Abstract:

Objective:

To evaluate the consumption of ultra-processed food and drink products and its association with the nutrient profile of the Colombian diet in 2005.

Materials and methods:

Food consumption based on 24-hour dietary records from 38 643 men and women was classified into four NOVA groups according to the extent and purpose of food processing.

Results:

Ultra-processed food and drink products represented 15.9% of the total energy daily intake, compared to 63.3% from minimally processed food, 15.8% from processed culinary ingredients, and 4.9% from processed food. Non-ultra-processed food items had a healthier nutritional profile compared to ultra-processed items in terms of contribution to total calories from protein, carbohydrates, total fat, saturated fat, free sugar, fiber and energy density.

Conclusions:

Ultra-processed food products have a less healthy nutrient profile than non-ultra-processed ones. An increase in the consumption of these foods must be prevented within Colombia.

Keywords:
processed food; diet; macronutrients; classification; NOVA; Colombia

Resumen:

Objetivo:

Evaluar el consumo de alimentos y bebidas ultraprocesadas y su asociación con el perfil nutricional dentro de la Encuesta Nacional de Nutrición de 2005 en Colombia.

Material y métodos:

El consumo de alimentos basados en registros alimentarios de 24 horas de 38 643 individuos se clasificó en cuatro grupos de NOVA.

Resultados:

Los productos de alimentos y bebidas ultraprocesados representaron 15.9% de la ingesta diaria total de energía, en comparación con 63.3% de los alimentos mínimamente procesados, 15.8% de los ingredientes culinarios procesados y 4.9% de los procesados. Los alimentos mínimamente procesados tenían un perfil nutricional más saludable en comparación con los artículos ultraprocesados en términos de contribución a las calorías totales, de proteínas, carbohidratos, grasa total, grasa saturada, azúcar libre, densidad de fibra y densidad de energía.

Conclusiones:

Los alimentos ultraprocesados tienen un perfil nutricional menos saludable que los alimentos no procesados.

Palabras clave:
alimentos procesados; dieta; macronutrientes; clasificación; NOVA; Colombia

Introduction

The use of the NOVA classification system, developed to study the impact of food processing on diet quality and health outcomes, has shown consistent associations between consumption of ultra-processed food and drink products (UPF) and obesity,¹1. Louzada ML, Baraldi LG, Steele EM, Martins AP, Canella DS, Moubarac JC, et al. Consumption of ultra-processed foods and obesity in Brazilian adolescents and adults. Prev Med. 2015;81:9-15. https://doi.org/10.1016/j.ypmed. 2015 .07.018
https://doi.org/10.1016/j.ypmed. 2015 .0... metabolic syndrome,²2. Tavares LF, Fonseca SC, Garcia-Rosa ML, Yokoo EM. Relationship between ultra-processed foods and metabolic syndrome in adolescents from a Brazilian Family Doctor Program. Public Health Nutr. 2012;15(1):82-7. https://doi.org/10.1017/S1368980011001571
https://doi.org/10.1017/S136898001100157... and dyslipidemia.³3. Rauber F, Campagnolo PD, Hoffman DJ, Vitolo MR. Consumption of ultra-processed food products and its effects on children's lipid profiles: a longitudinal study. Nutrition, metabolism, and cardiovascular diseases: NMCD 2015 ;25(1):116-22. https://doi.org/10.1016/j.numecd.2014.08.001
https://doi.org/10.1016/j.numecd.2014.08... More recently, the consumption of UPF was associated with higher nine-year incidence of overweight and obesity and hypertension in a Spanish cohort of middle-aged adult university graduates.⁴4. Mendonca RD, Lopes AC, Pimenta AM, Gea A, Martinez-Gonzalez MA, Bes-Rastrollo M. Ultra-processed food consumption and the incidence of hypertension in a mediterranean cohort: The Seguimiento Universidad de Navarra Project. Am J Hypertens. 2017;30(4):358-66. Although the mechanisms by which these foods are linked to weight gain and metabolic impairments still need to be fully determined, some explanations have been put forward.

