[This corrects the article DOI: 10.1016/j.eclinm.2025.103662.].

BACKGROUND:Prospective evidence on the association between ultra-processed food (UPF) consumption and type-2 diabetes, and the potential mediator role of body mass index (BMI), is lacking in Australia. OBJECTIVE:To investigate the association between UPF consumption and incident type-2 diabetes in Australian adults, and to further examine the mediating role of BMI in this association. DESIGN:Prospective study using the Melbourne Collaborative Cohort Study (MCCS) data. PARTICIPANTS:/Setting: Participants were recruited from the Melbourne metropolitan area between 1990-1994 (baseline), with follow-ups conducted in 1995-2002 and 2003-2007. A total of 25,214 participants aged 40-69 years, without diabetes at baseline, and who provided baseline dietary and follow-up diabetes data were included. MAIN OUTCOME MEASURES:Incidence of type-2 diabetes was assessed at follow-up 1 (self-report) and follow-up 2 (self-report, elevated plasma glucose (≥ 126 mg/dL fasting or ≥ 200 mg/dL non-fasting), or medication use). STATISTICAL ANALYSES PERFORMED:Adjusted Poisson regression models estimated Incidence Rate Ratios (IRRs) and 95% confidence intervals (CIs) for the risk of type-2 diabetes per 10% increase and by quartiles of UPF consumption (% total grams/day), using age as the time metric. Regression-based mediation analyses were employed to assess the mediation role of BMI. RESULTS:During follow-up (mean: 11.6 ± 1.7 years), 1,734 cases of type-2 diabetes occurred. The direct association between each 10% increase in UPF consumption and type-2 diabetes was statistically significant (IRR: 1.16; 95%CI: 1.11, 1.21), yet spline analyses indicated evidence of non-linearity. Participants in the highest quartile of UPF consumption had a 40% higher risk of type-2 diabetes (IRRhighxlow category = 1.40, 95%CI: 1.22, 1.60; p<0.001). BMI significantly mediated 18% of the association. CONCLUSIONS:In this large cohort of Australian adults, higher UPF consumption was associated with an increased risk of type-2 diabetes, with BMI as an important mediator.

Background:Body Mass Index (BMI) and waist circumference (WC) gain are key risk factors for cardiometabolic disease and mortality. Although plant-based diets are often promoted for health and sustainability, the rising inclusion of ultra-processed foods (UPF) within these diets raises concerns. This study assessed the associations of food origin (plant vs. animal) and processing level (UPF vs. non-UPF) with BMI and WC increase in a prospective cohort. Methods:A total of 17,374 participants aged 40-69 years from the UK Biobank cohort study were included. Dietary data were collected between 2009 and 2012, and follow-up assessments were conducted between 2012 and 2019. Dietary intake was assessed using a minimum of two and a maximum of five repeated 24-h dietary recalls. Foods were classified by plant or animal origin and processing level using the Nova system. Outcomes were defined separately for BMI and WC as increases of ≥5% and ≥10% from baseline to follow-up. Cox proportional hazards models were applied. Findings:During a mean follow-up of 5.3 years, 2477 cases of ≥5% BMI increase and 4567 of ≥5% WC increase were observed. A 10% higher energy intake from plant-sourced non-UPF was associated with 11% lower hazard of ≥5% BMI increase (HR 0.89, 95% CI 0.85-0.92) and 10% lower hazard of ≥5% WC increase (HR 0.90, 95% CI 0.88-0.93). A 10% higher intake of plant-sourced UPF was linked to increased risk of both BMI and WC increase (HR 1.10 and 1.09, respectively). Substitution analyses indicated that a higher contribution of plant-sourced non-UPF, at the expense of UPF (plant or animal), was consistently associated with a lower risk of study outcomes. Interpretation:Our findings highlight the importance of considering food origin alongside processing, showing that plant-sourced non-UPF may confer protective effects, whereas plant-sourced UPF contribute to adverse weight outcomes. Future research is needed to clarify the behavioural and biological mechanisms behind these findings. Funding:This research received funding from World Cancer Research Fund (WCRF UK), as part of the World Cancer Research Fund International grant programme.

