High ultra-processed food (UPF) consumption is associated with weight gain, obesity, metabolic syndrome, cardiovascular disease, all-cause mortality, and type 2 diabetes. "Food agency" refers to an individual's food preparation attitudes and capabilities within a given social and physical food environment. Although there is an association between the ability to prepare certain dishes and higher cooking frequency with lower UPF intake, it is still unclear if cooking and food agency influences UPF consumption due to the lack of research in this area. To date, studies of food agency have not included detailed dietary analyses. This cross-sectional study included 40 adults (73% female, aged 39±15 years, body mass index [BMI] 25.8±4.9 kg/m2) and aimed to determine the relationship between food agency and UPF intake. Food agency scores were calculated using the validated Cooking and Food Provisioning Action Scale (CAFPAS). Cooking behaviors and frequency were also collected. Dietary intake was assessed using three 24-hour dietary recalls with each item categorized by degree of processing using the NOVA classification system. Analyses included one-way ANOVAs between CAFPAS score quartiles [Q] and Pearson correlations between CAFPAS, cooking behaviors, and dietary intake. UPF intake was calculated in percent total calories and percent total grams to account for artificial sweeteners and other low calorie products that may be classified as UPFs. Low food agency was associated with a 14% higher UPF intake (% total calories) compared to high food agency (P=0.03). There were no differences between CAFPAS quartiles and UPF intake in % total grams. When age was divided into three categories, UPF intake was significantly lower in older adults (60+ years) compared to adults aged 19-39 years and 40-59 years by 26.4% and 29.1% respectively (P=0.02). When analyzed using bivariate analysis, lunch (r=-0.482, P=0.002) and dinner (r=-0.385, P=0.014) cooking frequency, frequency of cooking a meal from scratch or fresh ingredients (r=-0.320, P=0.044), and CAFPAS self-efficacy (r= -0.369; P= .019) were negatively correlated with UPF intake (% total kcal). These findings provide support for the possibility of reducing UPF intake through cooking interventions aimed at improving components of food agency such as problem solving, skills to create a meal from what is available, and cooking confidence. Future studies should include a larger, heterogeneous population to provide more insight into dietary differences between levels of food agency and expand the diversity of research in this area. / Master of Science / High ultra-processed food (UPF) consumption is linked to weight gain, obesity, metabolic syndrome, cardiovascular disease, all-cause mortality, and type 2 diabetes. "Food agency" refers to an individual's food preparation attitudes and capabilities within a given social and physical food environment. Although there is a link between the ability to prepare certain dishes and higher cooking frequency with lower UPF intake, it is still unclear if cooking and food agency influences UPF consumption due to the lack of research in this area. To date, studies of food agency have not included detailed dietary analyses. This study aimed to determine the relationship between food agency and UPF intake. Food agency scores were calculated using the validated Cooking and Food Provisioning Action Scale (CAFPAS). Cooking frequency and behaviors were also collected. Dietary intake was assessed using three 24-hour dietary recalls with each item categorized by degree of processing using the NOVA classification system. Participants with low food agency had higher UPF intake in percent total calories compared to those with high food agency. There were no differences between food agency and UPF intake in percent total grams. Adults aged 60 and over consumed less UPF compared to adults below the age of 60. Participants with higher food agency were more likely to make a meal from scratch or fresh ingredients. As frequency of cooking a meal from scratch or fresh ingredients, cooking dinner or lunch increased, and CAFPAS self-efficacy scores increased percent total calories from UPFs decreased. These findings provide support for the possibility of reducing UPF intake through cooking interventions aimed at improving components of food agency such as problem solving, skills to create a meal from what is available, and cooking confidence. Future studies should include a larger, heterogeneous population to provide more insight into dietary differences between levels of food agency and expand the diversity of research in this area.

