Ultra-processed foods, incident overweight and obesity, and longitudinal changes in weight and waist circumference: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Abstract

Objective: To evaluate the association of ultra-processed food (UPF) consumption with gains in weight and waist circumference, and incident overweight/obesity, in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort. Design: We applied FFQ at baseline and categorized energy intake by degree of processing using the NOVA classification. Height, weight and waist circumference were measured at baseline and after a mean 3·8-year follow-up. We assessed associations, through Poisson regression with robust variance, of UPF consumption with large weight gain (1·68 kg/year) and large waist gain (2·42 cm/year), both being defined as ≥90th percentile in the cohort, and with incident overweight/obesity. Setting: Brazil. Participants: Civil servants of Brazilian public academic institutions in six cities (n 11 827), aged 35-74 years at baseline (2008)(2009)(2010). Results: UPF provided a mean 24·6 (SD 9·6) % of ingested energy. After adjustment for smoking, physical activity, adiposity and other factors, fourth (>30·8 %) v. first (<17·8 %) quartile of UPF consumption was associated (relative risk (95 % CI)) with 27 and 33 % greater risk of large weight and waist gains (1·27 (1·07, 1·50) and 1·33 (1·12, 1·58)), respectively. Similarly, those in the fourth consumption quartile presented 20 % greater risk (1·20 (1·03, 1·40)) of incident overweight/obesity and 2 % greater risk (1·02; (0·85, 1·21)) of incident obesity. Approximately 15 % of cases of large weight and waist gains and of incident overweight/obesity could be attributed to consumption of >17·8 % of energy as UPF. Conclusions: Greater UPF consumption predicts large gains in overall and central adiposity and may contribute to the inexorable rise in obesity seen worldwide. Keywords Ultra-processed food Obesity Weight gain Food handlingThe world has witnessed a progressive, major increase in the burden of obesity over recent decades. Since 1980, the prevalence has doubled in more than seventy out of 195 countries (1) and obesity has become a major problem not only in high-income but also in low-and middleincome countries (2) .

Práticas alimentares segundo o Guia alimentar para a população brasileira: fatores associados entre brasileiros adultos, 2018*

“…A growing number of national and international studies have investigated the impact of food processing on health using the NOVA classification. 6 There is evidence that diets containing a higher share of ultra-processed food have poorer nutritional profiles, 7 and that consumption of such food is directly associated with higher prevalence and risk of overweight and obesity in adults 8,9 and adolescents, 10 as well as with the risk of developing hypertension 11 and cancer in general, especially breast cancer. 12 Studies have already demonstrated its association with abdominal obesity and poorer lipid profiles in children.…”

Consumo de alimentos ultraprocessados, qualidade nutricional da dieta e obesidade na população australiana

“…First, this is a cross-sectional study, and thus temporality and causality cannot be established. However, our results are biologically plausible and consistent with the randomized controlled trial that has assessed the short-term impact of ultra-processed diets on energy intake and weight gain , and with a few longitudinal studies that have assessed the association between the dietary share of ultra-processed foods and the incidence of obesity or of higher weight gain (Canhada et al, 2019;Rohatgi et al, 2017;. Besides, reverse causality cannot be ruled out.…”

“…In accordance with these findings, consumption of ultra-processed foods was found to be associated with 9-year incidence of overweight or obesity in a prospective cohort of Spanish middle-aged adult university graduates , weight gain in a cohort of American pregnant women (Rohatgi et al, 2017), incidence of obesity or of higher weight gain among Brazilian adults (Canhada et al, 2019), and in cross-sectional studies involving nationally representative sample of adults in the U.S. , Canada and Brazil . An ecological study including 19 European countries found a significant positive association between national household availability of ultra-processed foods and national prevalence of obesity among adults (Monteiro et al, 2017).…”

“…Indicators of ultra-processed food consumption were shown to be associated with obesity indicators in Spain , the U.S. , Canada , Brazil (Canhada et al, 2019;Silva et al, 2018;Canella et al, 2014), across 19 European countries (Monteiro et al, 2017), and across 80 high and middleincome countries (Vandevijvere et al, 2019).…”

Longitudinal associations between ultra-processed foods and blood lipids in childhood

“…Several studies have been conducted to quantify the burden of disease attributable to specific UPF consumption. In adults, consumption of UPF has been associated with an increased risk of overweight and obesity (21)(22)(23) , and related conditions, such as hypertension (24) , CVD (25) , as well as higher risk of overall cancer (26) . However, few studies focus on the association between consumption of UPF and risk of diseases in childhood (27)(28)(29) .…”