence of asthma in the capitals evaluated by PeNSE 2012 with previous results of the International Study of Asthma and Allergies in Childhood (ISAAC). Methods: Cross sectional study of 9th grade students at public and private schools of all Brazilian states and the Federal District (Brasília). A self reported questionnaire containing items from the ISAAC was applied in order to identify the presence of asthma symptoms. Results: The results of PeNSE indicate a high prevalence of asthma symptoms (23.2%) and of reports of a previous medical diagnosis of asthma (12.4%). Of the five state capitals in which the PeNSE results were compared to the ISAAC, São Paulo, Curitiba and Porto Alegre presented an increase in the prevalence of asthma symptoms. In Salvador, there was a reduction. Conclusion: Brazil is among the countries with the highest prevalence of asthma in the world, and the prevalence is still growing.
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Objective: To establish temporal trends in household food and drink consumption in Brazil, taking into account the extent and purpose of its industrial processing. Methods: Data was obtained from Household Budget Surveys conducted in Brazil in 1987-1988, 1995-1996, 2002-2003 and 2008-2009. In all surveys, probabilistic samples of households in the metropolitan areas were studied and, for the last two surveys, the scope was national. The units of analysis were food purchases records of clusters of households. The purchased food items were divided according to the extent and purpose of their industrial processing into: 'in natura' or minimally processed foods, processed culinary ingredients and ready-to-consume, processed and ultra-processed food and drink products. The quantity of each item was converted into energy. For each survey, the daily availability of calories per capita and the caloric share of the food groups were estimated. For the national surveys, estimates were calculated by income quintiles. Temporal trends were assessed using linear regression models and difference of means tests. Results: The caloric share of ready-to-consume products significantly increased between 2002-2003 and 2008-2009 (from 23.0% to 27.8% of total calories), mainly because of the increase in the consumption of ultra-processed products (20.8% to 25.4%). In the same period, there was a significant reduction in the caloric share of foods and culinary ingredients. The increase in the ultra-processed products caloric share occurred across all income quintiles. There was an uniform increase in the caloric share of ready-to-consume products in the metropolitan areas, mostly in place of ultra-processed products, accompanied by a decrease in the share of 'in natura' or minimally processed foods and culinary ingredients. Conclusions: The share of ultra-processed products significantly increased in the Brazilian diet, as seen in the metropolitan areas since the 1980s, and confirmed at a national level in the 2000s.
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Background: Non-steroidal anti-inflammatory drugs (NSAIDs), especially aspirin, and food additives (FAs) may exacerbate allergic symptoms in patients with chronic idiopathic urticaria and food-dependent exercise-induced anaphylaxis (FDEIA). Augmentation of histamine release from human mast cells and basophils by those substances is speculated to be the cause of exacerbated allergic symptoms. We sought to investigate the mechanism of action of aspirin on IgE-mediated histamine release. Methods: The effects of NSAIDs, FAs or cyclooxygenase (COX) inhibitors on histamine release from human basophils concentrated by gravity separation were evaluated. Results: Benzoate and tartrazine, which have no COX inhibitory activity, augmented histamine release from basophils similar to aspirin. In contrast, ibuprofen, meloxicam, FR122047 and NS-398, which have COX inhibitory activity, did not affect histamine release. These results indicate that the augmentation of histamine release by aspirin is not due to COX inhibition. It was observed that aspirin augmented histamine release from human basophils only when specifically activated by anti-IgE antibodies, but not by A23187 or formyl-methionyl-leucyl-phenylalanine. When the IgE receptor signaling pathway was activated, aspirin increased the phosphorylation of Syk. Moreover, patients with chronic urticaria and FDEIA tended to be more sensitive to aspirin as regards the augmentation of histamine release, compared with healthy controls. Conclusions: Aspirin enhanced histamine release from basophils via increased Syk kinase activation, and that the augmentation of histamine release by NSAIDs or FAs may be one possible cause of worsening symptoms in patients with chronic urticaria and FDEIA.
