Potential reductions in ultra-processed food consumption substantially improve population cardiometabolic-related dietary nutrient profiles in eight countries.

BACKGROUND AND AIMS: The negative effect on dietary nutrient profiles is the most obvious mechanism explaining the higher risk of cardiometabolic diseases associated with increased dietary share of UPF observed in large cohort studies. We estimate the proportion of diets with excessive energy density, excessive free sugars or saturated fat contents and insufficient fiber that could be avoided, if UPF consumption was reduced to levels among lowest consumers across eight countries, as well as the proportion of diets with multiple inadequacies. METHODS AND RESULTS: Using nationally-representative cross-sectional surveys from Brazil (2008-09), Chile (2010), Colombia (2005), Mexico (2012), Australia (2011-12), the UK (2008-16), Canada (2015), and the US (2015-16), inadequate energy density (≥2.25 kcal/g) or contents of free sugars (>10% of total energy intake), saturated fats (>10% of total energy intake) and fiber (<25 g/2000 kcal) population attributable fractions were quantified. Substantial reductions in nutrient inadequacies would be observed ranging from 50.4% in Chile to 76.8% in US for dietary energy density, from 15.5% in Colombia to 68.4% in Australia for free sugars, from 9.5% in Canada to 35.0% in Mexico for saturated fats, and from 10.3% in UK to 37.9% in Mexico for fiber. Higher reductions would be observed for diets with multiple nutrient inadequacies: from 27.3% in UK to 77.7% in Australia for ≥3 and from 69.4% in Canada to 92.1% in US, for 4 inadequacies. CONCLUSIONS: Lowering dietary contribution of UPF to levels among country-specific lowest consumers is a way to improve population cardiometabolic-related dietary nutrient profiles.

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

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

Individual assessment of bovine embryo development using a homemade chamber reveals kinetic patterns of success and failure to reach blastocyst stage.

Most early developmental data are lost in bovine embryo culture systems. We developed and validated a method for culture of bovine embryos in groups that allow individual assessment. An autoclavable low-cost multiembryo chamber (MEC) was prepared using a polyester mesh fixed to a glass coverslip. Embryonic development was not affected by MEC. Compared to conventional bovine culture system (oil-covered drops, control), cleavage (C, 71.2 ± 7.8%; MEC, 74.3 ± 6.0%), blastocyst rate (C, 29.9 ± 4.4%; MEC, 28.3 ± 5.0%) and blastocyst cell number (C, 94.1 ± 9.7; MEC, 92.9 ± 5.3) were similar. Caspase 3 positive cell index in blastocysts was increased in MEC group, but apoptosis rate was below 5% (C, 2.9 ± 0.5; MEC, 4.6 ± 0.6). Using MEC, we performed a retrospective analysis for 'failure' and 'success' embryos, based on their ability to reach the blastocyst stage. We detected the majority of 'success' embryos displayed 8 cells at 48 h post-insemination (hpi) (48.7%), but blastocysts derived from this pattern presented lower cell numbers (91.3 ± 4.2 vs. 107.9 ± 4.9) and higher apoptosis index (6.2 ± 0.6 vs. 4.4 ± 0.5) than blastocysts from 4-cell embryos at 48 hpi. Most (72.0%) embryos that were at morula stage 120 hpi reached blastocyst stage at 168 hpi. Those blastocysts presented more number of cells than blastocysts derived from embryos exhibiting 16 cells at 120 hpi (108.6 ± 4.1 vs. 83.9 ± 4.8). Combination of embryo kinetics data at 48 and 120 hpi revealed high chances of blastocyst formation for patterns: 8 cells/morula, 4 cells/morula, 8 cells/16 cells and 4 cells/16 cells. Blastocysts formed from 4-cell/morula and 8-cell/morula patterns represented 69% of all 168 hpi blastocysts. Blastocysts derived from 4 cells/16 cells displayed decreased apoptosis (3.1 ± 0.6). Our results suggest that MEC can be used for bovine embryo culture without detrimental effects on development and can help to predict blastocyst formation and quality of in vitro fertilization (IVF) embryos. Abbreviations: BSA: bovine serum albumine; COC: cumulus-oocyte complex; FERT-TALP: Tyrode's albumin lactate pyruvate fertilization; FBS: fetal bovine serum; IVF: in vitro fertilization; MEC: multiembryo chamber; PBS: phosphate buffered saline; SOF-AA: synthetic oviductal fluid with amino acids medium; TCM: Tissue Culture Medium.

Added sugars and ultra-processed foods in Spanish households (1990-2010).

