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

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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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... A cross-sectional study found that consumption of specific UPF items was positively associated with asthma and wheezing among adolescents. 9 However, a cohort study found no association between early childhood consumption of soft drinks or sugar-sweetened beverages and asthma. 10 A recent systematic review 11 based mainly on casecontrol and cross-sectional studies found that fast foods, mainly hamburgers, were associated with asthma, while soft drinks and takeaway food were not. ...
... In this previous study, the authors found that a higher intake of UPF was associated with a higher risk of both asthma and wheeze. 9 The inconsistent results could to some extent be explained by differences in study designs, as well as the assessment of UPF intake. First, the cross-sectional design of the previous study is prone to recall bias, as the outcome asthma/ wheeze has already occurred and can influence how case answer compared to non-case. ...
... sectional analysis of our study with this previous finding from Melo et al,9 the different number of UPF items mentioned, the lack of adjustment for total caloric intake and a wider age range ...
Article
Background: Diet has been of interest for asthma; however, it remains unknown whether the consumption of ultra-processed food (UPF) increase the risk of the disease. Our objective was to investigate whether UPF consumption during childhood was associated with wheeze, asthma and severe asthma in adolescence. Methods: We included 2,190 11-year-old children from the 2004 Pelotas Birth Cohort Study, without asthma at the age of 6 years. Consumption of UPF was assessed by Food Frequency Questionnaires at 6- and 11-year follow-ups. Wheeze, asthma and severe asthma data were assessed at 11-year follow-up. We classified foods according to the processing degree in ultra-processed food. We used logistic regression to estimate the odds ratio (OR) and 95% confidence intervals (CIs), for the association between UPF consumption and the asthma outcomes. Results: Cumulative incidence of wheeze and asthma between 6 and 11 years were 12.7% and 23.2%, respectively. In prospective analyses, comparing children in the highest and the lowest quintile of UPF consumption at age 6, we found no association with wheeze (OR=0.85; 95% CI=0.54-1.34), asthma (OR=0.84; 95% CI=0.58-1.21), or severe asthma (OR=1.12; 95% CI=0.62 - 2.03) in early adolescence. In cross-sectional analyses, comparing adolescents in the highest and lowest quintile of UPF consumption at 11years, we found no association with wheeze (OR=1.12; 95%CI=0.72-1.75), asthma (OR=1.00; 95%CI= 0.7-1.44), or severe asthma (OR=1.05; 95%CI= 0.59 - 1.86). Conclusion: Our study provided evidence that UPF consumption during childhood or adolescence is not associated with asthma or wheeze among adolescents.
... Study types were ecological (n = 3), cross-sectional (n = 19), prospective cohort (n = 19), case-control (n = 1); and one randomised controlled trial (RCT). Studies were conducted in Brazil (n = 16) [53,56,62,63,66,70,[73][74][75][76][77][78][79][80][81][82], France (n = 8) [61,[83][84][85][86][87][88][89], Spain (n = 6) [65,72,[90][91][92][93], USA (n = 4) [59,67,71,94], Canada (n = 2) [57,68], UK (n = 2) [55,60], and one each in Sweden [36], Lebanon [69] and Malaysia [64]. There was one study on 19 European countries [52], and one global study [37]. ...
... In a nationally representative sample of students aged 13-16 years, Melo et al. [80] found an association between a higher UPF score (based on consumption of selected sub-categories of UPF) and asthma in a dose-response manner. In a prospective cohort study in Brazil, Azerado et al. [82] followed 2190 children aged 6-11 years and found no association between UPF consumption (percent energy intake) and wheeze, asthma or severe asthma. ...
... One prospective study showed no association with inflammatory bowel disease. In the two studies investigating asthma, a prospective cohort study in children aged 6-11 years showed no association [82], and a cross-sectional study drawn from a representative sample of adolescents showed a direct association [80]. The studies are not directly comparable due to different study designs, age brackets and UPF definition, including 18 and 21 UPF groups in one study, and six in the other. ...
Article
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The nutrition literature and authoritative reports increasingly recognise the concept of ultra-processed foods (UPF), as a descriptor of unhealthy diets. UPFs are now prevalent in diets worldwide. This review aims to identify and appraise the studies on healthy participants that investigated associations between levels of UPF consumption and health outcomes. This involved a systematic search for extant literature; integration and interpretation of findings from diverse study types, populations, health outcomes and dietary assessments; and quality appraisal. Of 43 studies reviewed, 37 found dietary UPF exposure associated with at least one adverse health outcome. Among adults, these included overweight, obesity and cardio-metabolic risks; cancer, type-2 diabetes and cardiovascular diseases; irritable bowel syndrome, depression and frailty conditions; and all-cause mortality. Among children and adolescents, these included cardio-metabolic risks and asthma. No study reported an association between UPF and beneficial health outcomes. Most findings were derived from observational studies and evidence of plausible biological mechanisms to increase confidence in the veracity of these observed associations is steadily evolving. There is now a considerable body of evidence supporting the use of UPFs as a scientific concept to assess the ‘healthiness’ of foods within the context of dietary patterns and to help inform the development of dietary guidelines and nutrition policy actions.
... The existing evidence indicates that displacement by UPFs is driving a rising prevalence of obesity and other diet-related NCDs [23]. A growing body of evidence suggests that increases of UPFs in dietary proportion were associated with a higher incidence of adverse health outcomes [16,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. Decreasing the dietary share of UPFs may notably contribute to the prevention of diet-related NCDs [43][44][45]. ...