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Background: Childhood obesity is a global epidemic and is associated with a higher risk of chronic diseases such as hypertension, diabetes mellitus and other metabolic disorders. Several adipokines including resistin, visfatin, leptin and adiponectin are synthesized and secreted by adipocytes, which play an important role in obesity. Patients & methods: A total of 90 subjects (60 controls and 30 obese) between the ages of 5 and 18 years were selected. Serum visfatin, TNF-α, resistin, insulin and adiponectin were measured using ELISA and insulin resistance was calculated by the Homeostasis Model of Assessment-Insulin Resistance. Results: Mean ± standard deviation Homeostasis Model of Assessment-Insulin Resistance, serum TNF-α and visfatin levels were significantly higher in obese subjects (3.99 ± 0.94, 12.99 ± 3.42, 10.89 ± 2.72, respectively) compared with the control group (1.60 ± 0.34, 7.22 ± 2.22 and 4.97 ± 1.57, respectively). Mean ± standard deviation serum adiponectin levels were significantly lower in obese children (5.95 ± 1.02) compared with controls (9.07 ± 1.25). Binary logistic regression shows that adiponectin and visfatin are associated with obesity. Conclusion: Circulating levels of adipokines vary in obesity and adiponectin and visfatin are associated with obesity.
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Este estudo visa a contextualizar por meio de uma revisão sistemática da literatura, os riscos acarretados pelo consumo de aditivos alimentares. Em relação aos resultados dos estudos associando o consumo de aditivos ao aparecimento do câncer, os efeitos adversos à saúde foram observados principalmente nos estudos em que a Ingestão Diária Aceitável (IDA) foi excedida. Também apontou uma carência de pesquisas sobre o transtorno do déficit de atenção e hiperatividade. Já em relação à hipersensibilidade não específica, o número de estudos foi significativo e os resultados mais consistentes quanto às manifestações clínicas de rinite, urticária e angioedema provocadas pelos aditivos, em particular pelos os corantes artificiais. As crianças aparecem como grupo vulnerável, em razão do consumo potencial de alimentos com aditivos alimentares, particularmente corantes artificiais. Os resultados indicam que estudos de consumo de aditivos alimentares deveriam servir de base para a elaboração de estratégias de vigilância alimentar e nutricional, com a finalidade de promover hábitos alimentares saudáveis.
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Background: Measuring disease and injury burden in populations requires a composite metric that captures both premature mortality and the prevalence and severity of ill-health. The 1990 Global Burden of Disease study proposed disability-adjusted life years (DALYs) to measure disease burden. No comprehensive update of disease burden worldwide incorporating a systematic reassessment of disease and injury-specific epidemiology has been done since the 1990 study. We aimed to calculate disease burden worldwide and for 21 regions for 1990, 2005, and 2010 with methods to enable meaningful comparisons over time. Methods: We calculated DALYs as the sum of years of life lost (YLLs) and years lived with disability (YLDs). DALYs were calculated for 291 causes, 20 age groups, both sexes, and for 187 countries, and aggregated to regional and global estimates of disease burden for three points in time with strictly comparable definitions and methods. YLLs were calculated from age-sex-country-time-specific estimates of mortality by cause, with death by standardised lost life expectancy at each age. YLDs were calculated as prevalence of 1160 disabling sequelae, by age, sex, and cause, and weighted by new disability weights for each health state. Neither YLLs nor YLDs were age-weighted or discounted. Uncertainty around cause-specific DALYs was calculated incorporating uncertainty in levels of all-cause mortality, cause-specific mortality, prevalence, and disability weights. Findings: Global DALYs remained stable from 1990 (2·503 billion) to 2010 (2·490 billion). Crude DALYs per 1000 decreased by 23% (472 per 1000 to 361 per 1000). An important shift has occurred in DALY composition with the contribution of deaths and disability among children (younger than 5 years of age) declining from 41% of global DALYs in 1990 to 25% in 2010. YLLs typically account for about half of disease burden in more developed regions (high-income Asia Pacific, western Europe, high-income North America, and Australasia), rising to over 80% of DALYs in sub-Saharan Africa. In 1990, 47% of DALYs worldwide were from communicable, maternal, neonatal, and nutritional disorders, 43% from non-communicable diseases, and 10% from injuries. By 2010, this had shifted to 35%, 54%, and 11%, respectively. Ischaemic heart disease was the leading cause of DALYs worldwide in 2010 (up from fourth rank in 1990, increasing by 29%), followed by lower respiratory infections (top rank in 1990; 44% decline in DALYs), stroke (fifth in 1990; 19% increase), diarrhoeal diseases (second in 1990; 51% decrease), and HIV/AIDS (33rd in 1990; 351% increase). Major depressive disorder increased from 15th to 11th rank (37% increase) and road injury from 12th to 10th rank (34% increase). Substantial heterogeneity exists in rankings of leading causes of disease burden among regions. Interpretation: Global disease burden has continued to shift away from communicable to non-communicable diseases and from premature death to years lived with disability. In sub-Saharan Africa, however, many communicable, maternal, neonatal, and nutritional disorders remain the dominant causes of disease burden. The rising burden from mental and behavioural disorders, musculoskeletal disorders, and diabetes will impose new challenges on health systems. Regional heterogeneity highlights the importance of understanding local burden of disease and setting goals and targets for the post-2015 agenda taking such patterns into account. Because of improved definitions, methods, and data, these results for 1990 and 2010 supersede all previously published Global Burden of Disease results. Funding: Bill & Melinda Gates Foundation.
