Introduction : Il existe peu de données sur l’alimentation des Canadiens issus de la diversité culturelle, y compris des immigrants, particulièrement sur la consommation d’aliments ultra-transformés (AUT) associée à une faible qualité nutritionnelle et à un risque accru de maladies chroniques. Objectif : Cette étude vise à estimer les niveaux de consommation d’AUT parmi les adultes issus de la diversité culturelle au Canada et selon certains marqueurs d’acculturation. Méthode : Les données de rappel de 24 h (n= 13 697) issues de l’Enquête sur la santé dans les collectivités canadiennes (ESCC 2015) ont été utilisées afin d’estimer les niveaux d’apport en AUT (pourcentage calorique quotidien) parmi la diversité culturelle. Des analyses ont permis d’estimer la consommation en AUT selon certains marqueurs culturels (statut d’immigration, groupe ethnoculturel) et d’acculturation (pays de naissance, temps depuis l’immigration, langues parlées). Des analyses ANOVA ont permis de comparer la consommation d’AUT avec les groupes de référence sélectionnés. Résultats : La consommation d’AUT était moindre parmi les immigrants canadiens que les non-immigrants et présentait des variations parmi les communautés ethnoculturelles. Celle-ci était significativement plus élevée parmi les immigrants « blancs », ceux d’origine latino-américaine et ceux résidant au Canada depuis plus longtemps. Elle variait aussi selon les groupes ethnoculturels. La consommation d’AUT ne semblait pas associée aux langues parlées. Conclusion : L’apport calorique provenant des AUT varie en fonction de la diversité culturelle et devrait être considéré dans les interventions destinées à ces groupes au Canada. / Background: There is little data on the diet of culturally diverse Canadians, including immigrants, particularly on the consumption of ultra-processed foods (UPF) which is associated with poor nutritional quality and an increased risk of chronic disease. Objective: The aim of this study is to estimate the levels of UPF consumption among culturally diverse adults in Canada and according to selected acculturation markers. Methods: 24h recall data (n=13,697) from the Canadian Community Health Survey (CCHS 2015) was used to estimate the mean of the usual UPF intake levels (daily caloric percentage) among cultural diversity. Statistics helped estimate UPF intake according to certain cultural markers (immigration status, ethnocultural group) and acculturation markers (country of birth, time since immigration, languages spoken). ANOVA analyses were used to compare UPF consumption with selected reference groups. Results: UPF consumption was lower among Canadian immigrants than non-immigrants, and there were variations of consumption between ethnocultural communities. UPF consumption was significantly higher among "white" immigrants, those of Latin American origin and those who had been in Canada for longer. UPF consumption did not appear to be associated with variables of languages spoken. Conclusion: Caloric intake coming from UPF consumption varies according to cultural diversity, and this needs to be considered in interventions targeting ethnocultural groups in Canada.

Introdução - A obesidade infantil está pautada como assunto de saúde pública e exige a análise, implementação e avaliação de novas intervenções. O marketing é apontado como um dos fatores que interferem no aumento do índice de sobrepeso e de obesidade da população. As estratégias de comunicação publicitária se utilizam de processos cognitivos para determinar, através de elementos emocionais do receptor, a escolha e o consumo de alimentos não saudáveis, já que os publicitários respondem à demanda das empresas que buscam lucrar com seus produtos. Já se afirma que a regulamentação legal do marketing dos alimentos infantis não saudáveis deve ser adotada como instrumento de política pública na prevenção da obesidade. Assim, justifica-se a investigação de quais seriam as formas mais apropriadas para regular esse tipo de marketing no Brasil, de forma a garantir o direito à saúde e à alimentação adequada e saudável. Objetivo - Analisar o papel do marketing como um dos determinantes da obesidade infantil, buscando apontar, no campo jurídico, estratégias para a sua regulamentação no Brasil. Métodos - Revisão de literatura, análise de textos legislativos e de programas adotados para controle da obesidade infantil, além de entrevistas com representantes de entidades e profissionais diretamente ligados à implementação de políticas públicas, nacionais e internacionais, de controle da nutrição e saúde infantil, bem como de proteção dos direitos do consumidor infanto-juvenil. A interpretação dos dados levantados deu-se através do método científico dedutivo. Resultados - O crescente índice de obesidade no Brasil está demonstrado através de pesquisa nacional. A presença de alimentos no mercado com excesso de sal, gordura e açúcar precisa ser controlada. As teorias de comunicação explicam a influência do marketing na decisão emocional do consumidor. Os direitos à saúde e à alimentação adequada e saudável estão previstos na Constituição Federal. Conclusão - A regulamentação legal do marketing de alimentos não saudáveis é juridicamente possível e suas diretrizes devem focar os alimentos processados e ultraprocessados, além dos fatores que facilitam a persuasão da criança, impedindo o uso de elementos emocionais. / Introduction - Childhood obesity is considered a public health issue and requires the analysis, implementation and evaluation of new interventions. Marketing is considered as one of the factors that play a role in the increase of overweight and obesity rates in the population. Advertisement strategies use cognitive processes to determine, by means of emotional elements of the receptor, the choice and consumption of unhealthy foods, since advertisement professionals respond to the demand of companies willing to make a