title: Consumption of ultra-processed foods and obesity in Brazilian adolescents and adults.
abstract: OBJECTIVE
  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/m(2); 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.
  
  
  CONCLUSIONS
  Our findings support the role of ultra-processed foods in the obesity epidemic in Brazil.
authors.affiliation: Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, Av. Dr. Arnaldo, 715, 2° floor, São Paulo 01246-907, Brazil; Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de São Paulo, Av. Dr. Arnaldo, 715, S27, São Paulo 01246-907, Brazil. Electronic address: maria.laura.louzada@gmail.com.
authors.forename: Maria Laura da Costa
authors.initials: ML
authors.lastname: Louzada
authors.affiliation: Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, Av. Dr. Arnaldo, 715, 2° floor, São Paulo 01246-907, Brazil; Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de São Paulo, Av. Dr. Arnaldo, 715, S27, São Paulo 01246-907, Brazil. Electronic address: laribaraldi@gmail.com.
authors.forename: Larissa Galastri
authors.initials: LG
authors.lastname: Baraldi
authors.affiliation: Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, Av. Dr. Arnaldo, 715, 2° floor, São Paulo 01246-907, Brazil; Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de São Paulo, Av. Dr. Arnaldo, 715, S27, São Paulo 01246-907, Brazil. Electronic address: emar_steele@hotmail.com.
authors.forename: Euridice Martinez
authors.initials: EM
authors.lastname: Steele
authors.affiliation: Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de São Paulo, Av. Dr. Arnaldo, 715, S27, São Paulo 01246-907, Brazil. Electronic address: anapbmartins@gmail.com.
authors.forename: Ana Paula Bortoletto
authors.initials: AP
authors.lastname: Martins
authors.affiliation: Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de São Paulo, Av. Dr. Arnaldo, 715, S27, São Paulo 01246-907, Brazil. Electronic address: danicanella@gmail.com.
authors.forename: Daniela Silva
authors.initials: DS
authors.lastname: Canella
authors.affiliation: Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de São Paulo, Av. Dr. Arnaldo, 715, S27, São Paulo 01246-907, Brazil. Electronic address: jcmoubarac@gmail.com.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Moubarac
authors.affiliation: Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de São Paulo, Av. Dr. Arnaldo, 715, S27, São Paulo 01246-907, Brazil; Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455, S27, São Paulo 01246-903, Brazil. Electronic address: rlevy@usp.br.
authors.forename: Renata Bertazzi
authors.initials: RB
authors.lastname: Levy
authors.affiliation: Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de São Paulo, Av. Dr. Arnaldo, 715, S27, São Paulo 01246-907, Brazil. Electronic address: geoffreycannon@aol.com.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Cannon
authors.affiliation: Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, United States. Electronic address: ashkan.Afshin@tufts.edu.
authors.forename: Ashkan
authors.initials: A
authors.lastname: Afshin
authors.affiliation: Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0SP, UK. Electronic address: fumiaki.imamura@mrc-epid.cam.ac.uk.
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Imamura
authors.affiliation: Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, United States. Electronic address: dariush.mozaffarian@tufts.edu.
authors.forename: Dariush
authors.initials: D
authors.lastname: Mozaffarian
authors.affiliation: Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, Av. Dr. Arnaldo, 715, 2° floor, São Paulo 01246-907, Brazil; Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de São Paulo, Av. Dr. Arnaldo, 715, S27, São Paulo 01246-907, Brazil. Electronic address: carlosam@usp.br.
authors.forename: Carlos Augusto
authors.initials: CA
authors.lastname: Monteiro
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D001938:Brazil / Q000453:epidemiology; D002648:Child; D003430:Cross-Sectional Studies; D004032:Diet; D002149:Energy Intake; D057140:Fast Foods / Q000706:statistics & numerical data*; D005247:Feeding Behavior; D005260:Female; D005511:Food Handling; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology / Q000209:etiology*; D055815:Young Adult
keywords: Food; Nutrition; Obesity; Prevention; Risk factor