Considering the negative impact of the consumption of ultra-processed foods on health, the current study assessed the availability and nutritional profile of commercial ultra-processed foods for infants in Natal, Brazil.

A cross-sectional exploratory study.

Foods targeted at children under the age of 36 months sold in retail establishments located in high- and low-income areas of the one capital city of Brazil.

1645 food products consisting of ninety-five different types of food were available. The foods were assessed according to the NOVA classification: minimally processed, processed and ultra-processed. The nutritional content per 100 g was assessed according to processing classification.

Half of foods founded were breast milk substitutes and cereal foods (31·6 and 26·3 %, respectively). The foods were predominantly ultra-processed (79 %) and only 4·2 % were minimally processed, with similar proportions of ultra-processed foods being found in both high- and low-income areas. After excluding breast milk substitutes and follow-up formulas, all cereals, food supplements and some of the fruit or vegetable purees were ultra-processed, higher in energy density, fat, carbohydrate and protein and low in fibre (P < 0·05).

The findings reveal that ultra-processed foods for infants are widely available in Brazil, reaffirming the need to strengthen the regulation of foods for infants and young children by introducing complementary measures designed to promote the production and marketing of foods manufactured using lower levels of processing.

Iron and/or iodine deficiencies can have multiple serious adverse health outcomes, but examination of incidence rates of these deficiencies has rarely been conducted in any large population. This study examined incidence rates, temporal trends and demographic factors associated with medically diagnosed iron and iodine deficiencies/disorders in US military service members (SM).

The Defense Medical Epidemiological Database (DMED) was queried for medical visits of active duty SM to obtain specific International Classification of Diseases, Version 9, codes involving clinically diagnosed iron and iodine deficiencies/disorders.

Analysis of existing database (DMED).

Entire population of US military SM from 1997 to 2015 (average n per year = 1 382 266, 15 % women).

Overall incidence rates for iron and iodine were 104 and 36 cases/100 000 person-years, respectively. Over the 19-year period, rates for iron disorders increased steadily (108 % for men, 177 % for women). Rates for iodine disorders also increased steadily for men (91 %), but, for women, there was an initial rise followed by a later decline. Overall, women’s rates were 12 and 10 times higher than men’s for iron and iodine, respectively. Compared with whites, blacks and those of other races had higher rates of deficiencies of both minerals. Incidence rates for iodine deficiency increased substantially with age.

The overall incidence of clinically diagnosed iron and iodine deficiency among SM was low, but increased over the 19 years examined, and certain demographic groups were at significantly greater risk. Given the unexpected increases in incidence of these mineral disorders, increased surveillance may be appropriate.

Clinical Trial Registration No. ISRCTN58987177 (http//:www.isrctn.com/ISRCTN58987177)

To assess the quality and quantity of foods and beverages provided to children aged 0–5 years in family day care and identify structural and sociodemographic factors associated with the nutritional quality of food provided.

A cross-sectional study measured the food and beverages provided to children using weighed food records. The number of serves from different food groups was calculated according to the Australian Guide to Healthy Eating, and a healthy food provision index score was created. Associations between structural and sociodemographic factors and healthy food provision index scores were analysed using linear mixed models.

Family day care services in two large geographic areas in New South Wales, Australia.

One hundred and four children in thirty-three family day care services.

During attendance at childcare, most children met recommended servings of fruit but not dairy, vegetables, lean meat and meat alternatives and wholegrains. Discretionary foods exceeded recommendations. Children’s age, socio-economic status and the type of main meal provided were significantly associated with the healthy food provision index score.

Foods provided to children in family day care are aligned with dietary recommendations for fruit but not vegetables, dairy, lean meat and meat alternatives, wholegrains or discretionary foods. Interventions to promote healthy eating are needed to support families and educators to improve the nutritional quality of food provided to children.

The effects of adverse childhood experiences (ACE) on children and adolescents’ health status such as obesity are understudied. The current study addressed the effect of ACE on obesity status during childhood utilising multiple waves of national panel data.