BACKGROUND/OBJECTIVES: To study the association between ultra-processed foods acquisitions and added sugar content of total food purchases in Spanish households in 2010. Changes over time (1990-2000-2010) in ultra-processed food purchases and added sugars content of total food purchases are also compared. SUBJECTS/METHODS: We used data from three nationally representative Household Budget Surveys (HBS) conducted in 1990, 2000 and 2010. Number of studied households was 21,012, 33,730 and 22,116, respectively. Purchased foods and drinks were classified according to NOVA food groups as ultra-processed foods, processed foods, unprocessed or minimally processed foods, or processed culinary ingredients. Linear and Poisson regressions were used to estimate the association between quintiles of energy contribution of ultra-processed foods and added sugars contents of total food purchases in 2010. Changes over time were assessed using tests of linear trend and Student's t test. RESULTS: In 2010, ultra-processed foods represented 31.7% of daily energy acquisitions and 80.4% of all added sugars. Added sugars content of food purchases raised from 7.3% in the lowest to 18.2% in the highest quintiles of energy contribution of ultra-processed foods. The risk of exceeding 10% energy from added sugars quadrupled between the lowest and highest quintiles. The percentage of ultra-processed foods on all food purchases almost tripled between 1990 and 2010 (from 11.0 to 31.7%), paralleling the increase of added sugars content (from 8.4 to 13.0%). CONCLUSIONS: Cutting down exceeding added sugars availability in Spain may require a reduction in ultra-processed food purchasing.

Consumption of ultra-processed foods predicts diet quality in Canada.

This study describes food consumption patterns in Canada according to the types of food processing using the Nova classification and investigates the association between consumption of ultra-processed foods and the nutrient profile of the diet. Dietary intakes of 33,694 individuals from the 2004 Canadian Community Health Survey aged 2 years and above were analyzed. Food and drinks were classified using Nova into unprocessed or minimally processed foods, processed culinary ingredients, processed foods and ultra-processed foods. Average consumption (total daily energy intake) and relative consumption (% of total energy intake) provided by each of the food groups were calculated. Consumption of ultra-processed foods according to sex, age, education, residential location and relative family revenue was assessed. Mean nutrient content of ultra-processed foods and non-ultra-processed foods were compared, and the average nutrient content of the overall diet across quintiles of dietary share of ultra-processed foods was measured. In 2004, 48% of calories consumed by Canadians came from ultra-processed foods. Consumption of such foods was high amongst all socioeconomic groups, and particularly in children and adolescents. As a group, ultra-processed foods were grossly nutritionally inferior to non-ultra-processed foods. After adjusting for covariates, a significant and positive relationship was found between the dietary share of ultra-processed foods and the content in carbohydrates, free sugars, total and saturated fats and energy density, while an inverse relationship was observed with the dietary content in protein, fiber, vitamins A, C, D, B6 and B12, niacin, thiamine, riboflavin, as well as zinc, iron, magnesium, calcium, phosphorus and potassium. Lowering the dietary share of ultra-processed foods and raising consumption of hand-made meals from unprocessed or minimally processed foods would substantially improve the diet quality of Canadian.

Brazilian obesity prevention and control initiatives.

Obesity prevalence in the Brazilian adult population is 12.5% among men and 16.9% among women. Obesity control has been a subject of concern in Brazilian health policies since the publication of the National Food and Nutrition Policy in 1999. The initiatives include a comprehensive national intersectorial plan for obesity prevention and control focused on confronting its social and environmental causes, development of a food and nutrition education framework aimed at intersectorial public policies in the food and nutritional security field, promotion and provision of healthy food in school environments (linked to family farming), structuring nutrition actions in primary healthcare in the national healthcare system, promoting community physical activity, food regulation and control, and encouragement of public participation and food control. We conclude that several initiatives have been developed in Brazil to deal with the challenge of implementing an intergovernmental, intersectorial response to reverse the rising overweight and obesity rates. The success of this response will depend on a governance model that promotes joint and integrated action by different sectors and active participation of society to consolidate the actions, places and laws that protect health and promote healthy lifestyles.

Ultra-processed products are becoming dominant in the global food system.

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 has 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.

Obesity and inequities in health in the developing world.

OBJECTIVE: To update the social distribution of women's obesity in the developing world and, in particular, to identify the specific level of economic development at which, if any, women's obesity in the developing world starts to fuel inequities in health. DESIGN: Multilevel logistic regression analyses applied to anthropometric and socioeconomic data collected by nationally representative cross-sectional surveys conducted from 1992 to 2000 in 37 developing countries within a wide range of world regions and stages of economic development (gross national product (GNP) from 190 to 4440 US dollars per capita). SUBJECTS: : In total, 148 579 nonpregnant women aged 20-49 y. MEASUREMENTS: Body mass index to assess obesity status; quartiles of years of education to assess woman's socioeconomic status (SES), and GNP per capita to assess country's stage of economic development. RESULTS: Belonging to the lower SES group confers strong protection against obesity in low-income economies, but it is a systematic risk factor for the disease in upper-middle income developing economies. A multilevel logistic model-including an interaction term between the country's GNP and each woman's SES-indicates that obesity starts to fuel health inequities in the developing world when the GNP reaches a value of about 2500 US dollars per capita. CONCLUSIONS: For most upper-middle income economies and part of the lower-middle income economies, obesity among adult women is already a relevant booster of health inequities and, in the absence of concerted national public actions to prevent obesity, economic growth will greatly expand the list of developing countries where this situation occurs.

