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PURPOSE: Ultra-processed food may play a role in facilitating snacking behavior because of their convenience and low satiety potential. This study aimed to describe the association between consumption of ultra-processed foods and frequency of snacking. METHODS: We analyzed data from 46,164 participants (≥ 10 years old) in the 2017-2018 Brazilian Household Budget Survey. Dietary data were collected by 24-h dietary recalls over one or two days for each participant. We estimated energy intake, ultra-processed food consumption, and level of snacking. We measured the association between ultra-processed food consumption and level of snacking using multinomial logistic regression, stratified by age group (adolescents, 10-19 years old; adults, 20-64 years old; elders, 65 or older). RESULTS: We found a statistically significant tendency of increased daily energy intake and consumption of snacks and that ultra-processed food consumption was positively associated with the level of snacking for all age groups. For adolescents, adults, and elders in the highest quintile of ultra-processed food consumption as a share of their entire diet, the relative risk ratio (95% CI) of having more than two snacks per day compared to no snacks was 14.21 (9.09-22.21), 4.44 (3.54-5.57), and 4.21 (2.67-6.64), respectively, when compared to the lowest quintile. CONCLUSION: Higher consumption of ultra-processed food was associated with snacking behavior, and the strength of this association was stronger among adolescents. Efforts to mitigate ultra-processed food attributes that facilitate snacking should be incorporated into strategies to promote healthier food choices, especially among adolescents.

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Consumption of ultra-processed food (UPF) has been associated with several chronic diseases and poor diet quality. It is reasonable to speculate that the consumption of UPF negatively associates with flavonoid dietary intake; however, this assumption has not been previously examined. The present study aims to assess association between the dietary contribution of UPF and flavonoid intake in the US population aged 0 years and above. We performed a cross-sectional analysis of dietary data collected by 24-h recalls from 7640 participants participating in the National Health and Nutrition Examination Survey 2017-2018. Foods were classified according to the Nova classification system. The updated US Department of Agriculture (USDA) Database for the Flavonoid Content of Selected Foods (Release 3.3) database was used to estimate total and six classes of flavonoid intakes. Flavonoid intakes were compared across quintiles of dietary contribution of UPF (% of total energy intake) using linear regression models. The total and five out of six class flavonoid intakes decreased between 50 and 70 % across extreme quintiles of the dietary contribution of UPF (Pfor linear trend < 0·001); only isoflavones increased by over 260 %. Our findings suggest that consumption of UPF is associated with lower total and five of six class flavonoid intakes and with higher isoflavone intakes, supporting previous evidence of the negative impact of UPF consumption on the overall quality of the diet and health outcomes.

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OBJECTIVE: This paper describes the first web-based self-completed 24-h recall designed to categorise food intake according to Nova groups - Nova24h - and its agreement with a reference tool in estimating the dietary relative contribution of the four Nova food groups (% of total energy intake). DESIGN: Comparisons of estimates of dietary relative contributions of Nova groups obtained by Nova24h and one standard interviewer-led 24-h recall. SETTING: Nationwide adult cohort study in Brazil. PARTICIPANTS: The subjects were 186 participants of the NutriNet Brasil Cohort Study (n 186). RESULTS: No statistically significant differences were observed between the Nova24h and the reference tool mean contributions of unprocessed or minimally processed foods (52·3 % v. 52·6 %), processed culinary ingredients (11·6 % v. 11·9 %), processed foods (17·1 % v. 14·7 %) and ultra-processed foods (19·0 % v. 20·9 %). Intraclass correlation coefficients between individual estimates obtained for each Nova group showed moderate to good agreement (0·54-0·78). Substantial or almost perfect agreement between the tools was seen regarding the ability to rank participants according to quintiles of contribution of each Nova group (PABAK 0·69-0·81). CONCLUSIONS: Nova24h is a suitable tool for estimating the dietary relative energy contribution of Nova food groups in the NutriNet Brasil cohort. New studies are necessary to verify its adequacy in other populations.