Longitudinal survey.

Data were drawn from three waves of the second cohort of the National Survey of Child and Adolescent Well-Being (NSCAW II). NSCAW II study sampled cases from Child Protective Services investigations that were closed between February 2008 and April 2009 nationwide. We measured ACE cumulatively and as separate events and stratified by gender.

Totally, 3170 youth births to 14 years of age at baseline.

A count measure of ACE is indeed associated with greater odds of obesity during childhood. Differential effects for different types of ACE were also found, most notably neglect. For girls, physical and psychological neglect increased odds of obesity.

Findings support evidence for the importance of using both a count measure of ACE as well as separating out single events by gender.

To establish optimal gestational weight gain (GWG) in Chinese pregnant women by Chinese-specific BMI categories and compare the new recommendations with the Institute of Medicine (IOM) 2009 guidelines.

Multicentre, prospective cohort study. Unconditional logistic regression analysis was used to evaluate the OR, 95 % CI and the predicted probabilities of adverse pregnancy outcomes. The optimal GWG range was defined as the range that did not exceed a 1 % increase from the lowest predicted probability in each pre-pregnancy BMI group.

From nine cities in mainland China.

A total of 3731 women with singleton pregnancy were recruited from April 2013 to December 2014.

The optimal GWG (ranges) by Chinese-specific BMI was 15·0 (12·8–17·1), 14·2 (12·1–16·4) and 12·6 (10·4–14·9) kg for underweight, normal weight and overweight pregnant women, respectively. Inappropriate GWG was associated with several adverse pregnancy outcomes. Compared with women gaining weight within our proposed recommendations, women with excessive GWG had higher risk for macrosomia, large for gestational age and caesarean section, whereas those with inadequate GWG had higher risk for low birth weight, small for gestational age and preterm delivery. The comparison between our proposed recommendations and IOM 2009 guidelines showed that our recommendations were comparable with the IOM 2009 guidelines and could well predict the risk of several adverse pregnancy outcomes.

Inappropriate GWG was associated with higher risk of several adverse pregnancy outcomes. Optimal GWG recommendations proposed in the present study could be applied to Chinese pregnant women.

To assess changes in dietary patterns among youths in China after COVID-19 lockdown.

This study was based on the COVID-19 Impact on Lifestyle Change Survey (COINLICS), a national retrospective survey established in early May 2020. The questionnaire was distributed through social media platforms. The sociodemographic information and routine dietary patterns before and after lockdown of participants were investigated. t tests and χ2 tests were used to compare the differences in consumption patterns of twelve major food groups and beverages between sex and across educational levels before and after lockdown. Factor analysis was employed to obtain the main dietary patterns.

China.

A total of 10 082 youths.

A significant decrease was observed in the average weekly frequency of rice intake, while significant increases were observed in the frequency of intake of wheat products, other staple foods, fish, eggs, fresh vegetables, preserved vegetables, fresh fruit and dairy products (all P values < 0·01). Heterogeneities of average weekly frequency existed between sex and across educational levels to different extents. The three main dietary patterns derived were loaded most heavily on dairy products, rice and wheat products, separately; the rice pattern became more dominant than the wheat products pattern after lockdown. The frequency of sugar-sweetened beverage consumption had decreased, while the frequency of other beverages had increased.

Our timely survey would inform policymakers and health professionals of these significant changes in youths’ dietary patterns after lockdown, with heterogeneities observed to different extents between sex and across educational levels, for better policy-making and public health practice.

To determine changes and factors associated with child malnutrition, obesity in women and household food insecurity before and after the first wave of COVID-19 pandemic.

A prospective follow-up study.

