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Ultra-Processed Foods and Likely Impact on Human Health: Evidence from Brazil

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Ultra-Processed Foods and Likely Impact on Human Health: Evidence from Brazil Public Health Nutrition: 14(1), 5–13 doi:10.1017/S1368980010003241 Increasing consumption of ultra-processed foods and likely impact on human health: evidence from Brazil Carlos Augusto Monteiro1,2,*, Renata Bertazzi Levy1,3, Rafael Moreira Claro1, Ineˆs Rugani Ribeiro de Castro1,4 and Geoffrey Cannon5 1Nu´cleo de Pesquisas Epidemiolo´gicas em Nutric¸a˜o e Sau´de, Universidade de Sa˜o Paulo, Sa˜o Paulo, Brasil: 2Departamento de Nutric¸a˜o, Faculdade de Sau´de Pu´blica, Universidade de Sa˜o Paulo, Av. Dr. Arnaldo 715, 01246-904 Sa˜o Paulo, SP, Brasil: 3Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de Sa˜o Paulo. Sa˜o Paulo, Brasil: 4Instituto de Nutric¸a˜o, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brasil: 5World Public Health Nutrition Association, Rio de Janeiro, Brazil Submitted 2 June 2010: Accepted 25 October 2010 Abstract Objective: To assess time trends in the contribution of processed foods to food purchases made by Brazilian households and to explore the potential impact on the overall quality of the diet. Design: Application of a new classification of foodstuffs based on extent and purpose of food processing to data collected by comparable probabilistic household budget surveys. The classification assigns foodstuffs to the following groups: unprocessed/ minimally processed foods (Group 1); processed culinary ingredients (Group 2); or ultra-processed ready-to-eat or ready-to-heat food products (Group 3). Setting: Eleven metropolitan areas of Brazil. Subjects: Households; n 13 611 in 1987–8, n 16 014 in 1995–5 and n 13 848 in 2002–3. Results: Over the last three decades, the household consumption of Group 1 and Group 2 foods has been steadily replaced by consumption of Group 3 ultra- processed food products, both overall and in lower- and upper-income groups. In the 2002–3 survey, Group 3 items represented more than one-quarter of total energy (more than one-third for higher-income households). The overall nutrient profile of Group 3 items, compared with that of Group 1 and Group 2 items, revealed more added sugar, more saturated fat, more sodium, less fibre and much higher energy density. Conclusions: The high energy density and the unfavourable nutrition profiling of Keywords Group 3 food products, and also their potential harmful effects on eating and Food drinking behaviours, indicate that governments and health authorities should use Processed food all possible methods, including legislation and statutory regulation, to halt and Nutrition reverse the replacement of minimally processed foods and processed culinary Diet ingredients by ultra-processed food products. Food classification The present paper is informed by a general statement: that change in the economically developing world (the almost all work on nutrition and public health has over- ‘nutrition transition’) have tended to focus on shifts in estimated the significance of nutrients and of foods as such, consumption of energy and macronutrients, or else of and has underestimated or even overlooked the significance basic foods or food groups like meat or cereals and cereal of processing. To express this rather more strongly: ‘The products(5–9). Studies that include processed foods tend issue is not foods, nor nutrients, so much as processing’(1). to pick only a few types of product, and do not examine Authoritative reports, official and other dietary guide- ‘processed foods’ as such. This is despite the fact that lines, and other documents concerned with food and ‘processed foods’ are frequently identified as a core health, accept or assume that processed foods and drinks aspect of the ‘nutrition transition’(9,10). are implicated in the current pandemics of obesity and There are at least two reasons for ignorance of time chronic diseases(2,3). The manufacture and supply of such trends in the consumption of processed foods and of the products have expanded globally(4). Yet time trends in significance of food processing in human health and consumption are largely unknown, especially in lower- disease. One is that few countries undertake periodic income countries. Instead, studies examining dietary comparable population-based dietary surveys. Another is *Corresponding author: Email [email protected] r The Authors 2010 6 CA Monteiro et al. that conventional food classifications largely ignore food forty-five to 351), 145?6in1995–6(rangingfromforty- processing and consensus on criteria to classify foods seven to 474) and 65?7 in 2002–3 (ranging from fifteen to according to food processing still does not exist. 