Introdução: A prevalência de obesidade e doenças crônicas não transmissíveis tem aumentado em todo o mundo, enquanto as deficiências de micronutrientes continuam sendo um grave problema de saúde pública. Este cenário tem sido impulsionado, entre outros fatores, por transformações recentes no sistema alimentar global, caracterizadas principalmente pela substituição dos hábitos alimentares tradicionais pelo consumo de alimentos ultraprocessados. Objetivos: Os objetivos deste estudo são analisar o consumo de alimentos ultraprocessados no Brasil e sua influência sobre a qualidade nutricional da alimentação e indicadores de obesidade e avaliar o uso de dados de aquisição domiciliar de alimentos para estimar o consumo de alimentos ultraprocessados. Métodos: Foram produzidos quatro manuscritos baseados em dados da Pesquisa de Orçamentos Familiares 2008-2009. Os três primeiros utilizaram dados do módulo de consumo alimentar individual, que avaliou 34.003 adolescentes e adultos brasileiros. Todos os alimentos consumidos foram classificados de acordo com as características do processamento industrial. Alimentos ultraprocessados foram definidos como formulações industriais feitas predominantemente de substâncias extraídas diretamente de alimentos (óleos, gorduras, açúcar), derivadas de constituintes de alimentos (gorduras hidrogenadas, amido modificado) ou sintetizadas em laboratório a partir de matérias orgânicas (corantes, aromatizantes, realçadores de sabor). Exemplos incluem balas, chocolates, sorvete e guloseimas em geral, bolachas doces, salgadas, salgadinhos, refrigerantes e refrescos, hambúrgueres e outras refeições fast food. Modelos de regressão foram empregados para descrever a associação entre quintos do consumo de alimentos ultraprocessados ( por cento do total de energia), o perfil nutricional da alimentação (artigos 1 e 2) e indicadores de obesidade (artigo 3). No artigo 4, compararam-se as estimativas de consumo de alimentos ultraprocessados obtidas por dados do módulo de aquisição domiciliar de alimentos e do módulo de consumo alimentar individual. Resultados: Os alimentos ultraprocessados apresentaram maior densidade energética, maior conteúdo em açúcar livre e gorduras totais, saturadas e trans e menor teor de fibras, proteínas e de vários micronutrientes, em comparação ao conjunto dos outros alimentos. Maior consumo de alimentos ultraprocessados determinou generalizada deterioração no perfil nutricional da alimentação. O perfil nutricional da alimentação dos brasileiros que menos consumiram alimentos ultraprocessados aproximam este estrato da população das recomendações internacionais para prevenção da obesidade e doenças crônicas. Os indivíduos no quintil superior de consumo de alimentos ultraprocessados apresentaram maior índice de massa corporal (0,94 kg/m2; IC 95 por cento 0,42;1,47) e maiores chances de serem obesos (OR=1,98; IC 95 por cento : 1,26;3,12) em comparação àqueles no quintil inferior. Observou-se uma concordância razoável entre as estimativas de consumo de alimentos ultraprocessados obtidas a partir de dados de aquisição familiar de alimentos e de consumo alimentar individual. Conclusões: Os resultados indicam prejuízos à saúde decorrentes da substituição de refeições tradicionais baseadas em alimentos in natura ou minimamente processados por alimentos ultraprocessados e apoiam a recomendação para ser evitado o consumo desses alimentos. Além disso, os achados reforçam a utilização de dados de aquisição familiar de alimentos, que são coletados sistematicamente no Brasil desde os anos 70, como um proxy do consumo real de alimentos ultraprocessados. Na ausência de pesquisas de consumo alimentar individual com representatividade nacional, pesquisas domiciliares podem ser uma ferramenta valiosa para monitorar os padrões alimentares da população. / Introduction: Rates of obesity and other chronic diseases have increased worldwide while micronutrient deficiencies remain a serious public health problem. This transition is paralleled with recent transformations in the globalizing food system, mainly characterized by the replacement of traditional food habits by the consumption of ultra-processed foods. Objectives: The objectives of this study were to assess the consumption of ultra-processed foods in Brazil and its influence on the nutritional dietary quality and on obesity indicators, and to evaluate the use of household food acquisition data to estimate actual consumption of ultra-processed foods. Methods: Four manuscripts were produced based on data from the Brazilian Household Budget Survey 2008-2009. The first three manuscripts were based on the module of