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This study uses a systematic literature review to contextualize the risks associated with food additive intake. Studies comparing food additive intake and cancer showed that adverse health effects appeared when Acceptable Daily Intake (ADI) was exceeded. The review also detected a lack of studies on attention deficit-hyperactivity disorder. There were more studies on non-specific hypersensitivity, highlighting such clinical manifestations as rhinitis, urticaria, and angioedema, all associated with food additives, particularly artificial colorants. Children are a vulnerable group as potential consumers of food additives, particularly artificial colorants. Studies on food additive intake should provide the basis for effective food and nutritional surveillance strategies, aiming to promote healthy eating habits.
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Phase Three of the International Study of Asthma and Allergies in Childhood (ISAAC) measured the global prevalence and severity of asthma symptoms in children. A cross-sectional questionnaire survey of 798 685 children aged 13-14 years from 233 centres in 97 countries, and 388 811 children aged 6-7 years from 144 centres in 61 countries, was conducted between 2000 and 2003 in >90% of the centres. The prevalence of wheeze in the past 12 months (current wheeze) ranged from 0.8% in Tibet (China) to 32.6% in Wellington (New Zealand) in the 13-14 year olds, and from 2.4% in Jodhpur (India) to 37.6% in Costa Rica in the 6-7 year olds. The prevalence of symptoms of severe asthma, defined as >or=4 attacks of wheeze or >or=1 night per week sleep disturbance from wheeze or wheeze affecting speech in the past 12 months, ranged from 0.1% in Pune (India) to 16% in Costa Rica in the 13-14 year olds and from 0% to 20.3% in the same two centres, respectively, in the 6-7 year olds. Ecological economic analyses revealed a significant trend towards a higher prevalence of current wheeze in centres in higher income countries in both age groups, but this trend was reversed for the prevalence of severe symptoms among current wheezers, especially in the older age group. Wide variations exist in the symptom prevalence of childhood asthma worldwide. Although asthma symptoms tend to be more prevalent in more affluent countries, they appear to be more severe in less affluent countries.
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Occupational asthma (OA) caused by carmine (E-120) has been reported. We sought to evaluate the prevalence of sensitization and OA at a natural dye processing factory in which 2 workers had been given a diagnosis of carmine-induced OA 6 years previously. The 24 current employees and one worker who had recently left work because of asthma completed a questionnaire and underwent skin testing (carmine, cochineal, carminic acid, curcuma, annato, and chlorophyll), carmine IgE dot-blot analysis, and methacholine inhalation testing. Workers exhibiting positive occupational skin test responses, work-related asthma, or bronchial hyperresponsiveness underwent specific inhalation challenge and serial peak expiratory flow rate recording. Positive skin test responses to carmine (41.7%), cochineal (29.2%), and carminic acid (4.2%) were observed. Carmine IgE dot-blot results were positive in 4 subjects. No difference in atopy or smoking was observed between occupationally sensitized and nonsensitized subjects. Among the 5 employees reporting work-related asthma, 2 had positive skin test responses, and 4 had bronchial hyperresponsiveness. Five subjects underwent specific inhalation challenges: 2 workers had early asthma responses to carmine and cochineal challenges, and the remaining subjects did not have suggestive peak expiratory flow recordings. The subject who had left his job was given a diagnosis of carmine-induced OA. The prevalence of sensitization and OA caused by carmine was 41.6% and 8.3%, respectively. When the 3 workers who had left their jobs were included, the cumulative incidence of sensitization and OA was 48.1% and 18.5%, resembling the healthy worker effect. Prevention programs to establish the permissible levels of airborne allergen should be implemented.
