Elsevier

Preventive Medicine

Volume 81, December 2015, Pages 9-15
Preventive Medicine

Consumption of ultra-processed foods and obesity in Brazilian adolescents and adults

https://doi.org/10.1016/j.ypmed.2015.07.018Get rights and content

Highlights

  • The consumption of ultra-processed foods has increased in the past few years.

  • We hypothesized that ultra-processed foods may be a cause of the obesity epidemic.

  • The consumption of ultra-processed foods was associated with higher values of BMI.

  • The consumption of ultra-processed foods was associated with obesity.

  • Our study supports the role of ultra-processed foods in obesity epidemic in Brazil.

Abstract

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 ≥ 10 years 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 (0.94 kg/m2; 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.

Introduction

Ultra-processed foods are formulations made by the food industry mostly from substances extracted from foods or obtained from the further processing of constituents of foods or through chemical synthesis, with little if any whole foods (Monteiro et al., 2012, Moodie et al., 2013). Compared to the rest of the diet, these formulations have less fiber and protein, more added sugar, and, when solid, higher energy density (Monteiro et al., 2011, Moubarac et al., 2013). They are also extremely palatable and habit-forming, convenient, sold in large portion sizes, and aggressively advertised and marketed (Monteiro et al., 2012, Moodie et al., 2013, Ludwig, 2011). Sales of ultra-processed foods have increased in parallel with the rates of obesity worldwide, particularly in middle-income countries (Monteiro et al., 2013).

One analysis in Brazil showed that household purchase of ultra-processed foods was associated with greater prevalence of obesity (Canella et al., 2014). However, this study had only used purchase data rather than individual-level consumption data. To our knowledge, no evidence in a developing country is available for how much people consume ultra-processed foods across different demographic groups and how it is related to obesity.

The objective of the present study was to evaluate the association of the intake of ultra-processed foods with obesity indicators in a nationally representative sample of Brazilian adolescents and adults.

Section snippets

Design and population

We performed a cross-sectional analysis based on individual-level dietary data from 34,003 individuals aged ≥ 10 years in Brazil, collected as part of the 2008–2009 National Household Budget Survey (Instituto Brasileiro de Geografia e Estatística, Ibge, 2011a). These individuals represented a randomly selected subsample of 25% of the 55,970 total households randomly selected for the budget survey. The survey employed a complex clustered sampling procedure, first selecting census tracts and then

Results

A total of 30,243 Brazilian adults were evaluated (Table 1). Consistent with the national population, the great majority resided in urban areas, 51% were women and 52% African-descent. Forty-one percent of the participants were excess weight and 12% obese.

Mean reported energy intake was 1908 kcal. Nationally, more than two thirds (68.6%) of these calories came from unprocessed, minimally, or moderately processed foods, while 29.6% came from ultra-processed foods.

On average, rice and beans

Discussion

We found a cross-sectional association between the intake of ultra-processed foods and excess weight and obesity among Brazilian adolescents and adults. Although there was heterogeneity by sex and age, our finding supports that, on average, there are potential detrimental effects of consuming ultra-processed foods.

We suggest that this association is, at least partially, explained by intrinsic characteristics of ultra-processed foods that promote overconsumption. This is particularly important

Conclusion

In conclusion, our findings support the role of ultra-processed foods consumption in the obesity epidemic in Brazil. While cross-sectional, the size and generalizability of our study provide evidence that may support the role of ultra-processed foods in the obesity epidemic. These results demonstrate a need for interventional studies, including policy interventions, to test the effects of reducing ultra-processed foods on obesity.

Supplementary information is available at Preventive Medicine's

Conflict of interest

No conflicts of interest.

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    1

    M.L.C. Louzada was funded by the São Paulo Research Foundation (2013/08260-1).

    2

    J-C. Moubarac was funded by the São Paulo Research Foundation (2011/08425-5).

    3

    F. Imamura was supported by Medical Research Council Epidemiology Unit Core Support (MC_UU_12015/5).

    4

    D. Mozaffarian declare: Ad hoc honoraria for one-time scientific presentations/reviews on diet from Quaker Oats, Pollock Institute, and Bunge (each < 10 k/12 months); ad hoc consulting for Foodminds, Nutrition Impact, Amarin, Astra Zeneca, Winston and Strawn LLP, and Life Sciences Research Organization (each < 10 k/12 months); Unilever North America Scientific Advisory Board (< 10 k/12 months), royalties from UpToDate, for an online chapter on fish oil (< 10 k/12 months).

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