Several studies show that UPF, as a group, are more fatty, sugary, salty and energy-dense than are all other food groups taken together, in Canada,⁵5. Moubarac JC, Batal M, Louzada ML, Martinez-Steele E, Monteiro CA. Consumption of ultra-processed foods predicts diet quality in Canada. Appetite. 2017 ;108:512-20. https://doi.org/10.1016/j.appet.2016.11.006
https://doi.org/10.1016/j.appet.2016.11.... the United States,⁶6. Martinez-Steele E, Baraldi LG, Louzada ML, Moubarac JC, Mozaffarian D, Monteiro CA. Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study. BMJ Open. 2016;6(3):e009892. https://doi.org/10.1136/bmjopen-2015 -009892
https://doi.org/10.1136/bmjopen-2015 -00... the UK,⁷7. Adams J, White M. Characterisation of UK diets according to degree of food processing and associations with socio-demographics and obesity: cross-sectional analysis of UK National Diet and Nutrition Survey (2008-12). Int J Behav Nutr Phys Act. 2015 ;12:160. https://doi.org/10.1186/s12966-015-0317-y
https://doi.org/10.1186/s12966-015-0317-... Brazil,⁸8. Costa-Louzada ML, Martins AP, Canella DS, Baraldi LG, Levy RB, Claro RM, et al. Ultra-processed foods and the nutritional dietary profile in Brazil. Rev Saude Publica. 2015 ; 49: 38.^,99. Baraldi LG, Martinez-Steele E, Canella DS, Monteiro CA. Consumption of ultra-processed foods and associated sociodemographic factors in the USA between 2007 and 2012: evidence from a nationally representative cross-sectional study. BMJ open 2018;8(3):e020574. https://doi.org/10.1136/bmjopen-2017 -020574
https://doi.org/10.1136/bmjopen-2017 -02... ^,1010. Martinez-Steele E, Raubenheimer D, Simpson SJ, Baraldi LG, Monteiro CA. Ultra-processed foods, protein leverage and energy intake in the USA. Public Health Nutr . 2018 ;21(1):114-24. https://doi.org/10.1017/S1368980017001574
https://doi.org/10.1017/S136898001700157... and in Chile.¹¹11. Crovetto MM, Uauy R, Martins AP, Moubarac JC, Monteiro C. [Household availability of ready-to-consume food and drink products in Chile: impact on nutritional quality of the diet]. Rev Med Chil. 2014;142(7):850-8. https://doi.org/10.4067/S0034-98872014000700005
https://doi.org/10.4067/S0034-9887201400... ^,1212. Cediel G, Reyes M, da Costa-Louzada ML, Martinez-Steele E, Monteiro CA, Corvalán C, Uauy R. Ultra-processed foods and added sugars in the Chilean diet (2010). Public Health Nutr . 2018 :21(1):125-133. https://doi.org/10.1017/S1368980017001161
https://doi.org/10.1017/S136898001700116... Additionally, UPF, have a high glycemic load, are often sold in large portion sizes, are formulated to be extremely palatable and habit-forming,¹³13. Brownell KD. Thinking forward: the quicksand of appeasing the food industry. PLoS Med. 2012;9(7):e1001254. https://doi.org/10.1371/journal.pmed.1001254
https://doi.org/10.1371/journal.pmed.100... and are aggressively advertised and marketed.¹⁴14. Moodie R, Stuckler D, Monteiro C, Sheron N, Neal B, Thamarangsi T, et al. Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. Lancet. 2013;381(9867):670-9. https://doi.org/10.1016/S0140-6736(12)62089-3
https://doi.org/10.1016/S0140-6736(12)62... Furthermore, they stimulate appetite,¹⁵15. Isganaitis E, Lustig RH. Fast food, central nervous system insulin resistance, and obesity. Arterioscler Thromb Vasc Biol. 2005;25(12):2451-62. https://doi.org/10.1161/01.ATV.000018 6208.06964.91
https://doi.org/10.1161/01.ATV.000018 62... and are more likely to be eaten mindlessly.¹⁶16. Ogden J, Coop N, Cousins C, Crump R, Field L, Hughes S, Woodger N. Distraction, the desire to eat and food intake. Towards an expanded model of mindless eating. Appetite . 2013;62:119-26. https://doi.org/10.1016/j.appet.2012.11.023
https://doi.org/10.1016/j.appet.2012.11.... Current evidence suggests that consumption of sweetened ultra-processed beverages such as soft drinks have less impact on satiety compared to solid food.¹⁷17. Almiron-Roig E, Palla L, Guest K, Ricchiuti C, Vint N, Jebb SA, Drewnowski A. Factors that determine energy compensation: a systematic review of preload studies. Nutr Rev. 2013;71(7):458-73. https://doi.org/10.1111/nure.12048
https://doi.org/10.1111/nure.12048... In contrast, minimally processed food have been found to be more satiating and less hyperglycemic.¹⁸18. Fardet A. Minimally processed foods are more satiating and less hyperglycemic than ultra-processed foods: a preliminary study with 98 ready-to-eat foods. Food Funct. 2016 ;7(5):2338-46. https://doi.org/10.1039/C6FO00107F
https://doi.org/10.1039/C6FO00107F...

