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      Smoking and consumption of ultra-processed foods — a combination of risky choices: A cross-sectional study using Vigitel 2018 data

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          ABSTRACT

          BACKGROUND:

          Smoking and unhealthy diet are important risk factors for cardiovascular and metabolic diseases, contributing to public health crises.

          OBJECTIVE:

          To evaluate the consumption of natural/minimally processed and ultra-processed foods by Brazilian adults (18–59 years old) according to smoking status.

          DESIGN AND SETTING:

          Cross-sectional study of a representative population sample from 26 state capitals and the Federal District (Brazil-2018).

          METHODS:

          Data were obtained from Vigitel—Surveillance System for Risk and Protection Factors for Chronic Diseases by Telephone Survey. Participants were categorized as smokers, ex-smokers, and never smokers. Multinomial logistic regression was used for analyses.

          RESULTS:

          Of the 30,800 adults evaluated, 9.4% (95%CI: 8.7-10.2) were smokers and 16.5% (95%CI: 15.8-17.3) were ex-smokers. Smokers were less likely to consume fruit and natural juice, and more likely to consume soda or artificial juice (≥ 5 days/week) than ex-smokers and never smokers. Regarding the daily frequency of consumption, smokers were observed to be less likely to eat fruit more than 1 time/day and more likely to drink ≥ 3 cups/cans of soda/day. Compared to never smokers, smokers had a 42% higher chance of consuming ≥ 3 glasses of natural juice/day. On the day before the interview, fruit, milk, tubers, squash, and okra consumption were lower among smokers than non-smokers. Smokers were more likely to report consuming soft drinks, fruit juice, sauces, ready-made dishes, margarine, and sausages.

          CONCLUSION:

          Smokers had lower fruit consumption, and higher consumption of natural juices and ultra-processed foods. We highlight the need for strategies that encourage healthy eating and smoking cessation.

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          Most cited references41

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          The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing.

          Given evident multiple threats to food systems and supplies, food security, human health and welfare, the living and physical world and the biosphere, the years 2016-2025 are now designated by the UN as the Decade of Nutrition, in support of the UN Sustainable Development Goals. For these initiatives to succeed, it is necessary to know which foods contribute to health and well-being, and which are unhealthy. The present commentary outlines the NOVA system of food classification based on the nature, extent and purpose of food processing. Evidence that NOVA effectively addresses the quality of diets and their impact on all forms of malnutrition, and also the sustainability of food systems, has now accumulated in a number of countries, as shown here. A singular feature of NOVA is its identification of ultra-processed food and drink products. These are not modified foods, but formulations mostly of cheap industrial sources of dietary energy and nutrients plus additives, using a series of processes (hence 'ultra-processed'). All together, they are energy-dense, high in unhealthy types of fat, refined starches, free sugars and salt, and poor sources of protein, dietary fibre and micronutrients. Ultra-processed products are made to be hyper-palatable and attractive, with long shelf-life, and able to be consumed anywhere, any time. Their formulation, presentation and marketing often promote overconsumption. Studies based on NOVA show that ultra-processed products now dominate the food supplies of various high-income countries and are increasingly pervasive in lower-middle- and upper-middle-income countries. The evidence so far shows that displacement of minimally processed foods and freshly prepared dishes and meals by ultra-processed products is associated with unhealthy dietary nutrient profiles and several diet-related non-communicable diseases. Ultra-processed products are also troublesome from social, cultural, economic, political and environmental points of view. We conclude that the ever-increasing production and consumption of these products is a world crisis, to be confronted, checked and reversed as part of the work of the UN Sustainable Development Goals and its Decade of Nutrition.
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            Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake

            We investigated whether ultra-processed foods affect energy intake in 20 weight-stable adults, aged (mean ± SE) 31.2 ± 1.6 years and BMI = 27 ± 1.5 kg/m2. Subjects were admitted to the NIH Clinical Center and randomized to receive either ultra-processed or unprocessed diets for 2 weeks immediately followed by the alternate diet for 2 weeks. Meals were designed to be matched for presented calories, energy density, macronutrients, sugar, sodium, and fiber. Subjects were instructed to consume as much or as little as desired. Energy intake was greater during the ultra-processed diet (508 ± 106 kcal/day; p = 0.0001), with increased consumption of carbohydrate (280 ± 54 kcal/day; p < 0.0001) and fat (230 ± 53 kcal/day; p = 0.0004), but not protein (-2 ± 12 kcal/day; p = 0.85). Weight changes were highly correlated with energy intake (r = 0.8, p < 0.0001), with participants gaining 0.9 ± 0.3 kg (p = 0.009) during the ultra-processed diet and losing 0.9 ± 0.3 kg (p = 0.007) during the unprocessed diet. Limiting consumption of ultra-processed foods may be an effective strategy for obesity prevention and treatment.
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              Consumption of ultra-processed foods and health status: a systematic review and meta-analysis