In 2019, the baseline Urban Health and Nutrition Study 2019 (UHNS-2019) was conducted in 603 households, which were selected randomly from 30 clusters to represent underserved urban settlements in Colombo. In the present study, 35 % of households from the UHNS-2019 cohort were randomly selected for repeat interviews, 1 year after the baseline study and 6 months after COVID-19 pandemic in Sri Lanka. Height/length and weight of children and women were re-measured, household food insecurity was reassessed, and associated factors were gathered through interviewer-administered questionnaires. Differences in measurements at baseline and follow-up studies were compared.

A total of 207 households, comprising 127 women and 109 children were included.

The current prevalence of children with wasting and overweight was higher in the follow-up study than at baseline UHNS-2019 (18·3 % v. 13·7 %; P = 0·26 and 8·3 % v. 3·7 %; P = 0·12, respectively). There was a decrease in prevalence of child stunting (14·7 % v. 11·9 %; P = 0·37). A change was not observed in overall obesity in women, which was about 30·7 %. Repeated lockdown was associated with a significant reduction in food security from 57 % in UHNS-2019 to 30 % in the current study (P < 0·001).

There was an increase in wasting and overweight among children while women had a persistent high prevalence of obesity. This population needs suitable interventions to improve nutrition status of children and women to minimise susceptibility to COVID-19.

The objective of the current study was to identify factors across the socio-ecological model (SEM) associated with adolescents’ sugar-sweetened beverage (SSB) intake.

This cross-sectional study surveyed adolescents using previously validated instruments. Analyses included descriptive statistics, ANOVA tests and stepwise nonlinear regression models (i.e., two-part models) adjusted to be cluster robust. Guided by SEM, a four-step model was used to identify factors associated with adolescent SSB intake – step 1: demographics (i.e., age, gender), step 2: intrapersonal (i.e., theory of planned behaviour (attitudes, subjective norms, perceived behavioural control, behavioural intentions), health literacy, media literacy, public health literacy), step 3: interpersonal (i.e., caregiver’s SSB behaviours, caregiver’s SSB rules) and step 4: environmental (i.e., home SSB availability) level variables.

Eight middle schools across four rural southwest Virginia counties in Appalachia.

Seven hundred ninety seventh grade students (55·4 % female, 44·6 % males, mean age 12 (sd 0·5) years).

Mean SSB intake was 36·3 (sd 42·5) fluid ounces or 433·4 (sd 493·6) calories per day. In the final step of the regression model, seven variables significantly explained adolescent’s SSB consumption: behavioural intention (P < 0·05), affective attitude (P < 0·05), perceived behavioural control (P < 0·05), health literacy (P < 0·001), caregiver behaviours (P < 0·05), caregiver rules (P < 0·05) and home availability (P < 0·001).

SSB intake among adolescents in rural Appalachia was nearly three times above national mean. Home environment was the strongest predictor of adolescent SSB intake, followed by caregiver rules, caregiver behaviours and health literacy. Future interventions targeting these factors may provide the greatest opportunity to improve adolescent SSB intake.

Regular breakfast skipping is related to unhealthy dietary behaviours, such as consuming an overall poorer quality diet and lower rates of physical activity, both of which are linked to a higher BMI. Adolescent breakfast skippers struggle with mental focus, sleep issues and lower grades. Solutions that can be implemented to overcome breakfast skipping are needed.

A systematic literature review was undertaken to identify programmes that aimed to increase breakfast eating. Following the PRISMA framework, studies were sourced to examine details of behaviour change, evidence of theory use and other important programme learnings and outcomes.

Breakfast consumption empirical studies published from 2000 onwards.

Nineteen empirical studies that aimed to improve breakfast eating behaviour.

Out of the nineteen studies examined, ten studies reported an increase in breakfast consumption frequency for the entire study group or subgroups. Seven studies found no change, one was inconclusive and one observed a decrease in breakfast frequency. Positive changes to the dietary quality of breakfast were observed in five of the studies that did not observe increased frequency of breakfast consumption. Only six studies reported using theory in the intervention.

This evidence review points needed to extend theory application to establish a reliable evidence base that can be followed by practitioners seeking to increase breakfast eating rates in their target population.