UPF contribute to more than 50% of the daily energy intake in high-income countries such as the US,6 and Canada,⁵5. Moubarac JC, Batal M, Louzada ML, Martinez-Steele E, Monteiro CA. Consumption of ultra-processed foods predicts diet quality in Canada. Appetite. 2017 ;108:512-20. https://doi.org/10.1016/j.appet.2016.11.006
https://doi.org/10.1016/j.appet.2016.11.... while lower values are found in middle-income countries such as Brazil (21.5%),⁸8. Costa-Louzada ML, Martins AP, Canella DS, Baraldi LG, Levy RB, Claro RM, et al. Ultra-processed foods and the nutritional dietary profile in Brazil. Rev Saude Publica. 2015 ; 49: 38.Mexico (29.8%),¹⁹19. Marron-Ponce JA, Sanchez-Pimienta TG, Louzada M, Batis C. Energy contribution of NOVA food groups and sociodemographic determinants of ultra-processed food consumption in the Mexican population. Public Health Nutr . 2018 ;21(1):87-93. https://doi.org/10.1017/S1368980017002129
https://doi.org/10.1017/S136898001700212... and Chile (28.6%).¹²12. Cediel G, Reyes M, da Costa-Louzada ML, Martinez-Steele E, Monteiro CA, Corvalán C, Uauy R. Ultra-processed foods and added sugars in the Chilean diet (2010). Public Health Nutr . 2018 :21(1):125-133. https://doi.org/10.1017/S1368980017001161
https://doi.org/10.1017/S136898001700116... Given recent changes in market deregulation in Colombia and the introduction of a Trade Promotion Agreement (TPA) with the United States, greater access to UPF is expected in the near future.²⁰20. Bejarano-Roncancio J, Gamboa-Delgado EM, Aya-Baquero DH, Parra DC. Ultra-processed foods and beverages products entering Colombia through international trade agreements. Will they have an impact on the weight of colombians? Rev Chil Nutr. 2015 ;42(4):409-13. https://doi.org/10.4067/S0717-7518 2015 000400014
https://doi.org/10.4067/S0717-7518 2015 ... It is likely that traditional diets and cultural aspects related to eating habits will change, as has been the case in other Latin American countries.²¹21. Clark SE, Hawkes C, Murphy SM, Hansen-Kuhn KA, Wallinga D. Exporting obesity: US farm and trade policy and the transformation of the Mexican consumer food environment. Int J Occup Environ Health. 2012; 18(1):53-65. https://doi.org/10.1179/1077352512Z.0000000007
https://doi.org/https://doi.org/10.1179/... ^,2222. Hawkes C, Thow AM. Implications of the Central America-Dominican Republic-Free Trade Agreement for the nutrition transition in Central America. Rev Panam Salud Publica. 2008;24(5):345-60. https://doi.org/10.1590/S1020-49892008 001100007
https://doi.org/10.1590/S1020-49892008 0...