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OBJECTIVE: To assess the prospective association of two diet quality scores based on the Nova food classification with BMI gain. DESIGN: The NutriNet-Brasil cohort is an ongoing web-based prospective study with continuous recruitment of participants aged ≥ 18 years since January 2020. A short 24-h dietary recall screener including 'yes/no' questions about the consumption of whole plant foods (WPF) and ultra-processed foods (UPF) was completed by participants at baseline. The Nova-WPF and the Nova-UPF scores were computed by adding up positive responses regarding the consumption of thirty-three varieties of WPF and twenty-three varieties of UPF, respectively. Participants reported their height at baseline and their weight at both baseline and after approximately 15 months of follow-up. A 15-month BMI (kg/m2) increase of ≥5 % was coded as BMI gain. SETTING: Brazil. PARTICIPANTS: 9551 participants from the NutriNet-Brasil cohort. RESULTS: Increasing quintiles of the Nova-UPF score were linearly associated with higher risk of BMI gain (relative risk Q5/Q1 = 1·34; 95 % CI 1·15, 1·56), whereas increasing quintiles of the Nova-WPF score were linearly associated with lower risk (relative risk Q5/Q1 = 0·80; 95 % CI 0·69, 0·94). We identified a moderate inverse correlation between the two scores (-0·33) and a partial mediating effect of the alternative score: 15 % for the total effect of the Nova-UPF score and 25 % for the total effect of the Nova-WPF score. CONCLUSIONS: The Nova-UPF and Nova-WPF scores are independently associated with mid-term BMI gain further justifying their use in diet quality monitoring systems.

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Ultra-processed food (UPF) consumption has been associated with cardiovascular disease and cancer. Acrylamide is a probable human carcinogen commonly found in foods that are processed at high temperatures. The aim of this study was to examine the association between dietary energy contribution of UPF and acrylamide exposure, in the US. Among the 4418 participants from cross-sectional 2013-2016 National Health and Nutrition Examination Survey, aged 6+ years, with hemoglobin biomarkers of acrylamide exposure, 3959 that completed the first 24-h dietary recall and had information on all covariates were included in the study. UPF were identified based on the Nova classification system, a four-group food classification based on the extent and purpose of industrial food processing. Linear regression was used to compare average acrylamide and glycidamide hemoglobin (HbAA+HbGA) concentrations across quintiles of daily energy contribution of UPF. Adjusted geometric means of acrylamide and glycidamide hemoglobin concentrations increased monotonically from the lowest to the highest quintile of UPF consumption in the overall population. Compared to the lowest quintile, the highest quintile had 9.1% higher levels of HbAA+HbGA (94.1 vs. 86.3 pmol/g Hb). These positive associations were statistically significant among males and in the young adult population and were largely driven by UPF which are known potential sources of acrylamide. The main effects remained unchanged when excluding current smokers. As both acrylamides and UPF have been previously associated with cardiovascular disease and cancer, our results suggest that acrylamides in UPF may partially explain previously observed links between UPF consumption and these health outcomes.

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Although ultra-processed foods represent more than half of the total energy consumed by the UK population, little is known about the trend in food consumption considering the degree of food processing. We evaluated the trends of the dietary share of foods categorised according to the NOVA classification in a historical series (2018-2019) among the UK population. Data were acquired from the NDNS, a survey that collects diet information through a 4-d food record. We used adjusted linear regression to estimate the dietary participation of NOVA groups and evaluated the linear trends over the years. From 2008 to 2019, we observed a significant increase in the energy share of culinary ingredients (from 3·7 to 4·9 % of the total energy consumed; P-trend = 0·001), especially for butter and oils; and reduction of processed foods (from 9·6 to 8·6 %; P-trend = 0·002), especially for beer and wine. Unprocessed or minimally processed foods (≅30 %, P-trend = 0·505) and ultra-processed foods (≅56 %, P-trend = 0·580) presented no significant change. However, changes in the consumption of some subgroups are noteworthy, such as the reduction in the energy share of red meat, sausages and other reconstituted meat products as well as the increase of fruits, ready meals, breakfast cereals, cookies, pastries, buns and cakes. Regarding the socio-demographic characteristics, no interaction was observed with the trend of the four NOVA groups. From 2008 to 2019 was observed a significant increase in culinary ingredients and a reduction in processed food. Furthermore, it sheds light on the high share of ultra-processed foods in the contemporary British diet.