Introduktion. Ultraprocessad mat innebär industriellt producerad mat som ofta har ett lågt näringsvärde men hög energitäthet, t.ex. läsk, godis, sötsaker, chips och färdigmat. Produktion, tillgänglighet och marknadsföring av processad mat och dryck ökar, vilket många forskare tror driver den fetmaepidemi som ses i världen. Tidigare forskning har visat ett samband mellan ultraprocessad mat och både övervikt och fetma, metabola sjukdomar, cancer, depression och ångest. Syfte. Syftet var att utvärdera sambandet mellan ultraprocessad mat, övervikt och fetma, samt hur övrig kosthållning ser ut vid en högre konsumtion av ultraprocessad mat. Metod. Arbetet är en litteraturstudie baserad på åtta artiklar från databaserna OneSearch och PubMed. Resultat. Resultatet visade att det verkar finnas ett samband mellan ultraprocessad mat, övervikt och fetma. En högre konsumtion av ultraprocessad mat resulterar även i ett ökat totalt energiintag, lägre intag av protein, fibrer och kalium samt ett högre intag av totalt fett, mättat fett, fleromättat fett, transfett, kolesterol, totalt socker och natrium. Konsumtionen av ultraprocessad mat är högst bland vita/infödda, yngre, rökare, fysiskt inaktiva och lägre utbildade människor. Diskussion. Huvudsaklig orsak till resultatet tros vara att en kost rik på ultraprocessad mat är rik på fett och socker, vilket resulterar i ett ökat totalt energiintag och leder till viktuppgång. / Introduction. Ultra-processed food includes industrially produced food that often has a poor nutrition value but is high in energy density, e.g. soft drinks, candy, sweets, chips and pre-cooked food. Production, availability and marketing of processed foods and drinks has increased, which several researchers believe is the main reason for the obesity epidemic in the world. Previous research has shown an association between ultra-processed food and both overweight and obesity, metabolic diseases, cancer, depression and anxiety. Objective. The objective was to evaluate the association between ultra-processed food, overweight and obesity, and how the remaining diet is composed at an increased consumption of ultra-processed food. Method. The assignment is a literature review based on articles from the databases OneSearch and PubMed. Results. The results indicate an association between ultra-processed food, overweight and obesity. An increased consumption of ultra-processed food also results in an increased total energy intake, a decreased intake of protein, fibre and potassium and an increased intake of total fat, saturated fat, polyunsaturated fat, trans fat, cholesterol, total sugar and sodium. The consumption of ultra-processed food is higher among white/native, younger people, smokers, physically inactive and those with a lower degree of education. Discussion. The main reason of the result is believed to depend on the fact that a diet rich in ultra-processed food also is a diet rich in fat and sugar, which results in an increased total energy intake that results in weight gain.

Background: Bangladesh is home to 36 million adolescents with the majority living in rural areas. Adolescence presents an additional window of opportunity to correct nutritional deficits among rural Bangladeshi adolescents. A high-quality, diverse diet is pivotal in this regard. Ultra-processed food (UPF) consumption is an emergent threat to public health. This study aimed to explore dietary diversity (DD) and UPF consumption in terms of gender and socio-economic stratification among rural adolescents in Matlab, Bangladesh. Methods: Adopting cross-sectional design 1441 adolescents were surveyed. Dietary diversity score and ultra-processed food consumption score (UFCS) were constructed through 24-hour recalls. Means and consumption proportions were compared across gender and socio-economic strata. Binary and ordinal logistic regression models were fitted to isolate socio-demographic variables associated with inadequate DD and higher UFCS respectively. Results: 43% of the adolescents had inadequate DD. Pro-boy gap in DD was evident, so was heavy reliance on rice and scant consumption of nutrient-rich foods. UPF consumption was low. Belonging to the richest and to food secure households were associated with lower odds of inadequate DD. Girls were more likely to have inadequate DD but less likely to have higher UFCS. Gender modified the effect of socio-economic status on UPF consumption. Conclusions: The diet of adolescents in Matlab lacked diversity, putting them at significant risk of nutritional deficiencies. Improving their DD requires pragmatic policies and tailored programs to tackle affordability and food insecurity issues, address social norms and intra-household dynamics that favor boys, and sensitize the adolescents to importance of consuming diverse diet. / 15-year Follow-up of MINIMat Trial