Intestinal parasitic infections in young children in São Paulo, Brazil: prevalences, temporal trends and associations with physical growth.

The prevalences of intestinal parasitic infections were investigated, between 1995 and 1996, in a household-based sample of 1044 children aged <5 years who lived in the city of São Paulo, Brazil. Only 10.7% of the children were infected, the most prevalent parasites being Giardia duodenalis (5.5%), Ascaris lumbricoides (4.4%) and Trichuris trichiura (1.0%). A comparison between these data and results from two previous population-based surveys, completed in São Paulo in 1974 and 1985, revealed a dramatic decrease in the prevalence of intestinal helminths in this age-group, with less marked changes in the prevalence of Giardia, over the two past decades. Despite the low prevalence of malnutrition (2.4% of stunting and 0.6% of wasting) and intestinal parasites in this population, there was a significant association (P=0.05, after controlling for potential confounding variables) between helminth (but not Giardia) infection and height. The helminth-infected children had a mean height-for-age z-score of-0.412 [95% confidence interval (CI)=-0.637--0.186], compared with one of 0.015 (CI=-0.049-0.079) for the non-infected children. No significant relationship between intestinal parasitic infection and children's weight was detected. In conclusion, a small but significant negative relationship between intestinal helminthic infections and children's growth was detected in an urban environment with low prevalences of both intestinal parasitic infection and malnutrition.

[Assessment of the promotion of breastfeeding in public and private maternities of São Paulo city, Brazil]. / Avaliação da promoção do aleitamento materno nas maternidades públicas e privadas do Município de São Paulo.

OBJECTIVE: The World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) carried out a study to compare and evaluate the practices of protecting, promoting and supporting breastfeeding in public and private hospitals using the "ten steps" of the Hospital Initiative (BFHI) as a reference parameter. METHODS: Forty-five hospitals of the municipality of São Paulo participated in the study. Data on the practices of infant feeding were collected by interviewing nurseries' supervisors of all public hospitals (26), and from a random sample of private hospitals (19), corresponding to a third of the total, during the years 1996-1997. RESULTS: More than a quarter of the public hospitals and more than one third of the private hospitals did not comply with any of the BFHI steps. Seven of the "ten steps" were observed in only two public hospitals. In general, practices of protection, promotion, and support of breastfeeding were seen at a higher frequency in public hospitals. CONCLUSIONS: The present study shows that practices considered detrimental to the onset and progressing of breastfeeding - unnecessary separation of the mother and her newborn, restrictions regarding the length of time and frequency of breastfeeding, use of pre-lacteal foods and supplements - are still quite frequently observed in public and private hospitals within the city of São Paulo. Given the benefits of breastfeeding for both the mother's and their children's health, and the important role maternities play for an early and successful onset of breastfeeding, it is paramount that the BFHI patterns be adopted by hospitals within the municipality of São Paulo.

Delayed retrobulbar hematoma after blepharoplasty.

PURPOSE: To describe a case of late orbital hematoma after blepharoplasty and review the literature on this subject. METHODS: A healthy woman developed an orbital hematoma and loss of vision 7 days after an elective blepharoplasty. Computed tomography and magnetic resonance images of the orbits were obtained 1 day after the vascular accident. RESULTS: Computed tomography and magnetic resonance images clearly demonstrated that the site of the hemorrhage was the superior nasal fat pad. Blood from this region molded the globe and accumulated in the intraconal space behind the posterior sclera. The patient was successfully treated with conservative measures only. CONCLUSIONS: Orbital hematoma, which is the main cause of loss of vision after blepharoplasty, can be a late postoperative complication.

Independent effects of income and education on the risk of obesity in the Brazilian adult population.