There have been few prior examinations of the consumption of UPF within a representative Colombian population. In order to address this gap, this study uses the NOVA classification system, to quantify the intake of UPF in the Colombian population. It also assesses the relationship between UPF and the nutrient profile of dietary intake in Colombia in 2005.

Materials and methods

Data source, population and sampling

This study uses data from the first National Nutrition Survey and the Demographic and Health National Survey of Colombia (known as ENDS in Spanish - Encuesta de Demografia y Salud), conducted between October 2004 and July 2005 by the Colombian Institute of Family Welfare (ICBF) and Profamilia. The Ethics committee from the respective organizations (Profamilia and ICBF) reviewed and approved the study methods and procedures. The survey used a stratified, multistage, cross-sectional design to obtain national and sub-regional representativeness (16 sub-regions), with oversampling of rural areas and low socioeconomic status (SES) groups. It included 99% of the urban and rural population with a response rate of 74%.²³23. Encuesta Nacional de la Situación Nutricional en Colombia. Bogotá D.C.: Instituto Colombiano de Bienestar Familiar (ICBF), 2005 .The sample size and sampling design were intended to provide proportion and prevalence estimates, and model associations.

A secondary data analysis was performed using information from men, women and children between the ages of 2 and 64 years who completed an interviewer-administered 24-hour recall. The 24-hour dietary recalls were distributed randomly within the week to include week and weekend days. Sixty plastic models and figures were used to help participants better estimate the amount, quantity and weight of the particular food consumed. The food models have been previously standardized.²⁴24. Manjarrés LM, Correa JM. Software de análisis de consumo de alimentos ECA1. Medellin, Colombia, 2004.Color photographs were used for the estimation of beverages. The interviewer registered the type of food, the name of the preparation, the ingredients and the amount consumed as informed by the respondent. The person responsible for preparing the food had to be present during the interview to answer any questions. If the food consumed by a child was at the school or daycare center, the interviewer, accompanied by a supervisor, visited the school to get detailed information on the preparation of the food. Quality control and supervision was done throughout the entire data collection process and the interview was repeated in the case of inconsistencies.²³23. Encuesta Nacional de la Situación Nutricional en Colombia. Bogotá D.C.: Instituto Colombiano de Bienestar Familiar (ICBF), 2005 .

Categorizing food consumption using the NOVA classification system

Food intake (1 053 food items) was first classified into one of four NOVA groups.²⁵25. Monteiro C, Cannon G, Levy RB, Claro RM, Moubarac JC. The Food System. The big issue [Position paper]. World Nutr. 2012;3(12):527-69. The groups - unprocessed or minimally processed food, processed culinary ingredients, processed food and UPF - are mutually exclusive and vary in their extent and purpose of processing. Food items were then further categorized into one of 31 subgroups (table I). In some cases, it was not possible to access detailed information for a typical culinary preparation, or to disaggregate these recipes into their constituent ingredients (e.g. ´buñuelos´, ´empanadas´, ´natilla´). Since the main ingredient in these recipes was a minimally processed food (group 1) and a processed culinary ingredient (group 2), these aggregated preparations were classified as ‘freshly prepared food’ and classified as a subgroup within unprocessed or minimally processed food (59 food items or 5.6% out of 1 053 total items).