... The median follow-up ranged from 3.5 to 19 years in cohort studies. The mean age of participants was between 28 and 69 years, exclusive of the unknown one [41]. The female proportion ranged from 49 to 100%. ...
... Of the 20 eligible studies, 4 focused on allcause mortality [24][25][26][27], 2 on cardiocerebrovascular diseases [28,29], 2 on metabolic syndrome [30,31], 5 on overweight and obesity [16,[32][33][34][35], 2 on mental health diseases [36,37]. The remaining 5 studies respectively investigated gastrointestinal diseases [38], cancers [39], pregnancy outcome [40], respiratory diseases [41], and geriatric diseases [42]. ...
Article
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Background: Consumption of ultra-processed foods (UPFs) plays a potential role in the development of obesity and other diet-related noncommunicable diseases (NCDs), but no studies have systematically focused on this. This study aimed to summarize the evidence for the association between UPFs consumption and health outcomes. Methods: A comprehensive search was conducted in PubMed, Embase, and Web of Science to identify all relevant studies. Epidemiological studies were included, and identified studies were evaluated for risk of bias.A narrative review of the synthesized findings was provided to assess the association between UPFs consumption and health outcomes. Results: 20 studies (12 cohort and 8 cross-sectional studies) were included in the analysis, with a total of 334,114 participants and 10 health outcomes. In a narrative review, high UPFs consumption was obviously associated with an increased risk of all-cause mortality, overall cardiovascular diseases, coronary heart diseases, cerebrovascular diseases, hypertension, metabolic syndrome, overweight and obesity, depression, irritable bowel syndrome, overall cancer, postmenopausal breast cancer, gestational obesity, adolescent asthma and wheezing, and frailty. It showed no significant association with cardiovascular disease mortality, prostate and colorectal cancers, gestational diabetes mellitus and gestational overweight. Conclusions: This study indicated a positive association between UPFs consumption and risk of several health outcomes. Large-scale prospective designed studies are needed to confirm our findings.
... 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 . ...
Article
Full-text available
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.
... Eating plays an important role in building identity, reflects populations' cultures and encompasses diverse practices, including those related to preparing meals at home (Fischler, 2010;Maciel, 2001). However, given the changes in the current hegemonic food system, which end up reflecting in cooking practices and understanding, traditional food -composed of fresh foods and freshly cooked regular meals -is replaced with diet patterns that are strongly marked by consumption of ultra-processed foods (Garcia, 2003;Lang & Caraher, 2001;Monteiro, Moubarac, Cannon, Ng, & Popkin, 2013;Monteiro et al., 2018;, PAHO, 2015, p. 61;Popkin, 2006;Stuckler & Nestle, Ultra-processed foods are associated with low nutritional dietary quality, obesity and other chronic noncommunicable diseases, including in children Louzada et al., 2015a;PAHO, 2015;Rauber, Campagnolo , Hoffman , & Vitolo, 2015;Steele, Popkin, Swinburn, & Monteiro, 2017;Mendonça et al., 2017;Cornwell et al., 2018;Fiolet et al., 2018;Melo et al., 2018;Rauber et al., 2018;Schnabel et al., 2019). Thus, the increasing consumption of such foods worldwide has become a target of public health nutrition policies (Brasil, 2014;Monteiro, Cannon, Lawrence, Costa Louzada, & Pereira Machado, 2019;PAHO, 2015PAHO, , 2019. ...
... The Brazilian Dietary Guidelines encourages home cooking as an emancipatory competence to promote healthy eating (Brasil, 2014), but the preparation of ultra-processed foods is not considered part of those health-promoting cooking skills. Furthermore, in the Latin America region, the consumption of ultraprocessed foods has been discouraged (Brasil, 2014;PAHO, 2015PAHO, , 2019, given the growing evidence on the harms of these foods to populations' health (Wang & Lim, 2012;Monteiro, Moubarac, Cannon, Ng, & Popkin, 2013Louzada et al., 2015b;Rauber et al., 2015;Steele et al., 2017;Mendonça et al., 2017;Fiolet et al., 2018;Melo, Rezende, Machado, Gouveia, & Levy, 2018;Kim, Hu, & Rebholz, 2019;Cornwell et al., 2018;Schnabel et al., 2018;Monteiro, Cannon, Levy, et al., 2019;Schnabel et al., 2018). Therefore, our study bridges knowledge gaps by generating evidence that strengthens the positive role of cooking skills confidence related to cooking 'from scratch' against consumption of ultra-processed foods. ...