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Rationale: Asthma and obesity often occur together in children. It is unknown whether asthma contributes to the childhood obesity epidemic. Objectives: We aimed to investigate the effects of asthma and asthma medication use on the development of childhood obesity. Methods: The primary analysis was conducted among 2,171 non-obese children who were 5-8 years of age at study enrollment in the Southern California Children's Health Study (CHS) and were followed for up to 10 years. A replication analysis was performed in an independent sample of 2,684 CHS children followed from mean age of 9.7 to 17.8 years. Measurements and main results: Height and weight were measured annually to classify children into normal, overweight and obese categories. Asthma status was ascertained by parent- or self-reported physician-diagnosed asthma. Cox proportional hazards models were fitted to assess associations of asthma history with obesity incidence during follow-up. Results: We found that children with a diagnosis of asthma at cohort entry were at 51% increased risk of developing obesity during childhood and adolescence compared to children without asthma at baseline [HR (95% CI)=1.51 (1.08, 2.10)] after adjusting for confounders. Use of asthma rescue medications at cohort entry reduced the risk of developing obesity [HR (95% CI)=0.57 (0.33, 0.96)]. Additionally, the significant association between asthma history and increased risk of developing obesity was replicated in an independent CHS sample. Conclusions: Children with asthma may be at higher risk of obesity. Asthma rescue medication use appeared to reduce obesity risk independent of physical activity.
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Recent cross-sectional studies suggested children's current fast food consumption to be related to frequency of asthma and allergies. Prenatal diet has been suspected to contribute to children's asthma and atopic disease risks. We hypothesized that maternal fast food intake during pregnancy increases offspring's risk for asthmatic symptoms. We conducted a population based study of 1201 mother/child pairs in Los Angeles, California. Detailed information about prenatal fast food intake and other dietary, lifestyle/environmental factors, and pregnancy was collected shortly after birth; further data were retrieved from birth certificates. Using the International Study of Asthma and Allergies in Childhood core questions, asthma and rhinitis symptoms were assessed, and doctor's diagnoses were recorded in offspring 3.5 years after birth. Poisson regression with robust error variance using a log link function was used to estimate relative risks (RR). Models were adjusted using covariates or propensity scores. Maternal prenatal fast food consumption increased their children's risks for severe and current asthma symptoms (wheeze last 12 months combined with doctor's diagnosis) in a dose-dependent manner: 'once a month': RR: 0.99 (95%CI: 0.36, 2.75), 'once a week': 1.26 (0.47, 3.34); '3-4 days a week': 2.17 (0.77, 6.12); 'every day' 4.46 (1.36 14.6) compared to 'never', adjusting for potential confounders (P for trend=0.0025). Risks for rhinitis symptoms were also increased albeit less than for asthma symptoms. These findings suggest that in utero exposure to frequent fast food through maternal diet may be a risk factor for the development of asthmatic symptoms in young children. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
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About 334 million people worldwide suffer from asthma, and this figure may be an underestimation. It is the most common chronic disease in children. Asthma is among the top 20 chronic conditions for global ranking of disability-adjusted life years in children; in the mid-childhood ages 5–14 years it is among the top 10 causes. Death rates from asthma in children globally range from 0.0 to 0.7 per 100 000. There are striking global variations in the prevalence of asthma symptoms (wheeze in the past 12 months) in children, with up to 13-fold differences between countries. Although asthma symptoms are more common in many high-income countries (HICs), some low- and middle-income countries (LMICs) also have high levels of asthma symptom prevalence. The highest prevalence of symptoms of severe asthma among children with wheeze in the past 12 months is found in LMICs and not HICs. From the 1990s to the 2000s, asthma symptoms became more common in some high-prevalence centres in HICs; in many cases, the prevalence stayed the same or even decreased. At the same time, many LMICs with large populations showed increases in prevalence, suggesting that the overall world burden is increasing, and that therefore global disparities in asthma prevalence are decreasing. The costs of asthma, where they have been estimated, are relatively high. The global burden of asthma in children, including costs, needs ongoing monitoring using standardised methods.
Article
Objective: To analyse the dietary intake of Brazilian adolescents and investigate its association with sociodemographic factors as well as health-risk and health-protective behaviours. Design: Cross-sectional study. Setting: The study was based on data supplied by the National Survey of Schoolchildren's Health (2012) on sociodemographic factors, dietary intake and health-risk and health-protective behaviours of schoolchildren in Brazil. A nutritional scale was elaborated combining markers of healthy and unhealthy diets. Poisson regression analysis was applied to investigate the association between the sociodemographic factors and regular intake (≥5 times/week) of selected foods; linear regression analysis was applied to investigate the association of sociodemographic and behavioural factors with nutritional scale score. Subjects: A total of 109 104 adolescents attending the ninth year of education at 2842 schools in Brazil. Results: Fewer than 30 % of the adolescents consumed raw or cooked vegetables on a regular basis, whereas more than one-third reported regular intake of sweets, soft drinks and sweet biscuits. Adolescents from the southern area and the oldest ones were those most exposed to inadequate dietary intake. The nutritional scale average score was higher in the students attending public school and exhibited a positive correlation with protective behaviours, such as being physically active, having meals with parents and eating breakfast, and a negative correlation with risk behaviours such as eating while studying or watching television and having smoked, drunk alcohol or used other drugs in the previous 30 d. Conclusions: The results indicate an association between undesirable nutritional habits and other risk behaviours among Brazilian adolescents.