Energy and nutrient intake was calculated for every food item and every respondent using a software developed by the School of Nutrition and Dietetics at the University of Antioquía, in Medellín, Colombia.²⁴24. Manjarrés LM, Correa JM. Software de análisis de consumo de alimentos ECA1. Medellin, Colombia, 2004.Total energy (kcal), energy density (kcal/g for solids only - excluding beverages like juice, milk and milk-based drinks, sugar sweetened drinks), total protein, carbohydrates, free sugars, fats, saturated fats, and fiber (g/1 000 kcal) were also estimated. Energy density was calculated by dividing the number of kilocalories of solid food (liquids were excluded) by the amount consumed, in grams (considered the weight as consumed i.e. cooked versus raw), for each food. The amount of free sugars in each of the 1 053 food items reported in the survey was not available in the Encuesta Nacional de la Situación Nutricional (ENSIN) data set, and was estimated by the authors based on the total sugar content of identical or similar food items found in the Colombia Nutritional Information Table,²⁴24. Manjarrés LM, Correa JM. Software de análisis de consumo de alimentos ECA1. Medellin, Colombia, 2004. the United States Department of Agriculture (USDA) food composition table,²⁶26. United States Department of Agriculture. USDA National nutrient database for standard reference, release 28 [internet]. USA, Government2016 . Available from: https://ndb.nal.usda.gov/ndb/2016
https://ndb.nal.usda.gov/ndb/2016 ... or from nutrition labels found in local supermarkets. Based on the Pan-American Health Organization (PAHO) Nutrient Profile Model, depending on the product, free sugars were equal to declared added sugars, declared total sugars (sugary drinks and confectionery), 75% of total sugars (granola bars) or 50% of total sugars (flavored milk and yogurt, fruit in syrup).²⁷27. Pan American Health Organization. Pan American Health Organization Nutrient Profile Model. Washington, DC: PAHO, 2016 .

Data management and analysis

The ENSIN data was merged with the demographic information contained in the ENDS data to link food consumption with individual level information on education, socioeconomic status, sex, age and place of residence. Responses with missing data on total energy, with extreme total energy intakes (<200 kcal and >5 000 kcal) and responses from pregnant women were excluded from the analysis. The final sample size included 38 643 individuals. The study population’s absolute and relative consumption of energy (% of total energy intake) was analyzed across the four NOVA groups and the 31 subgroups. Student’s t-tests were used to compare the average nutrient content of non-UPF (unprocessed/minimally processed food, processed culinary ingredients and processed food) and UPF, across individuals within the sample. The nutrient content was compared to recommended value ranges from the World Health Organization for free sugar intake, total fats, saturated fats, protein, and dietary fiber,²⁸28. World Health Organization. Effect of increased potassium intake on cardiovascular disease, coronary heart disease and strok. Geneva: WHO, 2012.^,2929. Pereira MA, O'Reilly E, Augustsson K, Fraser GE, Goldbourt U, Heitmann BL, et al. Dietary fiber and risk of coronary heart disease: a pooled analysis of cohort studies. Arch Intern Med. 2004;164(4):370-6. https://doi.org/10.1001/archinte.164.4.370
https://doi.org/10.1001/archinte.164.4.3... ^,3030. World Health Organization. Diet, nutrition, and the prevention of chronic diseases. Geneva: WHO , 2003.^,3131. World Health Organization. World Health Organization issues new guidance on dietary salt and potassium. Geneva: WHO^,3232. World Health Organization. Guideline: Sugars intake for adults and children. Geneva: WHO , 2015 . and from the World Cancer Research Foundation for energy density.³³33. World Cancer Research Foundation. Energy density: findings the balance for cancer prevention. London: WCRF, 2009.

Individuals were classified into quintiles based on the dietary contribution of UPF (% of total energy intake). The average content of each nutrient (protein, carbohydrates, free sugars, total fats, saturated fats, energy density, and dietary fiber) was assessed in the overall diet and compared across quintiles. Crude and adjusted standardized regression coefficients were used to identify the direction and the statistical significance of the association between quintiles of the dietary contribution of UPF and the content of nutrients. Adjusted analysis accounted for socioeconomic strata, place of residence, education, age and sex. The 2004-2005 ENDS sample weights were used in all analyses to account for differential probabilities of selection. All data analyses were performed STATA 14.

