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      Food environment solutions for childhood obesity in Latin America and among Latinos living in the United States

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          Summary

          The food environment is a major contributor to unhealthy diets in children and, therefore, to the increasing rates of obesity. Acclaimed by scholars across the world, Latin American countries have been leaders in implementing policies that target different aspects of the food environment. Evidence on the nature and to what extent children are exposed and respond to unhealthy food environments in the region and among Latinos in the United States is, however, deficient. The objective of this review is to use the integrated International Network for Food and Obesity/noncommunicable diseases (NCDs) Research, Monitoring and Action Support (INFORMAS) framework to create healthy food environment to (i) compare the key elements of childhood obesity‐related food environments in Latin America and for Latinos living in the United States; (ii) describe the evidence on solutions to improve childhood obesity‐related food environments; and (iii) identify research priorities to inform solutions to fight childhood obesity in these populations. We found that an integrated body of evidence is needed to inform an optimal package of policies to improve food environments to which children in Latin America and Latino children in the United States are exposed and more efficiently translate policy solutions to help curb growing childhood obesity levels across borders.

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          Ultra-processed foods: what they are and how to identify them

          The present commentary contains a clear and simple guide designed to identify ultra-processed foods. It responds to the growing interest in ultra-processed foods among policy makers, academic researchers, health professionals, journalists and consumers concerned to devise policies, investigate dietary patterns, advise people, prepare media coverage, and when buying food and checking labels in shops or at home. Ultra-processed foods are defined within the NOVA classification system, which groups foods according to the extent and purpose of industrial processing. Processes enabling the manufacture of ultra-processed foods include the fractioning of whole foods into substances, chemical modifications of these substances, assembly of unmodified and modified food substances, frequent use of cosmetic additives and sophisticated packaging. Processes and ingredients used to manufacture ultra-processed foods are designed to create highly profitable (low-cost ingredients, long shelf-life, emphatic branding), convenient (ready-to-consume), hyper-palatable products liable to displace all other NOVA food groups, notably unprocessed or minimally processed foods. A practical way to identify an ultra-processed product is to check to see if its list of ingredients contains at least one item characteristic of the NOVA ultra-processed food group, which is to say, either food substances never or rarely used in kitchens (such as high-fructose corn syrup, hydrogenated or interesterified oils, and hydrolysed proteins), or classes of additives designed to make the final product palatable or more appealing (such as flavours, flavour enhancers, colours, emulsifiers, emulsifying salts, sweeteners, thickeners, and anti-foaming, bulking, carbonating, foaming, gelling and glazing agents).
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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 cancer risk: results from NutriNet-Santé prospective cohort

              Abstract Objective To assess the prospective associations between consumption of ultra-processed food and risk of cancer. Design Population based cohort study. Setting and participants 104 980 participants aged at least 18 years (median age 42.8 years) from the French NutriNet-Santé cohort (2009-17). Dietary intakes were collected using repeated 24 hour dietary records, designed to register participants’ usual consumption for 3300 different food items. These were categorised according to their degree of processing by the NOVA classification. Main outcome measures Associations between ultra-processed food intake and risk of overall, breast, prostate, and colorectal cancer assessed by multivariable Cox proportional hazard models adjusted for known risk factors. Results Ultra-processed food intake was associated with higher overall cancer risk (n=2228 cases; hazard ratio for a 10% increment in the proportion of ultra-processed food in the diet 1.12 (95% confidence interval 1.06 to 1.18); P for trend<0.001) and breast cancer risk (n=739 cases; hazard ratio 1.11 (1.02 to 1.22); P for trend=0.02). These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet (lipid, sodium, and carbohydrate intakes and/or a Western pattern derived by principal component analysis). Conclusions In this large prospective study, a 10% increase in the proportion of ultra-processed foods in the diet was associated with a significant increase of greater than 10% in risks of overall and breast cancer. Further studies are needed to better understand the relative effect of the various dimensions of processing (nutritional composition, food additives, contact materials, and neoformed contaminants) in these associations. Study registration Clinicaltrials.gov NCT03335644.
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                Author and article information

                Contributors
                taillie@unc.edu
                Journal
                Obes Rev
                Obes Rev
                10.1111/(ISSN)1467-789X
                OBR
                Obesity Reviews
                John Wiley and Sons Inc. (Hoboken )
                1467-7881
                1467-789X
                21 June 2021
                June 2021
                : 22
                : Suppl 3 , Childhood Obesity Prevention Across Borders: The Promise of US‐Latin American Research Collaboration ( doiID: 10.1111/obr.v22.S3 )
                : e13237
                Affiliations
                [ 1 ] Center for Food Studies and Research (NEPA) University of Campinas Campinas Brazil
                [ 2 ] Center for Epidemiological Studies in Nutrition and Health University of São Paulo São Paulo Brazil
                [ 3 ] Trinity Business School Trinity College Dublin Dublin Ireland
                [ 4 ] School of Community and Health Sciences University of Nevada Reno Nevada USA
                [ 5 ] Rudd Center for Food Policy and Obesity University of Connecticut Hartford Connecticut USA
                [ 6 ] School of Nutrition, University of Costa Rica San José Costa Rica
                [ 7 ] CONACYT, Health and Nutrition Research Center National Institute of Public Health Cuernavaca Mexico
                [ 8 ] Instituto de Nutricion y Tecnologia de Alimentos University of Chile Santiago Chile
                [ 9 ] Department of Nutrition, Gillings School of Global Public Health, and Carolina Population Center University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
                Author notes
                [*] [* ] Correspondence

                Lindsey Smith Taillie, Department of Nutrition, Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina at Chapel Hill, 170 Rosenau Hall, Cb #7400, 135 Dauer Drive, Chapel Hill, NC, 27599‐7400, USA.

                Email: taillie@ 123456unc.edu

                Author information
                https://orcid.org/0000-0001-7317-5790
                https://orcid.org/0000-0002-9883-6441
                https://orcid.org/0000-0002-6219-298X
                https://orcid.org/0000-0002-9830-076X
                https://orcid.org/0000-0002-2823-6651
                https://orcid.org/0000-0003-3766-7709
                https://orcid.org/0000-0002-4555-2525
                Article
                OBR13237 OBR-02-21-5021
                10.1111/obr.13237
                8365715
                34152071
                eb8b6423-58a6-417e-a5bb-7aa0b2e54907
                © 2021 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 25 February 2021
                : 26 February 2021
                Page count
                Figures: 3, Tables: 2, Pages: 20, Words: 17472
                Funding
                Funded by: Bloomberg Philanthropies (LST, ACD, CC, MLJ) , doi 10.13039/100000002;
                Funded by: University of Las Vegas, Reno (EC) , doi 10.13039/100000061;
                Categories
                Supplement Article
                Obesity Prevention Across Borders: The Promise of US‐Latin American Research Collaboration
                Supplement Articles
                Custom metadata
                2.0
                June 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.5 mode:remove_FC converted:16.08.2021

                Medicine
                childhood,food environment,obesity,policy
                Medicine
                childhood, food environment, obesity, policy

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