The present commentary contains a clear and simple guide designed to identify ultra-processed foods. It responds to the growing interest in ultra-processed foods among policy makers, academic researchers, health professionals, journalists and consumers concerned to devise policies, investigate dietary patterns, advise people, prepare media coverage, and when buying food and checking labels in shops or at home. Ultra-processed foods are defined within the NOVA classification system, which groups foods according to the extent and purpose of industrial processing. Processes enabling the manufacture of ultra-processed foods include the fractioning of whole foods into substances, chemical modifications of these substances, assembly of unmodified and modified food substances, frequent use of cosmetic additives and sophisticated packaging. Processes and ingredients used to manufacture ultra-processed foods are designed to create highly profitable (low-cost ingredients, long shelf-life, emphatic branding), convenient (ready-to-consume), hyper-palatable products liable to displace all other NOVA food groups, notably unprocessed or minimally processed foods. A practical way to identify an ultra-processed product is to check to see if its list of ingredients contains at least one item characteristic of the NOVA ultra-processed food group, which is to say, either food substances never or rarely used in kitchens (such as high-fructose corn syrup, hydrogenated or interesterified oils, and hydrolysed proteins), or classes of additives designed to make the final product palatable or more appealing (such as flavours, flavour enhancers, colours, emulsifiers, emulsifying salts, sweeteners, thickeners, and anti-foaming, bulking, carbonating, foaming, gelling and glazing agents).

Objectives To assess the association between consumption of ultra-processed foods and obesity in the Canadian population. Methods Cross-sectional study including 19,363 adults aged 18 years or more from the 2004 Canadian Community Health Survey, cycle 2.2. Ultra-processed food intake was estimated using daily relative energy intake of ultra-processed food (% of total energy intake) from data obtained by 24-h food recalls. Obesity was assessed using body mass index (BMI ≥ 30 kg/m 2). Univariate and multivariate linear regressions were performed to describe ultra-processed food consumption according to socioeconomic and demographic variables, and multivariate logistic regression was performed to verify the association between ultra-processed food consumption and obesity, adjusting for potential confounders, including socio-demographic factors, physical activity, smoking, immigrant status, residential location, and measured vs self-reported weight and height. Results Ultra-processed foods make up almost half (45%) of the daily calories consumed by Canadian adults. Consumption of these foods is higher among men, younger adults, those with fewer years of formal education, smokers, those physically inactive, and Canadian-born individuals. Ultra-processed food consumption is positively associated with obesity. After adjusting for confounding factors, individuals in the highest quintile of ultra-processed food consumption were 32% more likely of having obesity compared to individuals in the first quintile (predicted OR = e 0.005 × 56 = 1.32; 95% CI = 1.05-1.57). Conclusion Canadians would benefit from reducing consumption of ultra-processed foods and beverages and increasing consumption of freshly prepared dishes made from unprocessed or minimally processed foods. Résumé Objectifs Cette étude vise à évaluer l'association entre la consommation d'aliments ultra-transformés et l'obésité. Méthodes Étude transversale comprenant 19 363 adultes âgés de 18 ans ou plus qui ont participé à l'Enquête sur la santé dans les collectivités canadiennes, 2004, cycle 2.2. La consommation d'aliments ultra-transformés est estimée en utilisant l'apport énergétique relatif provenant des aliments ultra-transformés du rappel alimentaire de 24 heures. L'obésité est déterminée en utilisant l'indice de masse corporelle (IMC) ≥ 30 kg/m 2. Les régressions linéaires univariée et multivariée ont été réalisées pour décrire la consommation d'aliments ultra-transformés selon différents groupes socioéconomiques et démographiques, et la régression logistique multivariée a été réalisée pour évaluer l'association entre la consommation de ces aliments et l'obésité, Electronic supplementary material The online version of this article (