profit by selling their their products. The regulation of the marketing of unhealthy foods for children must be adopted as a public policy instrument for the prevention of obesity. Thus, we should investigate what are the most appropriate ways to regulate this kind of marketing in Brazil to guarantee the right to health and to adequate and healthy foods. Objective - Analyze the role of marketing as one of the determinants of childhood obesity, and try to identify legal strategies for its regulation in Brazil. Methods - Literature review, analysis of legal texts and programs implemented for the control of childhood obesity and interviews with representatives of institutions and professionals directly related to the implementation of public national and international policies for the control of childhood nutrition and health, as well as the protection of children and youth consumer rights. Deductive scientific method was used to interpret data. Results - Increasing obesity rates have been demonstrated by national surveys. The presence of foods with excessive salt, fat and sugar in market must be controlled. Communication theories explain the influence of marketing in the emotional decision of consumers. The right to health and to adequate and healthy foods is determined by the Federal Constitution. Conclusion - It is possible to regulate the marketing of unhealthy foods according to the law. The guidelines for regulation must focus on processed and ultra processed foods and the factors that facilitate persuasion of children, by prohibiting the use of emotional elements.

Introdução - A obesidade infantil está pautada como assunto de saúde pública e exige a análise, implementação e avaliação de novas intervenções. O marketing é apontado como um dos fatores que interferem no aumento do índice de sobrepeso e de obesidade da população. As estratégias de comunicação publicitária se utilizam de processos cognitivos para determinar, através de elementos emocionais do receptor, a escolha e o consumo de alimentos não saudáveis, já que os publicitários respondem à demanda das empresas que buscam lucrar com seus produtos. Já se afirma que a regulamentação legal do marketing dos alimentos infantis não saudáveis deve ser adotada como instrumento de política pública na prevenção da obesidade. Assim, justifica-se a investigação de quais seriam as formas mais apropriadas para regular esse tipo de marketing no Brasil, de forma a garantir o direito à saúde e à alimentação adequada e saudável. Objetivo - Analisar o papel do marketing como um dos determinantes da obesidade infantil, buscando apontar, no campo jurídico, estratégias para a sua regulamentação no Brasil. Métodos - Revisão de literatura, análise de textos legislativos e de programas adotados para controle da obesidade infantil, além de entrevistas com representantes de entidades e profissionais diretamente ligados à implementação de políticas públicas, nacionais e internacionais, de controle da nutrição e saúde infantil, bem como de proteção dos direitos do consumidor infanto-juvenil. A interpretação dos dados levantados deu-se através do método científico dedutivo. Resultados - O crescente índice de obesidade no Brasil está demonstrado através de pesquisa nacional. A presença de alimentos no mercado com excesso de sal, gordura e açúcar precisa ser controlada. As teorias de comunicação explicam a influência do marketing na decisão emocional do consumidor. Os direitos à saúde e à alimentação adequada e saudável estão previstos na Constituição Federal. Conclusão - A regulamentação legal do marketing de alimentos não saudáveis é juridicamente possível e suas diretrizes devem focar os alimentos processados e ultraprocessados, além dos fatores que facilitam a persuasão da criança, impedindo o uso de elementos emocionais. / Introduction - Childhood obesity is considered a public health issue and requires the analysis, implementation and evaluation of new interventions. Marketing is considered as one of the factors that play a role in the increase of overweight and obesity rates in the population. Advertisement strategies use cognitive processes to determine, by means of emotional elements of the receptor, the choice and consumption of unhealthy foods, since advertisement professionals respond to the demand of companies willing to make a profit by selling their their products. The regulation of the marketing of unhealthy foods for children must be adopted as a public policy instrument for the prevention of obesity. Thus, we should investigate what are the most appropriate ways to regulate this kind of marketing in Brazil to guarantee the right to health and to adequate and healthy foods. Objective - Analyze the role of marketing as one of the determinants of childhood obesity, and try to identify legal strategies for its regulation in Brazil. Methods - Literature review, analysis of legal texts and programs implemented for the control of childhood obesity and interviews with representatives of institutions and professionals directly related to the implementation of public national and international policies for the control of childhood nutrition and health, as well as the protection of children and youth consumer rights. Deductive scientific method was used to interpret data. Results - Increasing obesity rates have been demonstrated by national surveys. The presence of foods with excessive salt, fat and sugar in market must be controlled. Communication theories explain the influence of marketing in the emotional decision of consumers. The right to health and to adequate and healthy foods is determined by the Federal Constitution. Conclusion - It is possible to regulate the marketing of unhealthy foods according to the law. The guidelines for regulation must focus on processed and ultra processed foods and the factors that facilitate persuasion of children, by prohibiting the use of emotional elements.