Article
Ultra-processed foods are industrial formulations requiring little if any preparation before consumption. Their consumption is increasing in many countries and one of the possible determinants is the decrease in home cooking. As parents are key for family meals, we analysed the influence of parents' cooking skills confidence on children's consumption of ultra-processed foods at dinner. This is a cross-sectional study with 657 child-parent pairs from nine private schools in São Paulo, Brazil. Food consumption data were collected using two children's dinner dietary recalls while the Cooking Skills Index was used to collect parents' cooking skills, measuring their confidence in their own skills related to cooking 'from scratch', according to the Dietary Guidelines for the Brazilian Population. Food items were classified according to the NOVA classification system, considering the nature, extension and purpose of food processing. We used linear regression models to test associations between parents' cooking skills confidence and the contribution of ultra-processed foods to total energy intake at dinner, adjusting for socio-demographic variables. Parents' mean age was 38.3 and children's mean age was 7.8. These parents were mostly women, white, married, employed, with full secondary education and per capita household incomes up to ~ USD 320.00/month. They reached an average of 78.8 points (SD 14.8) in the Cooking Skills Index. Children's mean energy intake at dinner was 672.2 kcal (31.3% from ultra-processed foods). The increase in parents' cooking skills confidence was directly associated with decrease in consumption of ultra-processed foods (β = -0.17; p = 0.007), which remained after adjustment (β = -0.15; p = 0.026). These findings suggest that parents' cooking skills confidence potentially protect their children against ultra-processed foods, indicating the need for revaluing cooking to promote healthy eating.
... Nearly half of the energy intake (49.2%) of 784 adolescents was composed of such products [13]. Research also shows that high consumption of ultra-processed items is associated with higher prevalence of obesity in every age range [9], as well as increased risk for arterial hypertension [14], higher incidence of cancer [15] in adults, abnormalities in the lipid profiles of children [16], asthma and wheezing [17], and metabolic syndrome (MetS) in adolescents [18]. ...
Article
Objective To investigate the association between percent contribution of ultra-processed foods to total dietary energy intake and measurements of body composition obtained using high validity methods. Research Methods & Procedures Cross-sectional study with 1525 adolescents aged 18-19 years old from the second follow-up of the 1997/98 São Luís birth cohort, Brazil. To evaluate nutritional status and body composition, the Body Mass Index (BMI)-for-age was used, along with waist circumference, total and android body fat percentage, muscle mass, and Lean Mass Index (LMI). Food consumption was evaluated by a Food Frequency Questionnaire. Food items were grouped according to the level of processing according to the NOVA classification. Through semi-structured questionnaires, sociodemographic and lifestyle data were abstracted. Adjusted linear regression models were used to evaluate the associations between consumption of ultra-processed foods and body composition measurements. Results Total average energy consumption was 2,919.7 kcal, with 58% (1,634.9 kcal) derived from natural or minimally processed foods and 37% (1,136.5 kcal) from ultra-processed products. In the adjusted analyses, BMI, muscle mass, and LMI were inversely associated with consumption of ultra-processed foods. A 1% increase in the percent contribution of ultra-processed items to total dietary energy intake was associated with a 0.04 kg decrease in muscle mass (b= -0,04; CI95%= -0.06 – -0.02; p-value <0.001) and a 0.01 kg/m² decrease in Lean Body Mass (b= -0.01; CI95%= -0.02 – -0.01; p-value <0.001). Conclusion The contribution of ultra-processed foods to total dietary energy intake of Brazilian adolescents was associated with body composition, especially with decreasing lean body mass.
... Finally, we found that a diet rich in fried and processed meats was associated with asthma and asthma-associated intestinal metabolites. Several prior studies have found positive associations between processed or fried meat consumption and asthma, [52][53][54] and one recent systematic review found that hamburger consumption had a particularly strong association with asthma. 55 Our findings support a causal pathway whereby intestinal metabolites mediate at least part of the association between fried and processed meat consumption and asthma. ...
Article
Background The intestinal metabolome reflects the biological consequences of diverse exposures and might provide insight into asthma pathophysiology. Objective We sought to perform an untargeted integrative analysis of the intestinal metabolome of childhood asthma in this ancillary study of the Vitamin D Antenatal Asthma Reduction Trial. Methods Metabolomic profiling was performed by using mass spectrometry on fecal samples collected from 361 three-year-old subjects. Adjusted logistic regression analyses identified metabolites and modules of highly correlated metabolites associated with asthma diagnosis by age 3 years. Sparse canonical correlation analysis identified associations relevant to asthma between the intestinal metabolome and other “omics”: the intestinal microbiome as measured by using 16S rRNA sequencing, the plasma metabolome as measured by using mass spectrometry, and diet as measured by using food frequency questionnaires. Results Several intestinal metabolites were associated with asthma at age 3 years, including inverse associations between asthma and polyunsaturated fatty acids (adjusted logistic regression β = −6.3; 95% CI, −11.3 to −1.4; P = .01) and other lipids. Asthma-associated intestinal metabolites were significant mediators of the inverse relationship between exclusive breast-feeding for the first 4 months of life and asthma (P for indirect association = .04) and the positive association between a diet rich in meats and asthma (P = .03). Specific intestinal bacterial taxa, including the family Christensenellaceae, and plasma metabolites, including γ-tocopherol/β-tocopherol, were positively associated with asthma and asthma-associated intestinal metabolites. Conclusion Integrative analyses revealed significant interrelationships between the intestinal metabolome and the intestinal microbiome, plasma metabolome, and diet in association with childhood asthma. These findings require replication in future studies.
... Several studies, including a randomised clinical trial (7) , have already shown the association between the consumption of ultra-processed foods and NCD outcomes such as obesity (7)(8)(9)(10)(11)(12)(13) , CVD and metabolic diseases (14)(15)(16) , asthma and wheezing (17) , frailty (18) , depression (19,20) , gastrointestinal disorders (21) , cancers (22) and mortality (23)(24)(25)(26) . Such association may be explained by the negative influence of ultra-processed food consumption on diet quality. ...