Results

The mean age of this Colombian sample was 26.5 years (±0.2 years). A majority of the sample was female (51.9%), of lower-middle socioeconomic status, with secondary education or higher (46.9%). Over 70% of the participants resided in urban areas (table II).

The average daily energy intake from all food and drinks was 1 835 kcal. Unprocessed or minimally processed food accounted for 63.3% of total energy intake, processed culinary ingredients contributed 15.8%, and processed food and UPF accounted for 4.9 and 15.9% respectively (table I). The contribution of culinary preparations to total energy intake, calculated by combing energy intakes from unprocessed or minimally processed food and processed culinary ingredients was 1 418 kcal or 79.1%. Within the unprocessed or minimally processed food category, the largest contributors to energy intake were plantains, roots and tubers (16.0%), followed by cereal grains and flours (14.2%). Freshly prepared food (preparations of primarily unprocessed food) accounted for 7.1% of the total energy, milk and yogurt contributed 5.5%, and red meat and fruits contributed 5.1 and 3.6% respectively.

Among the processed culinary ingredients, sugars were the largest contributor to total energy (8.9%), followed by vegetable oils (6.1%). In the processed food category, the largest contribution came from cheese (1.9%), followed by fresh bread and bakery products (1.7%). Within UPF, the largest contributor to total energy intake were industrial breads (5.0%), sugar-sweetened beverages (2.5%) and packaged sweet and savory snacks (2.5%). Sausages and reconstituted meat (1.3%), confectionery (1.5%) were some of the other subcategories of importance.

The average Colombian diet met WHO recommendations for protein (12.8% compared to the recommendation of 10-15%), carbohydrates (64.6%, compared to the recommendation of 55-75%), total fats (24.8%, compared to the recommendation of 15-30%), and saturated fats (8.6%, recommended value <10%) (table III). However, the fiber density of the average diet was below recommended levels (11.0 g/1 000 kcal compared to the recommendation of 12.5g/1000 kcal), while average energy density, and free sugars clearly exceeded the recommendations. Average values for energy density were 1.5 kcal/g (recommended range 1.25 g/kcal - 1.45 g/kcal), and 14.1% for free sugars (<10% is recommended).³²32. World Health Organization. Guideline: Sugars intake for adults and children. Geneva: WHO , 2015 .

Not surprisingly, the nutrient profile of non-ultra-processed items most closely aligned with recommended intake levels. UPF, however, did not meet recommendations for energy density, fiber density, protein, and free sugars. At 25.3%, the free sugar content of UPF was more than twice the recommended level. Between groups comparisons further highlighted the discrepancies in nutrient levels. The energy density of UPF was twice as much as that of non-UPF (3.1 vs 1.4 kcal/g), fiber density was nearly half (5.4 vs 11.9 g/1 000 kcal) and protein content was also much lower (8.8 vs 13.8%).

Significant differences were also found in the nutrient profile across quintiles of UPF consumption. Compared to the lowest quintile, the quintile with the highest intake UPF had substantially higher daily total energy intake (1 511 kcal vs 2 039 kcal), greater energy density and larger percentage contributions to total energy from free sugars, total fats, and saturated fats (table IV). There was a significant reduction in fiber density and percentage contribution to total energy from protein and carbohydrates from the lowest to the highest quintile. After adjusting for sociodemographic variables, a positive and statistically significant trend was found between quintiles of the dietary share of UPF and the dietary energy density (β: 0.24) and the content of free sugars (β: 0.14), total fats (β: 0.16), and saturated fats (β: 0.22). In contrast, a negative and statistically significant trend was observed for dietary content of carbohydrates (β: -0.19), protein (β: -0.07) and fiber (β: -0.26).