Introdução Evidências sugerem impacto das características do ambiente nas taxas de obesidade, por mediadores em nível comunitário, como acesso a comércios, disponibilidade e custo de alimentos. Porém, há insuficiente compreensão sobre a interação do meio nas práticas alimentares. Objetivos Ampliar a compreensão a respeito das relações entre o ambiente e as práticas alimentares em diferentes contextos socioeconômicos e de acesso à alimentação em que vivem indivíduos no município de São Paulo. Métodos Estudo de abordagem qualitativa baseado em dados de auditoria de ambiente alimentar, inquérito e entrevistas individuais. A amostragem propositiva abrangeu diversos estratos do ambiente socioeconômico e alimentar no município de São Paulo e incluiu 48 indivíduos adultos de ambos os sexos. O roteiro de entrevistas semiestruturadas foi elaborado a partir de duas perguntas norteadoras: Como é a percepção dos indivíduos sobre os estabelecimentos de comercialização de alimentos no bairro em que vivem e a sua influência nas práticas alimentares? e Como é a rotina de aquisição, preparo e consumo dos alimentos no bairro em que vivem e como isso se relaciona ao consumo de frutas e hortaliças e de alimentos ultraprocessados?. Para a categorização dos discursos aplicou-se análise de conteúdo proposta por Bardin. A trajetória interpretativa foi conduzida sob o referencial teórico das representações sociais. A análise de clusters hierárquica foi utilizada para o agrupamento dos indivíduos, retendo-se dois grupos: cluster 1 e cluster 2, diferenciados pelo nível socioeconômico e pela disponibilidade de alimentos saudáveis nos locais avaliados. Resultados As representações sociais sobre os ambientes alimentares estudados corresponderam às características aferidas em auditoria, revelando desigualdades entre os locais estudados. No cluster 1, caracterizado pelo maior nível socioeconômico e pelo melhor acesso à alimentação saudável, prevaleceu a percepção favorável sobre a disponibilidade de feiras, sacolões e supermercados, destacando oportunidades para a aquisição de alimentos com qualidade, variedade e preços acessíveis, dentre os quais as frutas e hortaliças. Os indivíduos do cluster 2 viviam em locais de menor nível socioeconômico e de menor acesso à alimentação saudável e representaram a falta de acesso à estabelecimentos de comércio de alimentos e a indisponibilidade de frutas e hortaliças. Nos dois clusters verificou-se a representação social: refrigerantes, salgadinhos, biscoitos recheados e fast-food se encontra em todo lugar, sobre a disponibilidade de alimentos ultraprocessados. A preocupação com a saúde foi a principal motivação para o consumo de frutas e hortaliças entre os dois clusters, e o gosto, a falta de hábito e o custo foram identificados como barreiras. Sobre o consumo de alimentos ultraprocessados, no cluster 1 ocorreu maior percepção sobre as barreiras, como a preocupação com a saúde. Já no cluster 2, se destacaram as motivações para este consumo, como o gosto e a presença de crianças. Conclusão A forma como conhecem e compreendem as características do ambiente alimentar está refletida em algumas ações dos sujeitos sobre as suas práticas de aquisição e consumo de alimentos. / Background Evidences suggest an impact of environmental characteristics on obesity and non-communicable diseases rates, by mediators at the community level such as access to markets, cost and availability of food. However, there is insufficient comprehension about the interaction of the environment in food pratices. Objective Enhancing knowledge about the relations between the environment and eating habits in different socioeconomic and food access contexts, whereupon São Paulos individuals live. Methods This is a qualitative study based on food environment audit data, inquiry and individual interviews. The purposeful sampling comprised different strata of the socioeconomic and food environments in São Paulo and included 48 adults of both genders.The script for semi-structured interviews was drawn from two guiding questions: How is the perception of the individuals on the food establishments in the neighborhood they live in, and their influence on eating habits? and How is the acquisition routine, preparation and consumption of foods in their neighborhood, and how does it relate to the consumption of fruits and vegetables, and ultra-processed food?. For categorizing the speeches Bardins content analisys was applied. The interpretative trajectory was conducted under the theoretical framework of social representations. The hierarchical clusters analisys was used for grouping individuals, retaining two groups: cluster 1 and cluster 2, differentiated by the socioeconomic level and by the availability of healthy foods at the locations assessed. Results The social representations about the food environments investigated corresponded to the characteristics measured in audit, revealing disparities between the locations assessed. In cluster 1,characterized by higher socioeconomic level and better access to healthy food, prevailed favorable perception about the availability of fairs, grocery stores and supermarkets, standing out opportunities to food acquisition with quality, variety and affordable prices, among which are fruits and vegetables.Individuals from cluster 2 lived in places of lower socioeconomic level and less access to healthy food, and they accounted for the lack of access to food establishments and the unavailability of fruits and vegetables.In both clusters there was the social representation: soft drinks, snacks, cookies and fast food are everywhere, about the availability of ultra-processed food. The concern about healthcare was the main motivation for fruits and vegetables consumption among both clusters, and the taste, the lack of habit and costs were identified as barriers. Regarding to ultra-processed food consumption, in cluster 1 there was a greater awareness about the barriers, like the concern for healthcare. On the other hand, in cluster 2, the motivations for this consumption were highlighted, such as the taste and the presence of children. ConclusionThe way individuals know and understand the environmental characteristics is reflected in some of their actions about the purchasing practices and food consumption.