              Increasing evidence suggests that high consumption of ultra-processed foods (UPF) is associated with an increase in non-communicable diseases, overweight and obesity. The present study systematically reviewed all observational studies that investigated the association between UPF consumption and health status. A comprehensive search of MEDLINE, Embase, Scopus, Web of Science and Google Scholar was conducted, and reference lists of included articles were checked. Only cross-sectional and prospective cohort studies were included. At the end of the selection process, twenty-three studies (ten cross-sectional and thirteen prospective cohort studies) were included in the systematic review. As regards the cross-sectional studies, the highest UPF consumption was associated with a significant increase in the risk of overweight/obesity (+39 %), high waist circumference (+39 %), low HDL-cholesterol levels (+102 %) and the metabolic syndrome (+79 %), while no significant associations with hypertension, hyperglycaemia or hypertriacylglycerolaemia were observed. For prospective cohort studies evaluating a total population of 183 491 participants followed for a period ranging from 3·5 to 19 years, highest UPF consumption was found to be associated with increased risk of all-cause mortality in five studies (risk ratio (RR) 1·25, 95 % CI 1·14, 1·37; P < 0·00001), increased risk of CVD in three studies (RR 1·29, 95 % CI 1·12, 1·48; P = 0·0003), cerebrovascular disease in two studies (RR 1·34, 95 % CI 1·07, 1·68; P = 0·01) and depression in two studies (RR 1·20, 95 % CI 1·03, 1·40; P = 0·02). In conclusion, increased UPF consumption was associated, although in a limited number of studies, with a worse cardiometabolic risk profile and a higher risk of CVD, cerebrovascular disease, depression and all-cause mortality.
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                Author and article information

                Contributors
                Role: conceptualization (equal)Role: data curation (equal)Role: formal analysis (lead)Role: investigation (lead)Role: methodology (equal)Role: validation (equal)Role: visualization (equal)Role: writing – original draft (equal)Role: reviewed and approved the final version of the manuscript submitted for publication
                Role: conceptualization (equal)Role: formal analysis (supporting)Role: investigation (equal)Role: methodology (supporting)Role: validation (equal)Role: visualization (equal)Role: writing – review and editing (equal)Role: reviewed and approved the final version of the manuscript submitted for publication
                Role: investigation (equal)Role: validation (equal)Role: visualization (equal)Role: writing – review and editing (equal)Role: reviewed and approved the final version of the manuscript submitted for publication
                Role: Supervision (Equal)Role: Validation (Equal)Role: Visualization (Equal)Role: Writing – review and editing (Equal)Role: reviewed and approved the final version of the manuscript submitted for publication
                Journal
                Sao Paulo Med J
                Sao Paulo Med J
                spmj
                São Paulo Medical Journal
                Associação Paulista de Medicina - APM
                1516-3180
                1806-9460
                19 July 2024
                2024
                : 142
                : 5
                : e2023156
                Affiliations
                [I ]PhD student, Collective Health Postgraduate Program, Department of Collective Health, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
                [II ]Professor, Gerontology Postgraduate Program, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
                [III ]Associate Professor, Department of Public Policies and Collective Health, Health and Society Institute, Universidade Federal de São Paulo (UNIFESP), Santos (SP), Brazil.
                [IV ]Professor, Collective Health Postgraduate Program, Department of Collective Health, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
                Author notes
                Address for correspondence: Priscila Maria Stolses Bergamo Francisco Departamento de Saúde Coletiva, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP) Rua Tessália Vieira de Camargo, 126 — Campinas (SP), Brazil. CEP 13083-887 Tel.: (19) 3521-9244 E-mail: primaria@ 123456unicamp.br

                Conflict of interest: No conflict of interest

                Editor responsible for the evaluation process: Paulo Manuel Pêgo-Fernandes MD, PhD

                Author information
                https://orcid.org/0000-0002-9020-8600
                https://orcid.org/0000-0003-1813-996X
                https://orcid.org/0000-0003-3003-2153
                https://orcid.org/0000-0001-7361-9961
                Article
                00211
                10.1590/1516-3180.2023.0156.R1.16022024
                11262210
                39045982
                c7056799-cb57-4f36-982a-ed632cdcef43
                © 2024 by Associação Paulista de Medicina

                This is an open-access article distributed under the terms of the Creative Commons License

                History
                : 02 May 2023
                : 11 January 2024
                : 16 February 2024
                Page count
                Figures: 0, Tables: 5, Equations: 0, References: 30
                Funding
                Funded by: CAPES
                Award ID: 88882.461722/2019-01
                Categories
                Original Article

                tobacco use disorder,smoking,feeding behavior,health surveys,food intake,tobacco,population survey,adults

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