Discussion

In 2005, the Colombian diet was largely based on culinary preparations made of unprocessed or minimally processed food, culinary ingredients, and processed foods. Plantains and tubers and cereal grains were the largest sources of energy in the diet, with some important contributions from red meat and poultry. The overall dietary share of fresh or minimally processed foods in Colombia (63.3%) was much higher than in Chile (33.8%),¹²12. Cediel G, Reyes M, da Costa-Louzada ML, Martinez-Steele E, Monteiro CA, Corvalán C, Uauy R. Ultra-processed foods and added sugars in the Chilean diet (2010). Public Health Nutr . 2018 :21(1):125-133. https://doi.org/10.1017/S1368980017001161
https://doi.org/10.1017/S136898001700116... Canada (39.2%),⁵5. Moubarac JC, Batal M, Louzada ML, Martinez-Steele E, Monteiro CA. Consumption of ultra-processed foods predicts diet quality in Canada. Appetite. 2017 ;108:512-20. https://doi.org/10.1016/j.appet.2016.11.006
https://doi.org/10.1016/j.appet.2016.11.... and the US (29.6%),³⁴34. Martinez-Steele E, Popkin BM, Swinburn B, Monteiro CA. The share of ultra-processed foods and the overall nutritional quality of diets in the US: evidence from a nationally representative cross-sectional study. Popul Health Metr. 2017 ;15(1):6. https://doi.org/10.118 6/s12963-017-0119-3
https://doi.org/10.118 6/s12963-017-0119... and similar to Brazil (58%). However, the nutrient profile of the Colombian diet did not quite align with recommended consumption levels. For instance, while the proportion of energy from protein, carbohydrates, total and saturated fat was adequate, levels of free sugars, and energy density were at higher than recommended levels while fiber was less than recommended.

The Colombian diet composed of only non-UPF had a healthier nutrient profile than the UPF component. It had significantly healthier levels of protein, fiber, and energy density, and while free sugars intake was still higher than recommended levels, it was less than half of the levels seen in the UPF component. These results are similar to those found in a recent study within a representative sample of children (5-12 y) from low- to middle income families in Bogota.³⁵35. Cornwell B, Villamor E, Mora-Plazas M, Marin C, Monteiro CA, Baylin A. Processed and ultra-processed foods are associated with lower-quality nutrient profiles in children from Colombia. Public Health Nutr . 2018 ;21(1):142-7. https://doi.org/10.1017/S1368980017000891
https://doi.org/10.1017/S136898001700089... The authors found that processed and UPF had a less healthy nutrition profile compared to minimally processed foods; in particular, the processed and UPF were lower in essential vitamins and higher in sodium and trans-fats.

Industrialized breads, packaged snacks, sugar sweetened beverages and confectionery were the most commonly consumed categories of UPF in Colombia. Sugar sweetened beverages form a large proportion of UPF in other South American countries as well. In Brazil they are the third largest contributor of energy among UPF, preceded only by desserts and fast food,⁸8. Costa-Louzada ML, Martins AP, Canella DS, Baraldi LG, Levy RB, Claro RM, et al. Ultra-processed foods and the nutritional dietary profile in Brazil. Rev Saude Publica. 2015 ; 49: 38. while in Chile they are the primary contributor of energy.¹²12. Cediel G, Reyes M, da Costa-Louzada ML, Martinez-Steele E, Monteiro CA, Corvalán C, Uauy R. Ultra-processed foods and added sugars in the Chilean diet (2010). Public Health Nutr . 2018 :21(1):125-133. https://doi.org/10.1017/S1368980017001161
https://doi.org/10.1017/S136898001700116... Besides contributing to the overall energy intake, sugar sweetened beverages are also an important source of free sugars in the Colombian diet. Along with confectionary, and the use of table sugar in the preparation of coffee, fruit juices and desserts, they explain the high free sugars level of the Colombian diet. As demonstrated by the results of this study, participants in the first quintile of UPF intake, where calories from these foods represented 0.2% of total intake, still derived 12.4% of their total calories in the form of free sugars. Given the overwhelming evidence on the negative effects of sugar on human metabolic health, recommendations to avoid or limit UPF and to use sugar in moderation when preparing drinks, dishes meals, are essential in Colombia.