individual food consumption, which evaluated 34,003 Brazilian adolescents and adults. All food items were classified according to characteristics of food processing. Ultra-processed foods were defined as industrial formulations that are predominantly made from substances that are extracted from food (oils, fats, sugar), derived from food constituents (hydrogenated fats, modified starch) or synthesized in a laboratory from organic materials (colorants, flavorings, flavor enhancers). Examples included candies, chocolates, ice cream and confectionary in general, cookies, crackers, chips, sugar-sweetened beverages, hamburgers and other fast food dishes. Regression models were fitted to evaluate the association of quintiles of consumption of ultra-processed foods ( per cent of energy intake) with the nutrient intake profile (manuscripts 1 and 2) and obesity indicators (manuscript 3). In the fourth manuscript, estimates of the consumption of ultra-processed food obtained from the module of household food acquisition and from the module of individual food intake were compared. Results: The nutrient profile of ultra-processed foods, compared to the rest of the diet, revealed higher energy density, higher content in added sugar and in total, saturated, and trans fats, and lower in fiber, protein and many micronutrients. Higher contribution of ultra-processed foods to the total diet was associated with an overall deterioration of the nutrition profile of the diet. The 20 per cent lowest consumers of ultra-processed foods were anywhere near reaching international nutrient goals for the prevention of obesity and chronic non-communicable diseases. Individuals in the highest quintile of consumption of ultra-processed foods had significantly higher body-mass-index (0.94 kg/m2; 95 per cent CI: 0.42,1.47) and higher odds of being obese (OR=1.98; 95 per cent CI: 1.26,3.12) compared with those in the lowest quintile of consumption. Comparative analyses showed a reasonable agreement between the estimates of ultra-processed foods consumption obtained from household acquisition and individual food intake inside home data. Conclusions: The results from this study highlight the damage to health that is arising based on the observed trend of replacing traditional meals, based on natural or minimally processed foods, with ultra-processed foods. These results also support the recommendation of avoiding the consumption of these foods. In addition, our findings strengthen the use of household acquisition data, which is collected systematically in Brazil since the 70s, as a proxy of the actual intake of ultra-processed foods. In the absence of nationally representative dietary intake surveys, household data is a valuable tool to monitor national food and nutrition security.

Introducción: Desde el inicio de la pandemia por el nuevo coronavirus, a nivel mundial se han adoptado diversas medidas para disminuir la propagación de este. Entre ellas, el aislamiento social obligatorio, el cual ha generado cambios en el estilo de vida de las personas, especialmente en los niños preescolares, quienes han visto interrumpidas, y sustituidas sus actividades académicas a modalidades online, limitando sus actividades recreacionales por actividades más sedentarias. Sumado a esto, el Perú ya venía experimentando un aumento en el consumo de productos ultraprocesados, con incremento en la prevalencia de sobrepeso y obesidad en niños. Objetivo: Explorar cómo influye la evolución de la pandemia del COVID-19 en la elección de los productos ultraprocesados que realizan las madres para la alimentación del niño preescolar. Método: Estudio cualitativo con enfoque fenomenológico. Se realizó 26 entrevistas semiestructuradas utilizando una guía de preguntas. La muestra seleccionada fue por bola de nieve hasta alcanzar la saturación. Resultados: Las madres entrevistadas tuvieron entre 21 y 47 años de edad, la mayoría vivía en los distritos de Miraflores y Surco, contaban con estudios superiores completos y trabajo al momento de las entrevistas. Ellas expresaron que la experiencia de vivir la evolución de la pandemia ha generado cambios en la dinámica de sus familias como: alteraciones en los horarios, introducción del trabajo remoto, adaptación de sus hijos a la educación virtual y mayor sedentarismo. Se demostró que la mayoría tenía un adecuado conocimiento respecto a los productos ultraprocesados. Sin embargo, se evidenció una mayor elección de estos para los preescolares, siendo estos consumidos mayormente en las tardes. Conclusión: Los cambios generados por la evolución de la pandemia aumentaron la elección de productos ultraprocesados