Article
This study aims to investigate the dietary share of ultra-processed foods and its association with non-communicable diseases (NCDs)-related nutrient profile of adult and elderly population in Portugal. Cross-sectional data from the National Food, Nutrition and Physical Activity Survey (2015–2016) of the Portuguese population has been analyzed. Dietary intake was assessed by two non-consecutive 24-h recalls and food items were classified according to the NOVA system. We estimated the percentage of dietary energy provided by each of the NOVA food groups and assessed the NCD-related nutrient profile of the overall diet across quintiles of ultra-processed foods consumption. Weighted t-test, besides crude and adjusted linear and Poisson regressions have been performed. Ultra-processed foods contributed with around 24% and 16% of daily energy intake for adults and elderly, respectively. In both groups, as the consumption of ultra-processed foods increased, the dietary content of free sugars, total fats and saturated fats increased, while the dietary content of protein decreased. In adults, the total energy intake, the dietary energy density, and content of carbohydrates also increased as the consumption of ultra-processed foods increased, while the dietary content of fibre, sodium and potassium decreased. The prevalence of those exceeding the upper limits recommended for free sugars and saturated fats increased by 544% and 153% in adults, and 619% and 60% in elderly, when comparing the lowest to the highest quintile of ultra-processed consumption. Such a scenario demands for effective strategies addressing food processing in Portuguese population to improve their diet quality and prevention against diet-related NCDs.
... Obesity and related diseases have been described as important public health problems with increasing prevalence in Brazil (1,2). Unhealthy diets contribute to this epidemiological status (3,4). ...
Article
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The study of the diet quality should include not just the nutritional adequacy but also incorporate the multidimensional understanding and the current dietary recommendations. This study aimed to evaluate the relevance, clarity, and comprehensibility of the Scale of Quality of Diet (ESQUADA). Nutritionists' perspectives about the relevance and clarity of the items were evaluated through focus groups between November and December 2016. An exploratory content analysis investigated the themes that emerged from the focus groups, which were organized in a structured codebook. Two reviewers applied it to the data. Inter-rater reliability was analyzed by the kappa coefficient. The coding was analyzed using the frequencies and central aspects of the sub-themes. Laypersons' comprehension of the items was evaluated using a question regarding whether they understood each item in online questionnaire in February 2018. Descriptive statistics investigated the comprehensibility of each item. The reviewers presented adequate reliability on coding the data. Three themes emerged from the data considering the nutritionists' suggestions. The theme Item relevance indicated that the items assessed diet quality while considering sociocultural influences. However, the nutritionists suggested attention was needed to how some items were expressed and their response options. Of relevance, the themes Item clarity and Clarity of alternatives primarily encompassed discussions regarding item text (44%) and discrimination of alternatives (24%). The study of the comprehensibility indicated that all items were readily understood. These results support the relevance of the ESQUADA for evaluating quality of diet as well the comprehensibility of all the items by individuals uneducated in public health. Resumen: Análisis cualitativo y cuantitativo de la relevancia, claridad y comprensibilidad de la Escala de Calidad de la Dieta (ESQUADA). El estudio de la calidad de la dieta debe incluir la adecuación nutricional además sus dimensiones y las recomendaciones dietéticas actuales. Este estudio evaluó la relevancia, claridad y comprensibilidad de la Escala de Calidad de la Dieta (ESQUADA). Las perspectivas de los nutricionistas sobre la relevancia y claridad de los ítems se evaluaron en grupos focales entre noviembre y diciembre de 2016. Un análisis de contenido exploratorio investigó los temas que surgieron de los grupos. Estos temas fueron ordenados en un libro de códigos estructurado. Dos revisores lo aplicaron a los datos. La fiabilidad inter-evaluadores fue analizada por el coeficiente kappa. La codificación se analizó utilizando las frecuencias y aspectos centrales de los subtemas. La comprensión de los ítems por personas sin conocimientos de nutrición se evaluó mediante una pregunta sobre el entendimiento de cada ítem en uno cuestionario online in febrero de 2018. Las estadísticas descriptivas investigaron la comprensibilidad de cada ítem. Los revisores presentaron adecuada fiabilidad en la codificación de los datos. Tres temas surgieron de los datos. El tema Relevancia del ítem indicó que los ítems evaluaron la calidad de la dieta mientras consideraban las influencias socioculturales. Sin embargo, los nutricionistas sugirieron la necesidad de atención en el texto de algunos ítems y sus opciones de respuesta. Los temas Claridad del ítem y Claridad de las opciones abarcaron principalmente las discusiones sobre el texto del ítem (44%) y la discriminación de las opciones (24%). El estudio de la comprensibilidad indicó que todos los ítems se entendían fácilmente. Estos resultados apoyan la relevancia de ESQUADA para evaluar la calidad de la dieta y la comprensión de todos los ítems por personas sin conocimientos de nutrición. Palabras clave: Encuestas y cuestionarios, guías alimentarias, psicometría, comprensión, investigación cualitativa. ARCHIVOS LATINOAMERICANOS DE NUTRICIÓN Órgano Oficial de la Sociedad Latinoamericana de Nutrición
... Finally, using data from a representative sample of 109,104 Brazilian adolescents enrolled in the National Survey of School Health (2012), it was reported that the UPF consumption score was positively associated (P < 0.05 for linear trend between the categories of UPF consumption) with the presence of asthma and wheezing in a doseresponse manner (Melo, Rezende, Machado, Gouveia, & Levy, 2018). The adjusted OR of asthma and wheezing comparing highest (≥5 days/ week) to lowest (0-2 days/week) quintile of ultra-processed consumption scores (based on frequency of UPF consumption/week) were 1.27 (95% CI: 1.15, 1.41) and 1.42 (95% CI: 1.35, 1.50), respectively. ...