Introdução: A introdução da agricultura e pecuária foram muito recentes para que o genoma humano se adaptasse e a tecnologia avançada pós revolução Industrial foi ainda mais. Segundo Cordain, a substituição de alimentos minimamente processados por alimentos pós-agrícolas e pós-industriais influenciaram os indicadores nutricionais: carga glicêmica, composição de ácidos graxos e macronutrientes, densidade de micronutrientes, equilíbrio ácido-base, relação sódio/potássio e teor de fibras, levando a um desequilíbrio que é causa de várias doenças atuais da civilização. A Protein Leverage Hypothesis (PLH) propõe que a queda na ingestão de proteínas possa levar a obesidade e doenças cardiometabólicas associadas. Objetivos: Estudar o efeito do consumo de alimentos ultraprocessados nos indicadores nutricionais na população dos EUA, incluindo a composição de macronutrientes, densidade de fibras e micronutrientes e fitoestrógenos urinários; avaliar se a contribuição calórica de alimentos ultraprocessados é determinante para a qualidade nutricional das dietas contemporâneas; e finalmente estudar se a associação entre o consumo de alimentos ultraprocessados, proteína e energia correspondem às previsões do modelo PLH. Métodos: Foram avaliados os participantes do National Health and Nutrition Examination Survey 2009-2010, com pelo menos um recordatório alimentar de 24 horas. Os itens foram classificados em: alimentos in natura ou minimamente processados, processados, ultraprocessados e ingredientes de uso culinário. O manuscrito 1 examina a relação entre a contribuição calórica de alimentos ultraprocessados e qualidade nutricional da dieta, avaliando individual e globalmente a contribuição de cada ingrediente crítico, usando a análise de componentes principais (ACP). O manuscrito 2 estuda a associação entre a contribuição calórica dos alimentos ultraprocessados e consumo de açúcares de adição. O manuscrito 3 avalia como o consumo de alimentos ultraprocessados influencia o conteúdo proteico relativo da dieta e as ingestões absolutas de energia e proteína, e se essas relações se encaixam nas previsões da PLH. O manuscrito 4 avalia a relação entre a contribuição calórica de alimentos ultraprocessados e níveis de fitoestrógenos urinários. Resultados: O teor médio de proteínas, fibras, vitaminas A, C, D e E, zinco, potássio, fósforo, magnésio e cálcio na dieta diminuiu ao longo dos quintis de contribuição calórica de alimentos ultraprocessados, enquanto o de carboidratos, açúcares de adição e gordura saturada aumentou. Uma associação inversa de dose-resposta foi encontrada entre o consumo de alimentos ultraprocessados e qualidade nutricional total, medida através de um escore de padrão balanceado de nutrientes derivado usando ACP. Consistente com a PLH, a contribuição calórica de alimentos ultraprocessados foi inversamente associada à densidade proteica e diretamente ao consumo energético total, enquanto a ingestão absoluta de proteínas permaneceu constante com aumento do consumo de alimentos ultraprocessados. Os níveis médios de enterolignanos urinários diminuíram ao longo dos quintis de consumo de alimentos ultraprocessados, enquanto os níveis de isoflavonas permaneceram inalterados. Conclusões: Este estudo mostra que a diminuição da contribuição calórica de alimentos ultraprocessados é um meio racional e eficaz de melhorar a qualidade nutricional das dietas dos EUA / Background: The introduction of agricultural and animal husbandry has not provided the human genome time enough to adapt, much less the advancing technology after Industrial Revolution. According to Cordain et al., displacement of minimally processed foods by post-agricultural and post-industrial food items adversely affected the following dietary indicators: glycemic load, fatty acid and macronutrient compositions, micronutrient density, acid-base balance, sodium-potassium ratio and fiber content. Many current diseases of civilization, in turn may be ascribable to those unbalanced dietary indicators. Indeed, Raubenheimer and Simpson have proposed the Protein Leverage Hypothesis (PLH) to explain how a drop in dietary protein content might lead to obesity and associated cardiometabolic disease. Objective: This thesis aims to study the effect of an increased consumption of ultra-processed foods on dietary indicators in the US population, including macronutrient composition, micronutrient and fiber densities, and urinary phytoestrogens. It also explores whether the dietary share of ultra-processed foods, expressed as a percentage of total energy intake, is a meaningful determinant of overall nutritional quality of contemporary diets. Lastly, it also looks into whether the association between ultra-processed food, protein and energy consumptions fit predictions of the PLH model. Methods: Participants from cross-sectional 2009-2010 National Health and Nutrition Examination Survey with at least one 24-hour dietary recall were evaluated. Food items were classified according to extent and purpose of industrial food processing as: unprocessed or minimally processed foods, processed culinary ingredients, processed foods and ultra-processed foods. Manuscript 1, examines the relationship between dietary contribution of ultra-processed foods and nutritional quality of US diet through the evaluation of dietary contents of critical nutrients individually and also overall, using Principal Component Analysis (PCA). Manuscript 2 studies the association between dietary contribution of ultra-processed foods and energy intake from added sugars. Manuscript 3 examines how consumption of ultra-processed food influences relative dietary protein content and, absolute energy and protein intakes; it furthermore, tests whether the relationships fit PLH predictions. Manuscript 4 assesses the relationship between dietary contribution of ultra-processed foods and urinary levels of phytoestrogens. Results: The average content of protein, fiber, vitamins A, C, D and E, zinc, potassium, phosphorus, magnesium and calcium in US diet decreased significantly across quintiles of energy contribution of ultra-processed foods, while carbohydrate, added sugars and saturated fat contents increased. An inverse dose-response association was found between ultra-processed food consumption and overall dietary quality measured through a Nutrient balanced pattern PCA derived factor score. Consistent with PLH, dietary contribution of ultra-processed foods was inversely associated with protein density and directly associated with total energy intake, while absolute protein intake remained relatively constant with increases in ultra-processed food consumption. Average urinary mammal lignan levels decreased across quintiles of ultra-processed food consumption, while isoflavone levels remained unchanged. Conclusions: This study suggests that decreasing the dietary share of ultra-processed foods is a rational and effective way to improve the nutritional quality of US diets

Introdução: Comer fora de casa tem sido relacionado com o aumento no consumo de alimentos caracterizados pelo alto grau de processamento, tal como refrigerantes, doces e fast food. Embora indiquem uma associação entre alimentação fora do domicilio e o consumo de alimentos ultraprocessados, estudos realizados até o momento não consideraram o grau e extensão de processamento industrial dos alimentos na avaliação da dieta fora de casa. Objetivo: Avaliar o consumo de alimentos fora de casa e verificar sua associação com características socioeconômicas e indicadores nutricionais. Métodos: Trata-se de um estudo transversal utilizando o Módulo de Consumo Pessoal da Pesquisa de Orçamentos Familiares realizada pelo Instituto Brasileiro de Geografia e Estatística entre maio de 2008 e maio de 2009. Os alimentos foram agrupados de acordo com a extensão e propósito do processamento industrial. O hábito de comer fora de casa foi avaliado por meio de dois indicadores: o percentual de calorias consumidas fora e a frequência de dias em que cada indivíduo relatou realizar refeições fora de domicílio, ambos descritos segundo características sociodemográficas. Foi estimado o percentual de participação dos grupos e subgrupos alimentares no total de calorias e segundo local de consumo. Adicionalmente, o percentual de participação de alimentos ultraprocessados dentro e fora de casa foi descrito segundo características sociodemográficas. Modelo multinível foi aplicado para avaliar a associação entre comer fora de casa e a participação de alimentos ultraprocessados na dieta. Análise fatorial foi conduzida para identificar padrões de alimentação fora de casa e modelos de regressão linear foram utilizados para explorar associação entre os padrões encontrados e indicadores nutricionais. Resultados: Observa-se uma maior contribuição de alimentos ultraprocessados fora de casa, destacando a participação de itens alimentares como refrigerantes e refeições prontas. Quando comparado com o consumo exclusivamente dentro do domicílio, realizar refeições fora de casa aumenta em 51% o consumo de alimentos ultraprocessados. A análise de componentes principais, no entanto, monstra que existem padrões de alimentação fora de casa que podem ter ou não um impacto negativo na dieta. Foram encontrados três padrões de alimentação na população que explicam conjuntamente 13,6% da variância. O primeiro padrão, denominado refeição tradicional, inclui em sua composição arroz, feijão, legumes e verduras, raízes e tubérculos, macarrão e outras massas, carne bovina, aves e ovos. O segundo padrão, nomeado lanche, é composto por manteiga, leite, café e chás, pão francês, queijos processados e margarina. O terceiro padrão, denominado alimentos de conveniência por ser composto exclusivamente por alimentos ultraprocessados, inclui doces, refeições prontas (tais como fast food, salgados, pizza, entre outras) e refrigerantes. De maneira geral, observou-se uma associação direta entre o padrão de refeições tradicionais e nutrientes saudáveis na dieta, enquanto o padrão lanches e alimentos de conveniência foram associados diretamente com nutrientes não saudáveis. Conclusão: Os resultados apresentados indicam que no Brasil, comer fora de casa está associado ao aumento na participação de alimentos ultraprocessados na dieta. Existem, porém, padrões de alimentação fora de casa. Quando baseada em lanches e alimentos de conveniência, comer fora de casa acarreta em um impacto negativo na dieta. É, no entanto, possível manter uma alimentação saudável fora de casa quando se adere a padrões tradicionais da culinária brasileira / Introduction: Eating out has been related to the increase on the consumption of food characterized by high degree of processing, such as soft drinks, sweets and fast food. Although they indicate an association between eating out and ultra-processed food