Obesity is a serious public health issue. Investigating the eating behaviour of individuals plays an important role in preventing obesity. Therefore, the purpose of the current study is to adapt the long and first version of the ‘Three-Factor Eating Questionnaire’ (TFEQ), a scale that examines the eating behaviour of individuals, to Turkish culture and to carry out its validity and reliability study.

The data were collected using data collection forms, and anthropometric measurements of the individuals were made by the researchers. The data collection form included several parameters: socio-demographic characteristics, the TFEQ scale, whose validity and reliability analysis is conducted here, and the Dutch Eating Behaviour Questionnaire (DEBQ) which was used as a parallel form.

The Obesity Clinic at Ege University in Izmir.

The study group consisted of obese adult individuals (n 257).

It was seen that constructing the questionnaire with twenty-seven items and four sub-dimensions provides better information about Turkish obese individuals. Factor loadings ranged from 0·421 to 0·846, and item total score correlations ranged from 0·214 to 0·558. Cronbach’s α coefficient was found to be 0·639 for the whole scale. A positive, strong and statistically significant correlation was detected between TFEQ and DEBQ, which was used as a parallel form (r = 0·519, P < 0·001).

In Turkey, the long version of the TFEQ scale was found valid and reliable for obese adult individuals. TFEQ can be used by clinicians or researchers to study the eating behaviour of obese individuals.

The present study aimed to assess the effect of different types of breakfast cereal (BC) on portion size and the nutritional implications of potential under or overserving.

A cross-sectional analysis was performed using one BC from the seven established BC manufacturing methods (flaking (F), gun puffed (GP), oven puffed (OP), extruded gun puffed (EGP), shredded wholegrain (SW), biscuit formed (BF) and granola). Participants were asked to pour cereal as if they were serving themselves (freepour). Difference between the freepour and recommended serving size (RSS) was calculated (DFR). The Friedman test followed by Dunn’s multiple comparison test was used to test for a significant differences between cereal categories.

City of Chester, North West of the UK.

Adults (n 169; n 110 female, 32 (sd 18) years).

Freepour values were greater than RSS for all categories of BC. Median values for denser cereals such as SW, granola and oats were significantly (P < 0·001) greater than all other categories with granola having the highest median freepour value of 95 g. Median (and range of) DFR weight values for granola were significantly higher than other BC (50·0 g (−24·0 to 267·0 g), P < 0·001). BC with the lowest median DFR were F1 (7·0 g (−20 to 63·0 g)), GP (6·0 g (−26·0 to 69·0 g)), EGP (6·0 g (−26·0 to 56·0 g)), OP (5·0 g (−27·0 to 53·0 g)) and BF (0·0 g (−28·2 to 56·4 g)).

The degree of overserving may be related to the type of BC with denser cereals more readily overserved. Encouraging manufacturers to reformulate cereals and improving their nutritional properties may have benefit in reducing excess energy intake.

To determine if household food insecurity (HFI) is associated with the risk of developmental delays.

Cross-sectional study of a representative sample of children under 2 years old. Risk of developmental delays was assessed with the Denver Developmental Screening Test II. HFI was measured with the Brazilian Food Insecurity Measurement Scale. Multivariable logistic regression was used to test the association between HFI (food secure/insecure) and risk of developmental delays, adjusting for household, maternal and child variables.

Community Health Centers in the Federal District, Brazil.

1004 children under 2 years old.

Among participants, 15 % were at risk of developmental delays and about 40 % of children lived in food-insecure households. HFI was associated with the risk of developmental delays (adjusted OR 2·61; 95 % CI 1·42, 4·80) compared with food-secure households after adjusting for key confounders.

HFI was strongly associated with the risk of developmental delays in children under 2 years. Investments that prevent or mitigate HFI are likely to be key for improved human and national development.