Article
Background: The concept of ultra-processed foods (UPFs) is new, and it was proposed for the first time in 2009 as group 4 of the NOVA classification to address the degree of food processing. UPFs include not only “junk foods” but also foods marketed as healthy, such as light, vegan, organic, or gluten-free products. UPFs are characterized by the presence of highly-processed/purified “cosmetic” ingredients and/or additives to restore and/or exacerbate organoleptic properties, i.e., taste, aroma, color and texture. Substantial industrial processing techniques, e.g., puffing, extrusion cooking, and/or extreme fractioning/refining that greatly breakdown the food matrix, may also be markers of ultra-processing. The UPF concept has been consistently criticized for being an overly heterogeneous concept, and the NOVA classification has been criticized for being qualitative only and too imprecise. Scope and approach: This review is intended to discuss the UPF concept from a holistic perspective and to analyze the scientific soundness of criticisms about UPFs and NOVA. The UPF concept is first defined; then, its primary nutritional characteristics are described, followed by their association with health based on human studies. Key findings and conclusions: UPF criticisms differ between holistic and reductionist perspectives. In a holistic concept, reductionist researchers view the proposed definition of UPF as an imprecise, vague and heterogeneous technological group. However, from a holistic perspective, the UPF concept has serious advantages, such as broad and common deleterious health attributes (i.e., the loss of “matrix” effect, empty calories, poorly satiating, hyperglycemic and containing artificial compounds foreign to the human body).
... 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.
... A tendency of higher consumption of added sugar (refined sugar, honey, corn syrup) and UPF was found among children with overweight, diagnosed with food addiction [28]. A high UPF intake has also been associated with an increased waist circumference [29], dyslipidaemia [30], metabolic syndrome [31], asthma and wheezing among children [32], hypertension [33], metabolic syndrome [34], myocardial infarction and stroke [35], gastrointestinal disorders, total and breast cancer [36], depression, and all-cause mortality among adults [37]. ...
... Self reported symptoms on asthma and wheezing in the previous 12 months have been recorded. In conclusion, this study found that ultraprocessed food consumption was positively correlated with asthma and wheezing in Brasilian adolescents (19). ...
Article
In the Decade of Nutrition, food must be reconsidered. The main objective of our research was to establish if there are any correlations between ultraprocessed food consumption and increased asthma prevalence or other respiratory outcomes. Meanwhille, it will be an important step to design some lifestyle recommendations with direct benefits for asthma treatment. NOVA system for food classification is a new concept addressing food quality. Ultraprocessed food, made entirely from substances derived from food and additives, that includes other sources of nutrients and energy, is not usually used in culinary preparation. How asthma outcomes are influenced by Western diet that contains a lot of processed food and what benefits could arise from the Mediterranean diet are subjects for interesting studies. Substantial correlations have been established between unhealthy diets, especially Western diet, ultraprocessed foods and food allergies and asthma pathogenesis and control. NOVA clasification of processing foods and dietary inflammatory index are helpful tools in early identifying of correct dietary approach in asthma. More research in nutrition recommendations for asthma patients must be done and practical guidelines in nutritional interventions are future steps.
... 31 35 Three studies were cohort studies 16 31 35 and 16 were cross-sectional studies. 5 12-15 24 26-30 32-34 36 37 Six studies were conducted in Europe, 5 14 26 29 32 35 six in the USA, 12 16 24 31 33 36 four in Asia, 15 25 27 34 one in Brazil, 30 one in New Zealand 28 and one in Australia. 13 The studies were published between 2002 and 2019. ...
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Objectives To carry out meta-analysis and systematic review on the association between soft drinks consumption and asthma prevalence among adults and children. Design Systematic review and meta-analysis of observational research. Data sources Medline, Scopus, ISI Web of Science and the Cochrane Library were searched up to December 2018. Eligibility criteria We included observational studies investigating the association between soft drinks consumption (including maternal consumption during pregnancy) and asthma or wheeze. Data extraction and synthesis Data were extracted by one author and reviewed independently by two other authors. The most adjusted estimate from each original study was used in the meta-analysis. Meta-analysis was conducted using random-effects model. The quality of studies was assessed using the Newcastle–Ottawa scale and heterogeneity was evaluated using I ² statistic. Results Of 725 publications originally identified, 19 were included in this systematic review, including 3 cohort studies and 16 cross-sectional studies. Ten articles reported on children up to 18 years, 5 articles on adults (>18 years) and 2 articles on prenatal exposure. In total, 468 836 participants were included, with more than 50 000 asthma cases. Soft drinks consumption was associated with significantly increased odds of asthma in both adults (OR=1.37; 95% CI, 1.23 to 1.52) and children (OR=1.14; 95% CI, 1.06 to 1.21). Prenatal exposure had marginally statistically significant association (OR=1.11; 95% CI, 1.00 to 1.23) with asthma in children. In subgroup analysis for childhood exposure, the association persists for sugar-sweetened soft drinks but not for carbonated drinks. Conclusion Our findings show a positive association between soft drinks consumption and asthma prevalence, mostly from cross-sectional studies. Therefore, more longitudinal research is required to establish causality.