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Importance: Although consumption of ultraprocessed food has been linked to higher risk of cardiovascular disease, metabolic syndrome, and obesity, little is known about the association of consumption of ultraprocessed foods with cognitive decline. Objective: To investigate the association between ultraprocessed food consumption and cognitive decline in the Brazilian Longitudinal Study of Adult Health. Design, Setting, and Participants: This was a multicenter, prospective cohort study with 3 waves, approximately 4 years apart, from 2008 to 2017. Data were analyzed from December 2021 to May 2022. Participants were public servants aged 35 to 74 years old recruited in 6 Brazilian cities. Participants who, at baseline, had incomplete food frequency questionnaire, cognitive, or covariate data were excluded. Participants who reported extreme calorie intake (<600 kcal/day or >6000 kcal/day) and those taking medication that could negatively interfere with cognitive performance were also excluded. Exposures: Daily ultraprocessed food consumption as a percentage of total energy divided into quartiles. Main Outcomes and Measures: Changes in cognitive performance over time evaluated by the immediate and delayed word recall, word recognition, phonemic and semantic verbal fluency tests, and Trail-Making Test B version. Results: A total of 15 105 individuals were recruited and 4330 were excluded, leaving 10 775 participants whose data were analyzed. The mean (SD) age at the baseline was 51.6 (8.9) years, 5880 participants (54.6%) were women, 5723 (53.1%) were White, and 6106 (56.6%) had at least a college degree. During a median (range) follow-up of 8 (6-10) years, individuals with ultraprocessed food consumption above the first quartile showed a 28% faster rate of global cognitive decline (ß = -0.004; 95% CI, -0.006 to -0.001; P = .003) and a 25% faster rate of executive function decline (ß = -0.003, 95% CI, -0.005 to 0.000; P = .01) compared with those in the first quartile. Conclusions and Relevance: A higher percentage of daily energy consumption of ultraprocessed foods was associated with cognitive decline among adults from an ethnically diverse sample. These findings support current public health recommendations on limiting ultraprocessed food consumption because of their potential harm to cognitive function.

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OBJECTIVE: To estimate beef consumption and its influence on carbon and water footprints, as well as to improve the nutritional quality of the Brazilian diet. METHODS: The amount of beef and other foods consumed was evaluated by two 24-hour food records in a representative sample of the Brazilian population ≥ 10 years of age (n = 32,853) from 2008 to 2009. The environmental impact of the diet considered the coefficients of the carbon footprint (gCO2 and/kg) and the water footprint (liters/kg) of the foods, as well as their nutritional quality considering the nutrient composition of each food associated with the prevention of nutritional deficiencies or the increase/decrease in chronic disease risk. Linear and logistic regression models, crude and adjusted for sex, age, education, income, region, and area, were used to respectively study the association of fifths of the caloric contribution of beef with the environmental impacts of the diet and inadequate nutrient intake. RESULTS: Carbon and water footprints and protein, iron, zinc, vitamin B12, saturated fat, and sodium contents were higher in the fraction of the diet composed of beef, whereas fiber and added sugar contents were higher in the fraction composed by the other foods. Dietary beef contribution was directly associated with the carbon and water footprints of the diet and the risk of saturated fat and sodium excess, besides fiber insufficiency, inversely associated with the risk of protein, iron, zinc, and vitamin B12 insufficiency. CONCLUSION: Reducing beef consumption in Brazil would also reduce the carbon and water footprints of the diet, as well as the risk of chronic diseases related to food. Therefore, in order not to increase the risk of nutritional deficiencies, monitoring the increased intake of other foods rich in protein, iron, zinc, and vitamin B12 is suggested.

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