228). In all cases, the sampling weight of each unit of To help address this gap, the present paper uses a new analysis corresponded to the sum of the sampling weights classification of foods based on the extent and purpose of of the individual households surveyed in the unit. the industrial processing used in their production(11). This classification is applied to data collected by comparable Data collection household budget surveys conducted across the last three HBS are designed to obtain reliable information on all decades in Brazil, with a view to assess time trends in sources of household income and all household expenses. food consumption and to explore their potential impact Data on income and other sociodemographic variables were on the overall diet quality and health. obtained in the three surveys by trained field workers using standardized questionnaires. Information on foods and drinks purchased by each household was obtained using the Methods survey’s collective expense notebook. In this notebook, one household member was asked to record all food purchases Data source, studied population and sampling made by the household during seven consecutive days. The data analysed in the present study are derived from During this period, the record task was daily supervised by three household expenditure surveys (HBS) carried out by the field worker in charge of the household. the Instituto Brasileiro de Geografia e Estatı´stica – IBGE In 1987–8, the record of food purchases was restricted (Brazilian Federal Bureau of Geography and Statistics) to the description of the food item and the value of the from March 1987 to February 1988, from October 1995 to expense. In this case, the quantity of each food item September 1996, and from July 2002 to June 2003, in acquired by the household, expressed in fractions or probabilistic samples representative of Brazilian house- multiples of kilograms or litres, was derived using the holds located in the eleven metropolitan areas of Brazil food item’s average cost (by weight or volume) in the (Belem in the North region; Fortaleza, Recife and Salvador same week and metropolitan area (information routinely in the North-east region; Belo Horizonte, Rio de Janeiro estimated by IBGE in a random sample of selling points and Sao Paulo in the South-east region; Curitiba and Porto with the purpose to monitor the cost of living in metro- Alegre in the South region; and Goiania and Brasilia in the politan areas). In 1995–6 and 2002–3, the record of food West-centre region). According to the Census of 2000, purchases included the actual quantity of food acquired these eleven areas contain 34 % of all Brazilian households by the household. In these cases, quantities of specific and are home to 32 % of the total Brazilian population. food items acquired by the households were calculated Sampling used for HBS involves the prior definition of directly from the expense notebook or else, when infor- socio-geographic strata integrated by census tracts with mation was missing, derived from average costs estimated similar socio-economic profile and located within each from the households with valid information in the same metropolitan area. Subsequently, census tracts are randomly week and metropolitan area. selected from within each stratum and households are Expenditure on food made by household members randomly selected from within each tract. In order to make when eating outside the home is also collected by the data collection uniform across the year’s four trimesters, the HBS but not in sufficient detail to allow for estimating the interviews carried out within each stratum are spread out type and quantity of the food. Therefore, the present across the 12 months of the survey. The total number of study is restricted to foods available for consumption studied households was 13 611 in 1987–8, 16 014 in 1995–6 within households. Expenditure on food consumed out- and 13 848 in 2002–3. A detailed description of the HBS side the home by household members represented 24?5% sampling strategy is available elsewhere(12). of total household food expenses in 1987–8, 25?3% in The HBS reference period for collecting information on 1995–6 and 28?2 % in 2002–3. food purchases in each household is seven consecutive days (‘foods’ here means foods and drinks). Such a short Food classification reference period is insufficient for a reliable characteriza- The classification used in the present paper groups food- tion of the food purchase pattern of individual households, stuffs according to the extent and purpose of the industrial so we used groups of households as our units of analysis. processing used in their production(11). Industrial food We created the units of analysis by cross-tabulating the processing is defined here as all methods and techniques sampled household according to the eleven metropolitan used by the food, drink and associated industries to turn areas and ten family income intervals (n 110). In both whole fresh foods into food products. Agriculture and hor- cases, each unit of analysis comprises households that are ticulture, especially industrial and other intensive methods homogeneous in terms of territorial domain and family of farming, can be seen as a type of processing, but these income. The mean number of households surveyed in are not included here.
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