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Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2015-04-20T11:52:23Z No. of bitstreams: 2 Dissertação - Lana Angélica Braudes Silva - 2015.pdf: 2582509 bytes, checksum: a1d50e6dd6aa27091401b7168b128495 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-04-20T11:54:05Z (GMT) No. of bitstreams: 2 Dissertação - Lana Angélica Braudes Silva - 2015.pdf: 2582509 bytes, checksum: a1d50e6dd6aa27091401b7168b128495 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-04-20T11:54:05Z (GMT). No. of bitstreams: 2 Dissertação - Lana Angélica Braudes Silva - 2015.pdf: 2582509 bytes, checksum: a1d50e6dd6aa27091401b7168b128495 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2015-03-06 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The excessive consumption of ultra-processed products is associated with the obesity emergence and comorbities and this problem is increasingly in children population. The aim of this study was to investigate the prevalence and associated factors with the consumption of soft drinks and chips by children less than five years old. This is a population and household-based cross-sectional study with 653 children (aged 12 to 59 months) in 2011 and 2012. Cluster sampling in multistage and standardized questionnaire with socioeconomics, demographics, life style and anthropometrics questions were used. The dietary intake was assessed by a Food Frequency Questionnaire. Regular consumption of soft drinks and chips outcomes were dichotomized and classified as regular those who reported eating five times a week or more. The prevalence ratios were obtained using Poisson regression following a hierarchical model. At the month that preceded the interview, the prevalence of soft drinks intake was 79.3% and the chips consumption was 68.0%; and the frequencies of regular intake of these products were 27.1% and 9.5%, respectively. Children among 24 and 59 months, maternal education with 12 or more years of study, eating breakfast less than 3 times a week, time spent in front of television greater than or equals to two hours a day and chips regular consumption were associated with the soft drinks regular intake. The low socioeconomic status, maternal age greater than or equals to 35 years and soft drinks regular consumption were associated with chips regular intake. Soft drinks and chips regular intake was high among the children. Age, watching TV and chips regular intake were positively associated with the soft drinks regular consumption, and maternal education and eating breakfast were negatively associated. Soft drinks regular consumption was positively associated with chips regular intake, and socioeconomic status and maternal age were negatively associated. / O consumo excessivo de produtos ultraprocessados associa-se ao surgimento de obesidade e comorbidades, e essa problemática está cada vez mais frequente na população infantil. O objetivo do estudo foi investigar a prevalência do consumo de refrigerantes e salgadinhos de pacote por crianças menores de cinco anos e seus fatores associados. Trata-se de estudo transversal de base populacional e domiciliar com 653 crianças (12 a 59 meses), realizado em 2011 e 2012. Utilizou-se amostragem por conglomerados em múltiplos estágios e questionário padronizado com questões socioeconômicas e demográficas, de estilo de vida e perfil antropométrico. Avaliou-se o consumo alimentar por meio de Questionário de Frequência Alimentar. Os desfechos, consumo regular de refrigerantes e consumo regular de salgadinhos de pacote, foram dicotomizados e classificados como regular a ingestão referida em cinco dias por semana ou mais. As razões de prevalência foram obtidas por regressão de Poisson segundo modelo hierárquico. No mês antecedente à entrevista, a prevalência do consumo de refrigerantes foi de 79,3% e de salgadinhos de pacote, 68,9%; e as frequências do consumo regular destes produtos foram 27,1% e 9,5%, respectivamente. A faixa etária entre 24 e 59 meses, escolaridade materna igual ou superior a 12 anos de estudo, realizar o café da manhã menos de três vezes por semana, assistir TV por duas horas ou mais por dia e a ingestão regular de salgadinhos de pacote foram associadas ao consumo regular de refrigerantes. Associaram-se ao consumo regular de salgadinhos de pacote: pertencer à classe econômica baixa, idade materna maior ou igual a 35 anos e a ingestão regular de refrigerantes. O consumo de refrigerantes e salgadinhos de pacote foi elevado entre as crianças. A idade, tempo diante da TV e consumo regular de salgadinhos de pacote foram associados positivamente à ingestão regular de refrigerantes, e a escolaridade materna e a realização do café da manhã foram negativamente associados. O consumo regular de refrigerantes associou-se positivamente ao consumo regular de salgadinhos de pacote, e a classe econômica e a idade materna, associaram-se negativamente. Os achados podem fornecer subsídios para nortear estratégias de promoção e redução de riscos de doenças crônicas associadas ao consumo alimentar de crianças.