To assess whether higher adherence to the traditional Mediterranean diet (MedDiet) was associated with lower consumption of ultra-processed foods (UPF) and lower free sugar intake.

Cross-sectional analysis of baseline information among participants in the SENDO project, a Spanish paediatric cohort. Dietary information was collected through a semi-quantitative FFQ. Food items were classified according to the NOVA classification. Adherence to the MedDiet was evaluated through the KIDMED index.

Spain.

Three hundred eight-six children (52 % boys) with a mean age of 5·3 years old (sd 1·0) were included in the analysis.

74·4 % of the children had moderate adherence to the MedDiet (mean KIDMED score: 5·9 points; sd 1·7) and overall, 32·2 % of the total energy intake came from UPF. Each two additional points in the KIDMED score was associated with 3·1 % (95 % CI 2·1, 4·0) lower energy intake from UPF. Compared to those with low adherence to the MedDiet, children with medium and high adherence reported 5·0 % (95 % CI 2·2, 7·7) and 8·5 % (95 % CI 5·2, 11·9) lower energy intake from UPF, respectively. We also found that 71·6 % of the variability in free sugar intake was explained by the variability in UPF consumption.

Adherence to the traditional MedDiet was inversely associated with energy intake from UPF. Furthermore, most of the variability in free sugar intake was explained by the variability of UPF consumption. Public health strategies are needed to strengthen the adherence to the MedDiet in pre-schoolers while regulating the production, marketing and advertising of UPF.

To investigate whether the consumption of ultra-processed foods (UPF) during pregnancy is associated with gestational weight gain (GWG).

Cohort study with collection of two 24-h dietary recalls during each gestational trimester obtained on non-consecutive days and differentiating weekday v. weekend/holiday. The foods were classified according to the NOVA system into fresh or minimally processed foods and their culinary preparations, processed and UPF and subsequently analysed as a percentage contribution to dietary energy. The outcome was average GWG in the second and in the third trimesters, expressed in g/week.

Botucatu, a medium-sized Brazilian city.

Pregnant women with regular obstetric risk (n 259) undergoing prenatal care in primary healthcare.

In a multiple linear regression model, it was found that an increase of 1 percentage point in energy consumption from UPF in the third gestational trimester led to an average increase of 4·17 (95 % CI 0·55; 7·79) g in weekly GWG in this period. There was no association between second-trimester UPF consumption and GWG.

Consumption of UPF in the third gestational trimester is positively associated with average weekly GWG in this period.

To evaluate the association between the consumption of ultra-processed foods (UPF) and the practice of breast-feeding in children under 2 years of age assisted by the conditional cash transfer programme, Bolsa Família Programme (PBF).

A cross-sectional study. The consumption of UPF and the practice of breast-feeding were assessed using a structured 24-h recall. Associations were calculated using hierarchical Poisson regression, adjusted at the last level by socio-economic, demographic and environmental variables from previous hierarchical levels.

Six counties from the state of Alagoas, Brazil.

Children aged 6−24 months, assisted by PBF.

A total of 1604 children were evaluated, 11·7% of whom were overweight, and most had consumed UPF (90·6%) in the last 24 h. The most consumed UPF were biscuits, chocolate milk and baby food with 74·8, 66·8 and 24·9%, respectively. Through multivariable analysis, an association was found between lower consumption of UPF in the continuation of breast-feeding until the second year of life (prevalence ratio (PR) 0·91, 95 % CI 0·86, 0·96) and in the first year of life (PR 0·93, 95 % CI 0·88, 0·99).

It was found that the studied population had a high consumption of UPF, which harmed continued breast-feeding. We highlight the importance of strengthening public policies aimed at the promotion, protection and support of breast-feeding and healthy complementary feeding aimed at populations that have difficulties in physical and economic access to a healthy and adequate diet.

To investigate the relationship between ultra-processed food consumption and early childhood caries.