... Highdose bee venom exposure in vitro leads to an increase in the frequency of (A) IL-10producing CD73 − CD25 + CD71 + B cells, (B) CD19 + CD27 hi CD38 hi and (c)PLA-specific IgG4-switched B cells ultra-processed food and drink products in adolescents is associated with asthma and wheezing in a dose-dependent manner. 50 There is increasing evidence linking vitamin D levels, the microbiome, and allergies. 51 Early-life probiotic supplementation with Lactobacillus rhamnosus HN001 reduces the incidence of eczema and hay fever at 11 years of age. ...
Article
The European Academy of Allergy and Clinical Immunology (EAACI) supports three journals: Allergy, Pediatric Allergy and Immunology, and Clinical and Translational Allergy. One of EAACI’s major goals is to support the promotion of health in which prevention of allergy and asthma play a critical role and to disseminate the knowledge of allergic disease to all stakeholders. In 2018, the remarkable progress in the identification of basic mechanisms of allergic and respiratory diseases, and the translation of these findings into clinical practice was observed. Last year’s highlights include publication of EAACI Guidelines for Allergen Immunotherapy, many EAACI Position Papers covering important aspects for the specialty, better understanding of molecular and cellular mechanisms, identification of biomarkers for disease prediction and progress monitoring, novel prevention and intervention studies, elucidation of mechanisms of multimorbidities, introduction of new drugs to the clinics, recently completed phase three clinical studies, and publication of a large number of allergen immunotherapy studies and meta‐analyses.
... 12 And more specifically, ultra-processed foods are among factors having a potential to unfavorably influence allergy later in life. 13,14 Not only foods but more globally the environment may have an impact on childhood asthma, 15 possibly by providing inflammatory signals. 16 This issue further includes also studies on the various topics usually featured in PAI, and the first study I would like to highlight is a report by Niki Mitselou and colleagues from Stockholm. ...
... 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. ...
Article
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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.
... 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.
... 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]. ...
Article
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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.
... Cross-sectional and longitudinal studies conducted in the USA, Brazil, France and Spain have shown that ultraprocessed food consumption is associated with higher BMI (22,(25)(26)(27)(28) , overweight or obesity (25)(26)(27)(28)(29)(30) , waist circumference (27,28) , hypertension (31) , metabolic syndrome (32) , dyslipidaemias (33) , asthma and wheezing (34) , functional gastrointestinal disorders (35) and cancer, including breast cancer (36) . Moreira et al. estimated that halving the intake of ultra-processed foods in the UK could result in approximately 17 060 fewer CVD-related deaths in 2030, representing a 10 % reduction in CVD mortality (37) . ...
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Objective To estimate the consumption of ultra-processed foods and determine its association with dietary quality among middle-aged Japanese adults. Design Cross-sectional study using data from the Saitama Prefecture Health and Nutrition Survey 2011. Dietary intake was assessed using one- or two-day dietary records. Sociodemographic and lifestyle factors were obtained via self-administered questionnaire. Food items were classified according to the NOVA system into four groups: unprocessed or minimally processed foods; processed culinary ingredients; processed foods; and ultra-processed foods. The dietary share of each NOVA food group and their subgroups was calculated in relation to total energy intake, and the average dietary content of key nutrients was determined across tertiles of the dietary energy share of ultra-processed foods (low, middle and high intake). Setting Saitama Prefecture in Japan. Participants Community-dwelling adults aged 30–59 years (256 men, 361 women). Results Consumption of unprocessed or minimally processed foods, processed culinary ingredients, processed foods and ultra-processed foods contributed 44·9 ( se 0·8) %, 5·5 ( se 0·2) %, 11·3 ( se 0·4) % and 38·2 ( se 0·9) % of total daily energy intake, respectively. A positive and statistically significant linear trend was found between the dietary share of ultra-processed foods (tertiles) and the dietary content of total and saturated fat, while an inverse relationship was observed for protein, vitamin K, vitamin B 6 , dietary fibre, magnesium, phosphorus and iron. Conclusions Our findings show that higher consumption of ultra-processed foods was associated with decreased dietary quality among Japanese adults.
... In addition, increasing evidence suggests that these foods are harmful to health. Cross-sectional studies have found associations between consumption of ultraprocessed foods and obesity (da Costa Louzada et al., 2015 a ), metabolic syndrome(Tavares et al., 2012), and presence of asthma and wheezing(Melo, Rezende, Machado, Gouveia, & Levy, 2018). Prospective cohort studies have shown that high consumption of these foods is associated with obesity(Mendonça et al., 2016 a ), hypertension(Mendonça et al., 2017 b ), and cancer(Fiolet et al., 2018) in adults and dyslipidemia in children(Rauber et al., 2015). ...
... 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]. ...
Article
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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.
... 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.
... 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) . ...
Article
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.
... 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]. ...
Article
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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.