Submitted by Aline Batista (alinehb.ufpel@gmail.com) on 2018-05-18T22:10:38Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Aline_Longo.pdf: 1263882 bytes, checksum: 3cfecd84c4beeee8747151fba3894772 (MD5) / Approved for entry into archive by Aline Batista (alinehb.ufpel@gmail.com) on 2018-05-18T22:43:49Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Aline_Longo.pdf: 1263882 bytes, checksum: 3cfecd84c4beeee8747151fba3894772 (MD5) / Approved for entry into archive by Aline Batista (alinehb.ufpel@gmail.com) on 2018-05-18T22:43:55Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Aline_Longo.pdf: 1263882 bytes, checksum: 3cfecd84c4beeee8747151fba3894772 (MD5) / Made available in DSpace on 2018-05-18T22:43:55Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Aline_Longo.pdf: 1263882 bytes, checksum: 3cfecd84c4beeee8747151fba3894772 (MD5) Previous issue date: 2016-07-21 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / As doenças cardiovasculares, além de representarem a principal causa de morte no Brasil e no mundo, podem gerar doentes crônicos. A prevenção secundária de pacientes com tal comorbidade torna-se importante, e o estudo de fatores prognósticos auxilia em tal conduta. O objetivo deste trabalho foi avaliar fatores prognósticos de doença cardiovascular e investigar possíveis associações entre eles, em uma amostra de pacientes com aterosclerose manifesta do município de Pelotas/RS. Trata-se de estudo transversal, aninhado a um ensaio clínico randomizado, com dados dos pacientes do centro colaborador de Pelotas/RS. Foram coletadas variáveis clínicas, antropométricas, bioquímicas, sociodemográficas, alimentares e qualidade de vida relacionada à saúde. A análise estatística foi realizada através dos programas Graph Pad® e Stata®. A maioria da amostra era do sexo masculino, idosa, pertencente à classe econômica C, estudou até o ensino fundamental, era fumante ou ex-fumante e possuía excesso de peso, doença arterial coronariana, hipertensão, dislipidemia e histórico familiar de doença cardiovascular. Quanto ao consumo alimentar (n=74), classificado de acordo com o grau de processamento, o grupo de alimentos que mais contribuiu com o consumo calórico diário foi o in natura/minimamente processados (50,9%), seguido pelo consumo de alimentos ultraprocessados (35,1%), processados (11,1%) e ingredientes culinários processados (2,9%). Possuir excesso de peso e ser fumante/ex-fumante estiveram positivamente associados à pontuação da síndrome metabólica, com um acréscimo de 0,64 e 0,48 pontos, respectivamente (n=82). Com relação à qualidade de vida relacionada à saúde (n=70), o escore dos domínios de saúde física foi inferior ao escore de saúde mental (p<0,0001). Índice de massa corporal e circunferência da cintura estiveram negativamente associados à qualidade de vida relacionada à saúde, enquanto que o consumo de fibras dietéticas, potássio e magnésio apresentaram associação positiva. Na amostra analisada, o consumo de alimentos processados/ultraprocessados mostrou-se elevado, visto que foi quase igual ao consumo de alimentos in natura/minimamente processados. Fibra dietética, potássio e magnésio, estiveram positivamente associados à qualidade de vida relacionada à saúde. Por outro lado, altos valores de circunferência da cintura e índice de massa corporal estiveram negativamente associados à qualidade de vida relacionada à saúde. Ademais, o índice de massa corporal elevado (excesso de peso) e tabagismo foram responsáveis por aumentarem a pontuação da síndrome metabólica. Dessa forma, a prevenção secundária dos pacientes analisados deve contemplar intervenções para um estilo de vida mais saudável, principalmente voltadas à alimentação adequada e à manutenção do peso na faixa da normalidade. / Cardiovascular diseases, besides representing the leading cause of death in Brazil and worldwide, can lead to chronic conditions. Secondary prevention of patients with this comorbidity becomes important, and the study of prognostic factors helps in such conduct. The aim of this work was to evaluate prognostic factors of cardiovascular diseases and to investigate possible associations between them, in a sample of patients with established atherosclerosis disease, in Pelotas/RS. Cross-sectionals studies, nestled to a randomized clinical trial, were performed, with data of the collaborating site of Pelotas/RS. Clinical, anthropometric, biochemistry, sociodemographic, alimentary and health-related quality of life variables were collected. Statistical analyzes were carried out in Graph Pad® e Stata®. The majority of the sample was men, elderly, from economic level C, studied until elementary school, was former or current smoker and had overweight, coronary artery disease, hypertension, dyslipidemia and familiar history of cardiovascular diseases. About alimentary consumption (n=74), classified according to the degree of processing, the group that most contributed to caloric consumptio was unprocessed/minimally processed foods (50.9%), followed by ultra-processed (35.1%), processed (11.1%) and processed culinary ingredients (2.9%). Overweight and being current/former smoker were positively associated to the pontuation of metabolic syndrome, with an increase of 0.64 and 0.48 points, respectivetly (n=82). Regarding health-related quality of life (n=70), the score of physical health domains was lower than the mental health (p<0.0001). Body mass index and waist circumference were negatively associated to health-related quality of life, whereas the consumption of dietary fiber, potassium and magnesium presented a positive association. In the analysed sample, alimentary consumption across the degree of processing foods was elevated, since the consumption of processed/ultra-processed foods was almost the same of unprocessed/minimally processed foods. Dietary fiber, potassium and magnesium were positively associated to health-related quality of life. On the other hand, high values of waist circumference and body mass index were negatively associated to health-related quality of life. Moreover, elevated body mass index (overweight) and tobacco use were identified as risk factors that increase the pontuation of metabolic syndrome. Thus, the secondary prevention of patients analysed must contemplate interventions to an healthier lifestyle, mainly focused to an adequate diet and to the maintenance of a proper weigh.