consumption, studies do not consider the extent and purpose of food processing to evaluate eating out diet. Objective: Evaluate eating out food and verify its association with socioeconomic characteristics and nutritional indicators. Method: Cross-sectional study using the Individual Food Intake Survey, carried out with 34,003 individuals aged 10 or more, between May 2008 and May 2009. All food items were classified according to the extent and purpose of food processing. The habit of eating out was evaluated through two indicators: the percentage of calories eating out and the frequency of days in which each individual reported eating out, both indicators are described according to the sociodemographic characteristics. The percentage of food calories per group and subgroups was estimated according to the place of consumption. In addition, the ultra-processed food percentage eaten at home and out was described according to sociodemographic characteristics. Multilevel model was applied to evaluate an association between eating out and the participation of ultra-processed food on diet. Factor analysis was used to identify the eaten out food consumption patterns and linear regression models were used to explore the association between patterns and the nutrient content of the diet. Results: It is possible to observe a higher contribution of ultra-processed food out home, emphasizing the participation of food items such as soft drinks and ready-to-eat meals. When compared to consumption exclusively at home, eating meals out increases the consumption of ultra-processed foods by 51%. Principal component analysis, however, demonstrates that there are eating out patterns, whether or not may have a negative impact on the diet. We identified three food patterns. The first pattern, called traditional meal, was positive for rice, beans, vegetables and greens, roots and tubers, pasta, beef, poultry and eggs. The second pattern, called snack, was positive for butter, milk, coffee and tea, processed bread, processed cheese and margarine. The third pattern, called convenience food because it consists exclusively of ultra-processed food, was positive for sweet, ready to eat meals and soft drinks. In general, there was a positive association between traditional meal pattern and healthy dietary markers, while snacks and the convenience pattern were positively associated to unhealthy dietary markers. Conclusion: In Brazil, eating out is directly associated to ultra-processed food consumption. There is, however, eating out patterns. When based on snacks and convenience food, eating out has a negative impact in diet. It is, however, possible to maintain a healthy diet out when adhering to traditional Brazilian patterns

Objetivo: Este trabalho Investigou a associação dos gastos com frutas, legumes e verduras (marcadores de dieta saudável) e com carnes e carnes processadas (marcadores de dieta não saudável) com fatores socioeconômicos, demográficos e com preocupação com a saúde. Métodos: Trata-se de um estudo de análise transversal que utiliza dados secundários da Pesquisa de Orçamento Familiar (POF) 2008-2009 do IBGE, e investiga os fatores associados aos gastos com alimentos marcadores ou não de dieta saudável por meio de um modelo Tobit de regressão múltipla, determinando-se os efeitos marginais das variáveis explicativas. Assim, foi investigada a influência da preocupação com a saúde e de variáveis socioeconômicas e demográficas sobre gastos com dois grupos de alimentos: (a) frutas, legumes e verduras e (b) carnes e carnes processadas. Resultados: O presente estudo mostrou que os gastos com alimentos marcadores de dieta saudável (FLV) e com alimentos marcadores de dieta não saudável (CCP) estão associados a variáveis econômicas e sócio demográficas e à preocupação com a saúde, conforme a expectativa baseada na literatura sobre o tema. Há, no entanto, uma única exceção: o efeito dos gastos preventivos com a saúde sobre os gastos com FLV. Tal achado merece investigação adicional, em termos da constituição da variável proxy da preocupação com a saúde, adotada neste estudo. / Objective: This paper strives to identify how the expenses with fruits and vegetables (healthy diet markers), meats and processed meats (unhealthy diets markers) are influenced by the presence of health seeking behavior, socioeconomic and regional factors. Methods: A cross-sectional analysis study based on secondary data from \"Household Budget Survey 2008-2009,\" IBGE, using the multiple regression TOBIT model. The analysis was about how one\'s concern with health influences the expenses with two food groups: (a) fruits and vegetables and (b) meats and processed meats. Health seeking behavior and socioeconomic characteristics were included as variables. The marginal effect of each explanatory variable over the probability of expenses with the food groups studied was determined. Results: The study shows that the expenses with fruits and vegetables (healthy diet markers) and meats and processed meats (unhealthy diet markers) are related to economical, socio demographic variables and to the concern for health, just as expected based on previous studies. There is, however, one exception: the effect of preventive expenses with health over the expenses with fruits and vegetables. Such finding requires additional investigation regarding the constitution of the concern for health\'s proxy variable.