por parte de las madres de los niños preescolares. / Introduction: Since the beginning of the new coronavirus pandemic, measures have been taken worldwide to reduce its spreading. Among them, obligatory quarantine, which has generated changes in people’s lifestyles, especially that of preschool aged children, who have been forced to substitute their academic activities for online modalities and their recreational activities for more sedentary ones. In addition, Peru has been experiencing an increase in the consumption of ultra-processed products and in the prevalence of overweight and obesity in children. Objective: Explore how the evolution of the COVID-19 pandemic influences the choice of ultra-processed products that mothers make for feeding their preschool children. Methods: Qualitative study with a phenomenological approach. Twenty-six semi-structured interviews were conducted using a question guide. The sample was selected by snowball until reaching saturation. Results: The interviewed mothers were between 21 and 47 years old, the majority lived in the districts of Miraflores and Surco, had completed higher education and they had work at the time of the interviews. They expressed that the experience of living the evolution of the pandemic has generated changes in the dynamics of their families such as: alterations in schedules, introduction of remote work, adaptation of their children to virtual education and greater sedentary lifestyle. Most were shown to have adequate knowledge of ultra-processed products. However, a greater choice of these was evidenced for preschoolers, being these consumed mostly in the afternoons. Conclusion: The changes generated by the evolution of the pandemic increased the choice of ultra-processed products by the mothers of preschool children. / Tesis

Marco teórico: El sobrepeso y la obesidad está asociado con el incremento del consumo de alimentos industrializados (AI). Últimamente se ha identificado el perímetro de cuello (PC) como un buen indicador de grasa corporal y sobre todo riesgo en la salud. Por lo que nuestro objetivo es evaluar la asociación entre el consumo de energía de AI y el PC en peruanos de 15 a 65 años. Metodología: Se realizó un análisis secundario de la base datos del Estudio Latinoamericano de Nutrición y Salud (ELANS) realizado en Perú. Las variables de interés fueron el consumo de energía de AI y el PC, para evaluar su asociación se realizó una regresión de Poisson cruda y ajustada por variables confusoras y se calculó la razón de prevalencia (RP). Los análisis se realizaron a un nivel de confianza del 95%. Resultados: La media del PC fue de 35,4 cm (DE: 3,6) y la mediana del consumo de los AI fue de 372,4 kcal (227,6-554,1). Los que se encuentran en el segundo y tercil superior de consumo de energía en AI tienen mayor probabilidad de PC aumentado (RP: 1,05; IC:1,00-1,10, p=0,042; RP: 1,06; IC:1,01-1,12, p=0,017, respectivamente) en relación a los que estaban en el primer tercil. Conclusión: A medida que aumenta el tercil del consumo de energía de AI aumenta el riesgo de PC aumentado en peruanos de 15 a 65 años. Es importante identificar estrategias que permitan implementar políticas públicas que mejoren la calidad de AI y disminuyan el riesgo de PC aumentado. / Background: Overweight and obesity is associated with increased consumption of industrialized foods (IF). Lately, the neck perimeter (NP) has been identified as a good body fat indicator and specially of health risk. Therefore, our objective is to evaluate the association between energy consumption of IF and NC in Peruvians aged 15 to 65. Methods: A secondary analysis of the database of the Latin American Study of Nutrition and Health (ELANS) conducted in Peru was performed. The variables of interest were power consumption of IF and NP, to evaluate its association, a crude and adjusted for confounding variables Poisson regression was performed and the prevalence ratio (PR) was calculated. The analyses were performed at a 95% confidence interval. Results: The mean NC was 35,4 cm (SD: 3,6) and the median consumption of IF was 372,4 kcal (227,6-554,1). Those in the second and upper tertile of energy consumption of IF have a higher probability of increased NC (PR: 1,05; IC:1,00-1,10, p=0,042; PR: 1,06; IC:1,01-1,12, p=0,017, respectively) in relation to those who were in the first tertile. Conclusion: As the tertile of energy consumption of IF increases, the risk of increased NC increases in Peruvians aged 15 to 65. It is important to identify strategies to implement public policies that improve the quality of IF and reduce the risk of increased NC. / Tesis