... Foods and beverages can be categorized as ultra-processed according to the NOVA classification system, which organizes foods into four categories based on the extent and purpose of industrial food processing: unprocessed/minimally processed (e.g., fruits, milk, eggs); processed culinary ingredients (e.g., sugar, honey, vegetable oil); processed foods (e.g., salted or sugared fruits and nuts, smoked meats, fresh bread); and ultra-processed foods, which include both ready-to-eat foods and beverages (e.g., chips and cookies, baked goods, soft drinks) and ready-to-heat foods (e.g., frozen or boxed meals, canned soup) (Monteiro et al., 2012. Research has demonstrated strong links between ultra-processed food intake and poor diet quality, obesity, dyslipidemia, hypertension, allergies, cancer, and gastrointestinal diseases, suggesting that reducing consumption of ultra-processed foods and/or encouraging industry reformulation of nutrient-poor items could have a significant impact on population health (Cunha, da Costa, da Veiga, Pereira, & Sichieri, 2018;Fiolet et al., 2018;Juul, Martinez-Steel, Parekh, Monteiro, & Chang, 2018;Melo, Rezende, Machado, Gouveia, & Levy, 2018;Mendonça et al., 2016Mendonça et al., , 2017Monteiro, Levy, Claro, de Castro, & Cannon, 2011;Moubarac et al., 2013;Rauber et al., 2015Rauber et al., , 2018Schnabel et al., 2018;Silva et al., 2018). ...
Article
Ultra-processed foods are industrially formulated products that are convenient, highly-palatable, and contain few whole ingredients. While popular among US households regardless of SES, these foods constitute a relatively large proportion of grocery spending among low-income households participating in the Supplemental Nutrition Assistance Program (SNAP). Little is understood about the perceived factors influencing selection and consumption of these foods, particularly among households with children participating in SNAP. We conducted 5 focus groups with 45 parents of children under 18 years of age living in a low-income area of a Northeastern state. We conducted inductive-deductive thematic analysis to identify emergent themes and to identify similarities and differences by self-reported SNAP participation. Six themes related to ultra-processed food decision-making emerged, which were grouped into primarily rational or primarily intuitive processes. Rational decisions included concerns about the product's healthfulness, environmental sustainability, and desirable traits, which were each weighed against product cost when deciding between similar products. Intuitive themes included retailer marketing, household norms, and individual affective biases. The family social and emotional context and parenting practices were identified as important influences on preparation and consumption of ultra-processed foods. Differences between SNAP participants and non-participants emerged. SNAP participants selected ultra-processed foods because of their familiarity and long shelf-life -- attributes that mitigated fear of wasting money on foods that may be rejected by children or spoil quickly. Some SNAP participants purchased ultra-processed foods at the beginning of the monthly benefit cycle and stored them in anticipation of food scarcity at the end of the month. These findings underscore the distinct role of ultra-processed foods in meal planning and budgeting and the importance of rational considerations that particularly affect food choices of households participating in SNAP.
... 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.
... 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 . ...
Article
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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.
... Ultraprocessed foods are characterized by high energy density, high glycaemic index and high fat content, in contrast to low amounts of fibre and micronutrients (3,4,6,29) . In addition, these foods are related to increased risk of developing non-communicable diseases such as obesity (7,8) , some types of cancer (9) , asthma and metabolic syndrome in children (11,12) and gastrointestinal disorders (28) . The increase in the consumption of ultra-processed foods out of home can be partly attributed to the characteristics of these products such as wide availability, convenience, marketing appeal, convenience and ease of transportation and storage, allowing their consumption at any place (30)(31)(32) . ...
Article
Objective To describe out-of-home consumption according to the purpose and extent of industrial processing and also evaluate the association between eating out and ultra-processed food consumption, taking account of variance within and between individuals. Design Cross-sectional study. Setting Brazil. Participants The study was based on the Individual Food Intake of the Brazilian Household Budget Survey, carried out with 34 003 individuals aged 10 years or more, between May 2008 and May 2009. All food items were classified according to food processing level. The habit of eating out was evaluated through the frequency of days each individual reported eating out, described according to sociodemographic characteristics. The contribution of food energy per group and subgroup was estimated according to the frequency of eating out. In addition, multilevel modelling was employed to evaluate the association between eating out and ultra-processed food consumption. Results In Brazil, culinary preparations accounted for most of the energy eaten out. However, it was possible to observe a higher contribution of ultra-processed foods, especially sugary beverages and ready-to-eat meals, as the frequency of out-of-home consumption increased. Compared with food consumption exclusively at home, eating out increased the consumption of ultra-processed foods by 0·41 percentage points within and between individuals. Conclusion In Brazil, the same individual and different individuals had greater consumption of ultra-processed foods when they ate out of home compared with when they ate at home. So, it is necessary to implement public policies which discourage the out-of-home consumption of ultra-processed foods and that provide affordable and accessible less-processed food options.