Digestion of starch in humans starts in the mouth and progresses to the small intestine. Structures from salivary and pancreatic amylases hydrolysis can impact subsequent steps of digestion at the mucosa of the small intestine. However, structures of the starch digestion products along the gut from the mouth to the small intestines – products that impact glucose homeostasis are not well understood. This thesis focuses on the luminal step of starch digestion, i.e. impact of salivary and pancreatic amylase on the structure of hydrolysis products obtained from cooked starches from different botanical sources. Normal corn (NCS), wheat (NWS) and potato (NPS) starches were cooked at 1:0.7 (T0.7) or 1:2 (T2) starch:water ratios. Cooked starches were subjected to salivary amylase at conditions mimicking oral digestion. The composition of the hydrolysates was characterised by gel-permeation chromatography. Extent of hydrolysis was lower at T0.7 compared to T2, but the amount of carbohydrates in different fractions and the molecular weight profiles within each treatment were not different between starches from different botanical sources. However, debranching of the hydrolysates revealed structural differences in extent of amylose hydrolysis and amount and profile of lower molecular weight fractions between different starches. Cooked starches were also subjected to salivary and pancreatic amylases hydrolysis. Extent of 20 min hydrolysis was lower at T0.7 compared to T2 for all the starches. Oligosaccharide composition of 120 min hydrolysates differed in amounts of DP 2, 3, 5, 6 and 7 between processing treatments and starches. NCS (T2) was treated with saliva from six participants at equal activity. Salivary amylase activities ranged from 470 x 103 to 118 x 103 U/mL among the participants. While saliva from participant 2 (high amylase activity) greatly reduced the high molecular weight fraction, saliva from participant 6 (low amylase activity) more extensively hydrolysed the starch to small molecular weight fractions of oligosaccharides. These results show that different starch hydrolysates are produced during oral digestion by saliva from different individuals and are also different based on cooking condition or botanical source of starch. Further research is therefore needed to understand how these hydrolysate structures, impact glucose homeostasis.

Motivation Processed complementary food labels should protect and promote optimal breastfeeding and complementary feeding practices, important determinants of child survival, growth and development, and provide information regarding safe and appropriate use. However, there is a lack of formal guidelines from international normative bodies on the appropriate marketing of complementary foods. In recognition of the need for interim guidance, the Maternal, Infant and Young Child Working Group developed the Draft Guide for Marketing Complementary Foods, which provides practical guidance on how the marketing (including labelling) of processed complementary foods and supplements can be informed by the principles of the International Code of Marketing of Breast-milk Substitutes (the Code) and subsequent relevant World Health Assembly (WHA) resolutions in a way that supports optimal infant and young child feeding. Aim The aim of this study was to describe the extent to which the labelling practices (as a sub-set of marketing practices) of processed complementary food sold in South Africa comply with international guidance on the marketing of complementary foods that is fully aligned with the principles of the Code and subsequent relevant WHA resolutions (the Draft Guide for Marketing Complementary Foods). Methods Employing a cross-sectional study design, products were purchased from a sample of 17 retail grocery stores, three wholesale grocery stores, three retail pharmacies and three baby chain stores in the Gauteng, Western Cape and KwaZulu-Natal provinces from June to August 2011. Purchased products were then compared with a master list of complementary food products compiled through desk research, and missing products were identified and purchased. Label information was captured, then blinded and the order of products randomised. The Draft Guide for Marketing Complementary Foods was used to create a checklist with pre-set answers and accompanying criteria against which the captured labelling practices were then analysed. Results One hundred and sixty product labels of 35 manufacturers were analysed, none of which complied with all checklist criteria. Fifty-six (35%) labels did not provide an appropriate age of introduction, while 32 (20%) labels used phrases implying that the product was suitable for use before six months of age. Thirty-seven (23%) labels used images of infants appearing to be younger than six months. Only 20 (13%) labels carried a message regarding the importance of exclusive breastfeeding for the first six months of life, and none provided a message on the importance of the addition of complementary foods from six months together with continued breastfeeding to two years or beyond. Eight (5%) labels recommended feeding the product in a bottle and two labels (1%) used an image of a feeding bottle. Nineteen (12%) labels suggested a daily ration too large for a breastfed child, and 32 (20%) potentially promote the manufacturer’s infant formula. All labels provided label information in an appropriate language, but 102 (64%) labels relegated required label information to small text and were thus not easy to read. Only six (4%) labels failed to provide instructions for safe and appropriate use, while 44 (28%) did not include safety messages in their preparation and use instructions. Ten (6%) labels did not provide storage instructions, and 27 (17%) labels did not provide necessary warnings. Nutrient content claims, nutrient comparative claims, nutrient function/other function claims and reduction of disease risk claims were found on 126 (79%), eight (5%), 117 (73%) and 10 (6%) labels, respectively. Conclusion The labelling practices of processed complementary food labels in South Africa do not fully comply with international guidance on the marketing of complementary foods (the Draft Guide for Marketing Complementary Foods) and so do not sufficiently protect and promote optimal infant and young child feeding practices, revealing much room for improvement. Such guidance must be refined and formalised by international normative bodies and adopted into national legislation to assist manufacturers in ensuring that their complementary food labels meet an accepted standard and contribute towards the safe and appropriate use of processed complementary foods. / Thesis (MSc (Nutrition))--North-West University, Potchefstroom Campus, 2013.