BackgroundTrends in food availability and metabolic risk factors in Brazil suggest a shift toward unhealthy dietary patterns and increased cardiometabolic disease risk, yet little is known about the impact of dietary and metabolic risk factors on cardiometabolic mortality in Brazil.MethodsBased on data from Global Burden of Disease (GBD) Study, we used comparative risk assessment to estimate the burden of 11 dietary and 4 metabolic risk factors on mortality due to cardiovascular diseases and diabetes in Brazil in 2010. Information on national diets and metabolic risks were obtained from the Brazilian Household Budget Survey, the Food and Agriculture Organization database, and large observational studies including Brazilian adults. Relative risks for each risk factor were obtained from meta-analyses of randomized trials or prospective cohort studies; and disease-specific mortality from the GBD 2010 database. We quantified uncertainty using probabilistic simulation analyses, incorporating uncertainty in dietary and metabolic data and relative risks by age and sex. Robustness of findings was evaluated by sensitivity to varying feasible optimal levels of each risk factor.ResultsIn 2010, high systolic blood pressure (SBP) and suboptimal diet were the largest contributors to cardiometabolic deaths in Brazil, responsible for 214,263 deaths (95% uncertainty interval [UI]: 195,073 to 233,936) and 202,949 deaths (95% UI: 194,322 to 211,747), respectively. Among individual dietary factors, low intakes of fruits and whole grains and high intakes of sodium were the largest contributors to cardiometabolic deaths. For premature cardiometabolic deaths (before age 70 years, representing 40% of cardiometabolic deaths), the leading risk factors were suboptimal diet (104,169 deaths; 95% UI: 99,964 to 108,002), high SBP (98,923 deaths; 95%UI: 92,912 to 104,609) and high body-mass index (BMI) (42,643 deaths; 95%UI: 40,161 to 45,111).Conclusionsuboptimal diet, high SBP, and high BMI are major causes of cardiometabolic death in Brazil, informing priorities for policy initiatives.

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Background Ultra-processed foods (UPF) have been associated with major diet-related public health issues that share underlying drivers with climate change. Both challenges require major changes to the food system and so the potential benefits to health and the environment present a double motivation for transformation. Our aim is to assess the impacts of UPF on total greenhouse gas emissions (GHGE), water and ecological footprints in Brazil food purchases. Methods We have used data from 4 Brazilian Household Budget Surveys (1987, 1996, 2003, 2009). Each food item was classified into NOVA food groups (unprocessed/minimally processed, culinary ingredients, processed and ultra-processed). The information was linked to nutrition and footprint data. Purchases were converted into grams per capita per day to estimate total energy (kcal), percentage of energy from UPF, as well as total GHGE, water and ecological footprints. We performed linear regression to calculate year-adjusted means of footprints per 1000 Kcal by year-specific quintiles of UPF participation in the total energy. The data were analysed in R v.3.6.1 and STATA SE 14.1. Results The mean UPF participation in total energy varied from 13% (SD 2.4) in the 1st UPF quintile to 29% (SD 5.1) in the 5th quintile. The footprints increased linearly across quintiles: the mean g CO2eq varied from 1312 in the 1st to 1721 in the 5th UPF quintile (p-trend<0.001); the mean litres of water varied from 1420 in the 1st to 1830 in the 5th quintile (p-trend<0.001); the mean m2 varied from 9.4 in the 1st to 12.3 in the 5th quintile (p < 0.001). Conclusions The environmental impacts were higher for Brazilian diets with a larger fraction of energy from UPF. Specifically, low UPF diets seem to have lower GHGE, water and ecological footprints. Our findings offer new motivators for dietary change to simultaneously healthier and more sustainable eating patterns and will be of relevance to consumers and policymakers. Key messages Diets high in UPF cause more climate impact than diets with lower levels of UPF. Healthy and sustainable dietary patterns should be low in ultra-processed foods.