With a view to assess the independent effects of income and education on the risk of obesity we studied cross-sectional randomly selected samples of the adult population (20 y and over) living in 1996/97 in the less (northeastern) and the more (southeastern) developed region of Brazil (1971 and 2588 northeastern and 2289 and 2549 southeastern men and women, respectively). Independent effects of income and education on obesity (BMI > or = 30 kg/m(2)) were assessed through logistic regression analyses that controlled for age, ethnicity, household setting (urban or rural) and either education or income. The risk of obesity in men strongly increased with income in the two regions. The level of education did not influence the risk of male obesity in the less developed region but, in the more developed one, better-educated men had slightly less chance to be obese. In the less developed region obesity in women was strongly associated with both income (direct association) and education (inverse association). In the more developed region only the women's education influenced the risk of obesity, and the association between the two variables was inverse and strong as in the less developed region. Findings from this study reveal a scenario that is far from what has been generally admitted for the social distribution of obesity in the developing countries. They indicate that in transition societies income tends to be a risk factor for obesity, whereas education tends to be protective and that both gender and level of economic development are relevant modifiers of the influence exerted by these variables.

[Changes in composition and appropriate nutrition of family diet in the metropolitan areas of Brazil (1988-1996)]. / Mudanças na composição e adequação nutricional da dieta familiar nas áreas metropolitanas do Brasil (1988-1996).

OBJECTIVE: A new family budget survey carried out in the mid-nineties in Brazil allows an update of the secular trends (1962-1988) of dietary patterns of Brazilian population living in metropolitan areas. METHODS: Data sources are IBGE Institute of Statistics family budget surveys carried out from March 1987 to February 1988 (13,611 households) and from October 1995 to September 1996 (16,014 households) in all metropolitan areas of Brazil. The daily food availability per capita for each household was calculated dividing the total food acquired in a month by the number of individuals living in a household and the month's number of days. Dietary patterns were characterized according to the amount of selected food groups and nutrients relative to the diet caloric input. Comparisons between the two surveys included the metropolitan area population as a whole and subgroups from less (North and Northeast) and more developed (Mid-west, Southeast and South) regions. RESULTS: It was observed an increase in consumption of meat and dairy products (except for butter) and a reduction in eggs consumption in both less and more developed regions. Beans, roots and tubers consumption showed a steady decline in the whole country while cereals consumption remained the same (higher in developed regions) or had a slight increase (in less developed regions). The proportional consumption of vegetal oils and margarine remained constant in the less developed regions but their consumption was greatly reduced in the more developed ones. CONCLUSIONS: An increase in the diet's lipid content in less developed regions and of saturated fat in the country as a whole, associated with a decrease or even no consumption of beans, vegetables, fruits and complex carbohydrates, and a further increase in the excessive sugar consumption are the negative aspects of the trend observed from 1988 to 1996. Changes that may indicate a growing awareness of the population toward a healthier diet, such as a decline in egg intake and a slight reduction in diets with a high total lipid content, were found only in more developed regions.

Shifting obesity trends in Brazil.

OBJECTIVE: To describe secular trends in obesity in various settings and socio-economic groups of the adult population of Brazil. METHODS: Trend analysis of the prevalence of obesity in adults aged over 20 y (body mass index >/=30.0 kg/m2) applied to anthropometric and socio-economic data collected by three comparable household surveys undertaken in the two most populated Brazilian regions in 1975 (n=95,062), 1989 (n=15,585) and 1997 (n=10,680). RESULTS: While previous trends (1975-1989) showed increasing obesity prevalence for all population groups except for men in rural areas, recent trends (1989-1997) have pointed to a much more complex picture where increases in obesity tend to be more intense in men than in women, in rural than in urban settings and in poorer than in richer families. Particularly notable was the fact that, in the recent period, obesity was actually reduced for women belonging to the upper income groups, especially in urban settings. CONCLUSION: Earlier obesity trends in Brazil entirely agree with what has been described for both developed and developing countries where reliable secular trend information exists, but the 1989-1997 trend of a substantial reduction in the prevalence of obesity among upper income urban women (12.8-9.2%, or a 28% reduction), is unique in a developing country and, indeed, up to now has only been detected in Scandinavian populations. It is speculated that this declining obesity trend may be a result of an intense mass media work focused on combating a sedentary life style and promoting better food habits.

[Breastfeeding in two Brazilian State capitals: a comparative analysis]. / Situação do aleitamento materno em duas capitais brasileiras: uma análise comparada.

This paper describes rapid assessment of infant feeding practices based on surveys conducted on National Immunization Day in the cities of Florianópolis and João Pessoa, Brazil. Two different infant feeding patterns emerge clearly in the data analysis. Most infants begin breastfeeding, but exclusive breastfeeding (EBF) from 0-4 months (46.3% in Florianópolis and 23.9% in João Pessoa) and timely complementary feeding rates (32.2% in Florianópolis and 24.8% in João Pessoa) are below recommended standards. EBF and breastfeeding duration medians were 53 and 238 days, respectively, in Florianópolis and 16.5 and 195 days, respectively, in João Pessoa. The results pointed to increasing breastfeeding rates and duration medians in Florianópolis as compared to João Pessoa. Use of these data could improve planning and monitoring of breastfeeding activities and infant nutrition policies.