Motivation Processed complementary food labels should protect and promote optimal breastfeeding and complementary feeding practices, important determinants of child survival, growth and development, and provide information regarding safe and appropriate use. However, there is a lack of formal guidelines from international normative bodies on the appropriate marketing of complementary foods. In recognition of the need for interim guidance, the Maternal, Infant and Young Child Working Group developed the Draft Guide for Marketing Complementary Foods, which provides practical guidance on how the marketing (including labelling) of processed complementary foods and supplements can be informed by the principles of the International Code of Marketing of Breast-milk Substitutes (the Code) and subsequent relevant World Health Assembly (WHA) resolutions in a way that supports optimal infant and young child feeding. Aim The aim of this study was to describe the extent to which the labelling practices (as a sub-set of marketing practices) of processed complementary food sold in South Africa comply with international guidance on the marketing of complementary foods that is fully aligned with the principles of the Code and subsequent relevant WHA resolutions (the Draft Guide for Marketing Complementary Foods). Methods Employing a cross-sectional study design, products were purchased from a sample of 17 retail grocery stores, three wholesale grocery stores, three retail pharmacies and three baby chain stores in the Gauteng, Western Cape and KwaZulu-Natal provinces from June to August 2011. Purchased products were then compared with a master list of complementary food products compiled through desk research, and missing products were identified and purchased. Label information was captured, then blinded and the order of products randomised. The Draft Guide for Marketing Complementary Foods was used to create a checklist with pre-set answers and accompanying criteria against which the captured labelling practices were then analysed. Results One hundred and sixty product labels of 35 manufacturers were analysed, none of which complied with all checklist criteria. Fifty-six (35%) labels did not provide an appropriate age of introduction, while 32 (20%) labels used phrases implying that the product was suitable for use before six months of age. Thirty-seven (23%) labels used images of infants appearing to be younger than six months. Only 20 (13%) labels carried a message regarding the importance of exclusive breastfeeding for the first six months of life, and none provided a message on the importance of the addition of complementary foods from six months together with continued breastfeeding to two years or beyond. Eight (5%) labels recommended feeding the product in a bottle and two labels (1%) used an image of a feeding bottle. Nineteen (12%) labels suggested a daily ration too large for a breastfed child, and 32 (20%) potentially promote the manufacturer’s infant formula. All labels provided label information in an appropriate language, but 102 (64%) labels relegated required label information to small text and were thus not easy to read. Only six (4%) labels failed to provide instructions for safe and appropriate use, while 44 (28%) did not include safety messages in their preparation and use instructions. Ten (6%) labels did not provide storage instructions, and 27 (17%) labels did not provide necessary warnings. Nutrient content claims, nutrient comparative claims, nutrient function/other function claims and reduction of disease risk claims were found on 126 (79%), eight (5%), 117 (73%) and 10 (6%) labels, respectively. Conclusion The labelling practices of processed complementary food labels in South Africa do not fully comply with international guidance on the marketing of complementary foods (the Draft Guide for Marketing Complementary Foods) and so do not sufficiently protect and promote optimal infant and young child feeding practices, revealing much room for improvement. Such guidance must be refined and formalised by international normative bodies and adopted into national legislation to assist manufacturers in ensuring that their complementary food labels meet an accepted standard and contribute towards the safe and appropriate use of processed complementary foods. / Thesis (MSc (Nutrition))--North-West University, Potchefstroom Campus, 2013.