Beyond increasing free sugars content, a higher consumption of UPF seems to displace fiber-rich, minimally processed food. In our study, as the dietary share of UPF increased, the fiber density significantly decreased as the energy density, and the proportion of total fats and saturated fats of the diet increased. This macronutrient profile of UPF is also mirrored among diets in Brazil,¹1. Louzada ML, Baraldi LG, Steele EM, Martins AP, Canella DS, Moubarac JC, et al. Consumption of ultra-processed foods and obesity in Brazilian adolescents and adults. Prev Med. 2015;81:9-15. https://doi.org/10.1016/j.ypmed. 2015 .07.018
https://doi.org/10.1016/j.ypmed. 2015 .0... Canada,⁵5. Moubarac JC, Batal M, Louzada ML, Martinez-Steele E, Monteiro CA. Consumption of ultra-processed foods predicts diet quality in Canada. Appetite. 2017 ;108:512-20. https://doi.org/10.1016/j.appet.2016.11.006
https://doi.org/10.1016/j.appet.2016.11.... and the US,³⁴34. Martinez-Steele E, Popkin BM, Swinburn B, Monteiro CA. The share of ultra-processed foods and the overall nutritional quality of diets in the US: evidence from a nationally representative cross-sectional study. Popul Health Metr. 2017 ;15(1):6. https://doi.org/10.118 6/s12963-017-0119-3
https://doi.org/10.118 6/s12963-017-0119... suggesting that a higher dietary share of UPF lowers the overall nutritional diet quality.¹1. Louzada ML, Baraldi LG, Steele EM, Martins AP, Canella DS, Moubarac JC, et al. Consumption of ultra-processed foods and obesity in Brazilian adolescents and adults. Prev Med. 2015;81:9-15. https://doi.org/10.1016/j.ypmed. 2015 .07.018
https://doi.org/10.1016/j.ypmed. 2015 .0... The observed association between the increasing consumption of UPF and lowered diet quality is highly relevant given the negative effects of high energy density, high intake of free sugars, and saturated fats and low intake of fiber 29 on cardiovascular health, obesity and mortality.

Some limitations of this study should be highlighted. These include measurement errors, and the inability to obtain additional information from the respondents. The authors worked closely with the statisticians who developed the actual surveys and the sampling strategy to minimize any errors in the analysis of derived variables. In addition, misclassification of the food using NOVA was minimized by employing an iterative process with multiple expert consultations. In some cases, it was not possible to disaggregate certain culinary preparations into their constituent ingredients or precisely measure the free sugar content of food items (this was estimated using PAHO recommendations) which may have resulted in some loss of precise information. In addition, some typical culinary preparations which were impossible to disaggregate were mostly classified as unprocessed or minimally processed foods. As a result, the macronutrient content from these foods could have been overestimated since it was not possible for us to disaggregate into groups 1 and 2. The total contribution of this food group (culinary preparations) was 7.1% of the total energy in the diet. Future surveys should be designed to collect information on food processing to allow for the use of NOVA, as suggested by FAO.³⁶36. Food and Agriculture Organization of the United Nations. Guidelines on the collection of information on food processing through food consumption surveys. Rome: FAO, 2015 .Finally, data was used from the only available National Nutrition Survey that allowed for categorization of food intake collected using a 24-hour recall diary. Food intake data from the most recent nutrition surveys in Colombia use food frequency questionnaires, which make using the NOVA classification more challenging.

Conclusion

Ultra-processed foods have a less healthy nutrient profile than non-ultra-processed food. An increase in the consumption of these foods must be prevented within Colombia, which still sources mostly of its caloric consumption from unprocessed and minimally processed foods. These preventive measures may include marketing regulations, taxation, or labelling, similar to those under consideration in other Latin American countries. On the other hand, continued intake of unprocessed and minimally processed food must be incentivized along with raising consumer awareness of the benefits of eating freshly cooked food.

References

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