Background Ultra-processed foods consumption is an important risk factor for disease disorders, unhealthy feeding habits and climate changes. In the United Kingdom, ultra-processed food consumption represents more than 50% of calories per day. Furthermore, many studies shown that the locations are important for health foods habits. The aim of this abstract is to analyze the association between percentage share of ultra-processed foods consumption and percentage share kcal in each location consumers on U.K. Methods Cross-sectional data from the U.K. National Diet and Nutrition Survey (2014-2016) were analyzed. Foods items collected using a one-day food diary were classified according to the NOVA classification: unprocessed or minimally processed foods, processed culinary ingredients, processed foods and ultra-processed foods. All locations consumers were categorized on six groups: institutional (work, school), sit-downs restaurants, coffee shops, fast foods, home and others. To test the association, we used linear regression models, 95% confidences intervals were adopted. Results Ours crude analyzes shows that eat on fast foods, sit-down restaurants and other locations have been associated with percentage share of ultra-processed foods on daily kcal. Sit-down restaurants were negatively associated, and fast foods and other locations were positively associated. In the multiple model, adjusted for sex and age, the associations remained, with significance <0.00. Conclusions Our findings showed an association between some consumption locations and higher percentage share by ultra-processed foods on daily kcal. It is possible the inverse association found in sit-downs restaurants is because in these places there is a greater participation of unprocessed and minimally processed foods. Another important fact to consider is that in this population the consumption of ultra-processed foods is naturally high. Key messages Consumer locations have a different impact on the caloric share of ultra-processed foods. Encouraging consumption in some places can influence the improvement in the quality of the diet, decreasing the consumption of ultra-processed foods.

The objective of this project was to develop a brief self-administered dietary screener, in English and French, to rapidly assess alignment of adults’ dietary intake with the 2019 Canada’s Food Guide healthy food choices recommendations. In consultation with Health Canada and external advisors (n=15), guiding principles were defined. Existing screeners were scanned, and the healthy food choices recommendations were mapped to inform questions and response options. Cognitive interviews were conducted in English (n=17) and French (n=16) with adults aged 18-65 years from April to June 2021 to assess understanding of questions and face validity; recruitment emphasized variation in sociodemographic characteristics. Face and content validity were assessed with experts in nutrition, surveillance, and public health (n=13 English, 3 French) from April to May 2021. The testing indicated that the screener was well-understood overall but informed refinements to improve comprehension of the questions and their alignment with the healthy food choices recommendations. The resulting Canadian Food Intake Screener/Questionnaire court canadien sur les apports alimentaires includes 16 questions to rapidly assess alignment of intake with the 2019 Canada’s Food Guide healthy food choices recommendations, including healthy foods and foods to limit, in situations in which comprehensive dietary assessment is not feasible.

The Canadian Food Intake Screener/Questionnaire court canadien sur les apports alimentaires was developed to rapidly assess alignment of adults’ dietary intake over the past month with the 2019 Canada’s Food Guide’s healthy food choices recommendations. From July to December 2021, adults (n=154) aged 18-65 years completed the screener and up to two 24-hour dietary recalls. The screener scoring system was aligned with the Healthy Eating Food Index-2019 (HEFI-2019), to the extent possible. ANOVA compared screener scores among subgroups with known differences in diet quality. Using the recall data, the National Cancer Institute multivariate method was used to model HEFI-2019 components, with the screener score as a covariate, and the correlation coefficient between screener and total HEFI-2019 scores was estimated. The mean screener score was 35 points (SD=4.7; maximum, 65), ranging from 25 (1st percentile) to 45 (99th percentile). Differences in scores in hypothesized directions were evident by gender identity (p=0.06), perceived income adequacy (p=0.07), education (p=0.02), and smoking status (p=0.003). The correlation between screener and HEFI-2019 scores was 0.53 (SE=0.12). The screener’s moderate construct validity supports its use for rapid assessment of alignment of adults’ intake with the healthy food choices recommendations when comprehensive dietary assessment is not possible.