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This is a report published by the Food and Agriculture Organization of the United Nations. Jose Graziano da Silva, outgoing FAO director-general, says: ‘Glad to see FAO report on NOVA classification and ultra-processed food, by Carlos Monteiro and the NUPENS/USP team [ showing] consistent evidence on how the consumption of ultra-processed food causes obesity and many chronic non-communicable diseases’. Carlos Monteiro adds: ‘this is the first time that the peer-reviewed literature linking ultra-processed food intake to diet quality and to risk of non-communicable diseases has been brought together and analysed. This report as published by FAO is a great step forward'. The report examines the peer-reviewed literature on the effects of ultra-processed foods on diet quality and on health. Papers on the effects on diet quality reported results from nineteen nationally-representative studies. Papers on health outcomes reported results from nine nationwide cross-sectional studies, sixteen longitudinal studies and one randomized controlled trial. The results from the studies on diet quality show significant and graded associations between the dietary share of ultra-processed foods and dietary nutrient profiles prone to non-communicable diseases, including high or excessive content of free or added sugar, saturated and trans fats, and sodium, and also high dietary energy density; and low or insufficient content of protein and dietary fibre. The results from the studies on health outcomes show plausible, significant, graded associations between the dietary share of ultra-processed foods and the occurrence or incidence of several non-communicable diseases, including obesity and obesity-related outcomes, cardiovascular and metabolic diseases, breast and all cancers, depression, gastrointestinal disorders, frailty in the elderly, and also premature mortality. In the case of short-term increases in body weight and fat, this is solidly supported by a randomised controlled trial conducted by the US National Institutes of Health. These findings are all fully referenced in the report. Carlos Monteiiro adds: 'The conclusion is clear. Governments at all levels now need to agree and enact statutory including fiscal policies that support and protect enjoyment of freshly prepared meals. Worldwide, these are based on minimally processed foods and include processed culinary ingredients and processed foods. This means enormous opportunities for the food industry as a whole including producers of fresh foods, especially co-operative and family farmers that still produce most food all over the world, and also for producers of processed culinary ingredients and processed foods. At the same time, statutory measures must make ultra-processed foods, which are as great a menace to public health as tobacco, less attractive, affordable and available’. ISBN 978-92-5-131701-3
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Öz: Futbol kuşkusuz seyirci ve izlenme oranlarıyla diğer tüm spor branşlarından önemli oranda ayrılır. Bunu bilen sponsorlar en çok futbola yoğunlaşmaktadır. Çevrimiçi dijital teknolojiler, çok sayıda dijital platform aracılığıyla küresel ölçekte müşterilerle etkileşimde bulunma kapasitesine sahip olduklarından, uluslararası spor sponsorluğunun önemi kanıtlamıştır. Sporun bu değişimi dünya ekonomisinde büyük yer edinmesini sağlamıştır. Öyle ki Avrupa’daki bir kulübün geliri birçok küçük ülkenin milli gelirinden de fazladır. Çalışmamızın amacı; Türkiye’ deki spor sponsorluğunu futbol örneğiyle ele alarak; gelişim aşamalarını ve Avrupa Lig’lerine göre son durumunu incelemektir. Anahtar Kelimeler: Spor, Sponsorluk, Futbol.
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Understanding the drivers and dynamics of global ultra‐processed food (UPF) consumption is essential, given the evidence linking these foods with adverse health outcomes. In this synthesis review, we take two steps. First, we quantify per capita volumes and trends in UPF sales, and ingredients (sweeteners, fats, sodium and cosmetic additives) supplied by these foods, in countries classified by income and region. Second, we review the literature on food systems and political economy factors that likely explain the observed changes. We find evidence for a substantial expansion in the types and quantities of UPFs sold worldwide, representing a transition towards a more processed global diet but with wide variations between regions and countries. As countries grow richer, higher volumes and a wider variety of UPFs are sold. Sales are highest in Australasia, North America, Europe and Latin America but growing rapidly in Asia, the Middle East and Africa. These developments are closely linked with the industrialization of food systems, technological change and globalization, including growth in the market and political activities of transnational food corporations and inadequate policies to protect nutrition in these new contexts. The scale of dietary change underway, especially in highly populated middle‐income countries, raises serious concern for global health.
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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: 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 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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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 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.
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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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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: 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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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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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.
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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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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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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.
'Food intolerance' is often confused with a range of adverse symptoms which may be coincidental to ingestion of food. 'Food intolerance' is defined as a reaction in which symptoms must be objectively reproducible and not known to involve an immunological mechanism. A more precise term is non-allergic food hypersensitivity, which contrasts with food allergies which are due to an immunological mechanism. Some children will experience food reactions to food additives. Reported symptoms range from urticaria/angioedema to hyperactive behaviours. While parents/carers report that over one fifth of children experience of food reaction, only 1 in 20 of these are confirmed to have a non-allergic food hypersensitivity on testing.
*Ultra-processed consumption score was calculated by adding partial scores corresponding to weekly frequency intake of each ultra-processed product. The ultra-processed consumption score ranged from 0
  • Pense
PeNSE, Pesquisa Nacional de Saúde do Escolar (National Survey of School Health). *Ultra-processed consumption score was calculated by adding partial scores corresponding to weekly frequency intake of each ultra-processed product. The ultra-processed consumption score ranged from 0 to 42 points, the higher score, the higher the intake of these products. Quintiles of ultra-processed consumption score: Q1 (09 points); Q2 (10-14 points);
  • Instituto Brasileiro De Geografia E Estatística
Instituto Brasileiro de Geografia e Estatística [Brazilian Institute of Geography and Statistics]: Pesquisa Nacional de Saúde Escolar [National Survey of School Health]. Rio de Janeiro: IBGE; 2013.
Defining and assessing heterogeneity of effects: interaction
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Szklo M, Nieto F. Defining and assessing heterogeneity of effects: interaction. In: Szklo M, Nieto F, eds. Epidemiology: Beyond the Basics, 3rd edn. Burlington, VT: Jones & Bartlett Learning; 2014.
Ultra-processed foods and the nutritional dietary profile in Brazil
  • Costa Louzada