Background: With an estimated number of 1.2 billion in the world, adolescents represent a major transformative force in global health. Optimum adolescent nutrition is increasingly important for scaling up population health gains in low- and middle-income countries (LMICs) of South Asia. Nevertheless, little is known about the gender and socio-economic stratification of diets consumed by rural adolescents in these countries. The aim of this project was to understand the gender and socio-economic stratification of their diet with a dual, descriptive-analytic focus on dietary diversity (DD) and consumption of ultra-processed and deep-fried foods. Methods: This thesis builds upon cross-sectional analyses of data collected during 15-year follow-up of the MINIMat (Maternal and Infant Nutrition Interventions in Matlab) trial, from September 2017 to June 2019. Data on dietary and socio-demographic variables were collected through household survey; using a pre-tested, structured questionnaire. A single, 24-hour recall was employed to assess consumption of staples and non-staples arranged in 10 groups, ultra-processed foods (UPF) in four groups, and of one group of deep-fried foods. Data were analyzed using logistic regression models. The analytic sample comprised 2463 adolescents. Results: The prevalence of inadequate DD was 42.3% (40.3-44.2). Consumption of dark green leafy vegetables, vitamin A-rich fruits and vegetables, and animal-source foods–except fish–appeared low. The proportions of adolescents consuming meat, egg and dairy were higher among those from the richest households than those from the poorest households, and among boys than girls. Belonging to the poorest households (adjusted odds ratio (aOR): 1.59; 95% confidence interval (CI): 1.27-2.00) and the food insecure households (aOR: 1.34; 95% CI: 1.13-1.59), and attaining secondary education (aOR: 1.38; 95% CI: 1.11-1.71) were positively associated with inadequate DD. Adolescents having mothers with secondary education or above had lower odds of inadequate DD (aOR: 0.76; 95% CI: 0.60-0.96). Gender was not an independent predictor of inadequate DD.Approximately 83% (81.5-84.4) adolescents reportedly consumed at least one ultra-processed or deep-fried food in the 24 hours preceding the survey. Packaged confectioneries were the most consumed and sugar-sweetened beverages (SSB) the least consumed UPF group. Boys had greater odds of consumption than girls for all UPF groups and deep-fried foods. The association was strongest for SSB (aOR: 2.57; 95% CI: 1.97, 3.37), followed by deep-fried foods (aOR 1.96; 95% CI: 1.66, 2.32). Belonging to the richest households was associated with consumption of ready-to-eat foods (aOR 1.55; 95% CI: 1.12-2.16) and of SSB (aOR: 1.44; 95% CI: 1.02-2.03). Adolescents with higher educational attainment had lower odds of consuming SSB (aOR 0.73; 95% CI: 0.54-0.98). Conclusion: The studies presented compelling evidence of limited DD concurrent with emergent consumption of ultra-processed and deep-fried foods in a rural cohort of adolescents. Inadequate DD was more likely among those from the poorest and the food insecure households. For ultra-processed and deep-fried foods, gender association persisted across the food groups with boys having a greater likelihood of consumption than girls. Wealth status influenced consumption of “instant” foods and SSB only. This suboptimal dietary pattern may place the adolescents at heightened risk of different forms of malnutrition.

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