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The relationship between the global food system, and the worldwide rapid increase of obesity and related diseases, is not yet well understood. A reason is that the full impact of industrialized food processing on dietary patterns, including the environments of eating and drinking, remains overlooked and underestimated. Many forms of food processing are beneficial. But what is identified and defined here as ultra-processing, a type of process that had become increasingly dominant, at first in high-income countries, and now in middle-income countries, creates attractive, hyper-palatable, cheap, ready-to-consume food products that are characteristically energy-dense, fatty, sugary or salty, and generally obesogenic. In this study the scale of change in purchase and sales of ultra-processed products is examined and the context and implications are discussed. Data come from 79 high- and middle-income countries, with special attention to Canada and Brazil. Results show that ultra-processed products dominate the food supplies of high-income countries, and that their consumption is now rapidly increasing in middle-income countries. It is proposed here that the main driving force now shaping the global food system is transnational food manufacturing, retailing and fast-food service corporations whose businesses are based on very profitable, heavily promoted ultra-processed products, many in snack form.
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Background: There is epidemiological evidence that Mediterranean diet exposure is associated with lower asthma prevalence in children. We aimed to summarize the available data and to know whether the Mediterranean setting modifies this association. Methods: The literature search, up to May 2012, was on epidemiological studies in the general population of children assessing whether adherence to Mediterranean diet (measured as a score) was associated with the prevalence of 'current wheeze'; 'current severe wheeze'; or 'asthma ever'. Odds ratios (OR) of the eight included studies compared the highest tertile of the score with the lowest. Random-effects meta-analyses for the whole group of studies and stratified by Mediterranean setting (centers <100 Km from the Mediterranean coast) were performed. Differences between strata were assessed using the Q test. Results: For 'current wheeze', there was a negative significant association with the highest tertile of Mediterranean diet score (OR 0.85, 95% CI 0.75-0.98; p = 0.02), driven by Mediterranean centers (0.79, 0.66-0.94, p = 0.009), although the difference with the non-Mediterranean centers (0.91, 0.78-1.05, p = 0.18) was not significant. The results for 'current severe wheeze' were as follows: 0.82, 0.55-1.22, p = 0.330 (all); 0.66, 0.48-0.90, p = 0.008 (Mediterranean); and 0.99, 0.79-1.25, p = 0.95 (non-Mediterranean); with the difference between regions being significant. For 'asthma ever', the associations were as follows: 0.86, 0.78-0.95, p = 0.004 (all); 0.86, 0.74-1.01, p = 0.06 (Mediterranean); 0.86, 0.75-0.98; p = 0.027 (non-Mediterranean); with the difference between regions being negligible. Conclusions: Adherence to the Mediterranean diet tended to be associated with lower occurrence of the three respiratory outcomes. For current and current severe wheeze, the association was mainly driven by the results in Mediterranean populations.
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Asthma and overweight/obesity prevalence are both increasing worldwide. Overweight/obesity has been suggested as a risk factor for developing asthma. The aim of this review is to present and evaluate recent publications that help answer the question: "Is increased body weight (at least overweight status) related to asthma in children?" A systematic review of epidemiologic literature was carried out using the MEDLINE database. Epidemiologic studies on young human subjects (ie, infants, children, and adolescents), published in English during the period 2006-2011 were included. A comprehensive literature search yielded 434 studies for further consideration. Forty-eight studies fulfilled the review's eligibility criteria. Two researchers applied the MOOSE Guidelines for Meta-Analysis and Systematic Reviews of Observational Studies on all identified studies. Current evidence supports a weak yet significant association between high body weight and asthma. New information indicates that central obesity in children increases asthma risk. Also, the link between high body weight and asthma may be stronger in nonallergic asthma. There are mixed results about the importance of sex. Although the nature of the association between overweight/obese status and asthma remains unclear, prospective studies point that high body weight precedes asthma symptoms. These data add weight to the importance of preventing and treating a high body weight against asthma outcomes. Available research in children has not studied adequately the influence of weight change (either gain or loss) on asthma symptoms, an area of clinical importance. Beyond energy control, the role of diet as a possible inflammatory stimulus warrants further investigation. Limited data seem to favor the promotion of breastfeeding in attenuating the overweight/obesity-asthma relationship. Finally, future research should include weight intervention studies assessing various measures of body fat in relation to well-defined asthma outcomes.