Cross-sectional analysis of baseline data from a cluster randomised controlled study. Outcomes included the prevalence of children with non-cavitated and cavitated caries. The main exposure was the total daily consumption of ultra-processed foods (up to three times and four times or more), assessed through a FFQ. Potential confounders were socio-demographic characteristics of the child and caregiver/family, child breast-feeding, oral hygiene and use of dental services. Poisson regression using robust variance adjustment was used to estimate prevalence ratios (PR) and their respective 95 % CI.

Primary Healthcare Centers in an urban area of Pelotas, Southern Brazil.

Children aged 0–3 years (n 309).

Consumption of ultra-processed foods four times or more a day was found in 67·6 % of children; 24·4 and 12·0 % presented non-cavitated and cavitated caries, respectively. After adjustment, children who consumed ultra-processed foods four times or more a day were more likely to present both non-cavitated caries (PR 2·25, 95 % CI 1·19, 4·27, P = 0·013) and cavitated caries (PR 3·48, 95 % CI 1·18, 10·30, P = 0·024) compared with those who have consumed them up to three times a day.

Consumption of ultra-processed foods is associated with early childhood caries. Interventions aiming at reducing ultra-processed food consumption should be implemented to improve children’s oral health.

To evaluate the association of dietary inflammatory index (DII®) with the occurrence of cardiovascular events, cardiometabolic risk factors and with the consumption of processed, ultra-processed, unprocessed or minimally processed foods and culinary ingredients.

This was a cross-sectional study that analysed the baseline data from 2359 cardiac patients. Data on socio-demographic, anthropometric, clinical and food consumption were collected. Energy-adjusted food intake data were used to calculate DII, and the foods were classified according to the NOVA classification. Furthermore, the patients were grouped according to the number (1, 2 or ≥ 3) of manifested cardiovascular events. The data were analysed using linear and multinomial logistic regression.

Multicentre study from Brazil.

Patients with established cardiovascular events from the Brazilian Cardioprotective Nutritional Program Trial evaluated at baseline.

Most of the patients were male (58·8 %), older adults (64·2 %) and were overweight (68·8 %). Patients in the third tertile of DII (DII > 0·91) had were more likely to have 2 (OR 1·27, 95 % CI: 1·01–1·61) and ≥ 3 (OR 1·39, 95 % CI: 1·07–1·79) cardiovascular events, with poor cardiometabolic profile. They also were more likely to consume a higher percentage of processed, ultra-processed and culinary ingredients foods consumption compared with the patients in the first DII tertile (DII ≤ 0·91).

A more pro-inflammatory diet is associated with a greater chance of having 2 and ≥ 3 cardiovascular events and cardiometabolic risk factors and were more likely to consume processed, ultra-processed and culinary ingredients compared to those with a more anti-inflammatory diet.

To evaluate the complementary food consumption according to the extent and purpose of food processing based on NOVA classification among children aged 6–24 months of Federal District, Brazil.

We performed a cross-sectional study using a 24-h recall to estimate the daily energy intake and nutrients according to NOVA classification. We conducted a linear regression to assess the association between the processed and ultra-processed foods (UPF) energy intake and the daily energy intake from saturated fat, daily energy intake from total sugars and daily intake of sodium.

Federal District, Brazil.

Five hundred and thirty-eight children aged between 6 and 24 months attended at Primary Health Care Units from March 2017 to March 2018.

On average, children aged from 6 to 12 and from 12 to 24 months consumed 2393 and 4054 kJ/d, respectively, and processed and UPF represented one-third of dietary energy intake. Group 2 (processed and UPF) was higher carbohydrate contributors, and lower protein, fibre and most micronutrient contributors, when compared with Group 1 (unprocessed, minimally processed foods and processed culinary ingredients). In addition, the higher the energy intake from processed and UPF, the higher was the daily energy intake from saturated fat, daily energy intake from total sugar and daily intake of sodium.

Children are being exposed early to processed and UPF and their share affect the diet’s nutritional quality.

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

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

Brazil.

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

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

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