Emerging evidence links consumption of ultra-processed foods (UPF) to higher risks of non-communicable diseases and mortality, but the underlying mechanisms remain unclear. This study aimed to identify molecular signatures of UPF intake in participants from the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Foods were classified into four groups using the Nova system, including UPF. The analysis included 6,177 participants with data on 129 endogenous metabolites and 9,029 with data on 37 plasma fatty acids (FAs) from EPIC nested case-control studies. Concentrations were normalized across batches and centers. UPF intake (grams/day) was linked to metabolite and FA profiles using linear and LASSO regression models, adjusted for demographic, lifestyle, and dietary factors. UPF intake was associated with 22 circulating metabolites and eight plasma FAs. Most metabolite associations were inverse, particularly for compounds involved in energy (e.g., asparagine) and lipid metabolism (e.g., propionyl carnitine, glycerophospholipids, and sphingomyelins). FA profiles showed positive associations with industrial trans fats (e.g., elaidic acid), long-chain saturated FAs (e.g., stearic acid), and n-6 polyunsaturated FAs (e.g., dihomo-γ-linolenic acid). UPF consumption is associated with distinct metabolic and fatty acid profiles, providing insights into potential biological pathways linking UPF to adverse health outcomes.

IntroductionEvidence on the effects of low- and no-calorie sweetened (LCS) product consumption on overall dietary patterns remains limited, despite their frequent promotion as healthier alternatives. This study assessed the association between LCS product consumption and both the levels and temporal trends in free sugar intake and overall dietary patterns among UK adults.MethodsAnnual cross-sectional data from the National Diet and Nutrition Survey (NDNS) from 2008/09 to 2018/19 were analyzed. Adults aged ≥18 years (N = 8,304) were categorized into four levels of LCS product consumption: non-consumers (No-LCS) and three tertiles of consumers (Low-LCS: ≤75.0 g/day, Mid-LCS: >75.0–216.8 g/day, and High-LCS: >216.8 g/day), as measured by four-day food diaries. The associations between LCS product consumption and intakes of free sugar, energy, and minimally processed and ultra-processed foods as determined by the Nova classification were analyzed using multivariable linear regression, adjusted for sociodemographic factors.ResultsIn 2008/09, 45.9% of participants consumed LCS products, and this proportion remained stable over the 11-year period. Among LCS product consumers, the median LCS product intake increased significantly from 132.0 g/d in 2008/09 to 170.0 g/d in 2018/19. In the No-LCS group, free sugar and energy intakes decreased by −1.0 g/d (95% CI, −1.4 to −0.6) and −6.7 kcal/d (95% CI, −11.4 to −2.1) per year, respectively, with similar declines observed for the High-LCS group. In 2008/09, the mean water and minimally processed food consumption was lower in the High-LCS than the No-LCS group, by −141.2 g/d (95% CI, −203.8 to −78.6) and −306.3 g/d (95% CI, −359.5 to −216.7), respectively, and this difference persisted throughout the study period.DiscussionLCS consumption does not appear to align with potentially beneficial dietary patterns regarding free sugar, ultra-processed food and beverage, and minimally processed food and beverage intakes. These findings underline the importance of policies to consider overall dietary patterns that also address LCS consumption alongside reducing free sugar intake.

BACKGROUND & AIMS:Emerging evidence suggests an association between ultra-processed food (UPF) consumption and neurodegenerative diseases, but there is limited evidence for multiple sclerosis (MS). Diets rich in UPFs promote inflammation and oxidative stress that both play an important role in modulating the immune system, and thereby, potentially the pathogenesis of MS. This study aimed to investigate the longitudinal association between UPF consumption and MS onset in middle-aged and older adults. METHODS:The study included 185,788 adults who completed at least one valid dietary assessment and did not have MS at baseline (2009-2012). Dietary data was collected at 5 time points using a web-based 24-h dietary recall, and UPFs were categorised using the Nova food classification system. MS cases were identified based on medical history and linkage to data on hospital admissions (using ICD-coded diagnoses ICD10-g35; ICD9-3409), and self-reported MS diagnosis. Prospective associations between UPF consumption (as a percentage of total food intake in grams per day) and risk of MS onset were assessed using multivariable Cox proportional hazards models were adjusted for age, sex, ethnicity, education, Townsend deprivation index, smoking status, total energy intake and serum 25-hydroxyvitamin D. RESULTS:Participants had a mean age of 56.0 years (SD 8.0) and 54% were female. UPFs comprised 19.1% of total dietary grams intake, with carbonated drinks, ready-to- eat/heat meals and industrial-processed breads being the most consumed UPF subgroups. Over a mean follow-up of 8.9 years (SD: 2.7), 384 incident MS cases occurred. Each 10% increase in UPF consumption was associated with an estimated 9% increase in risk of MS (HR 1.09; 95% CI: 1.003 to 1.19; p-value = 0.04). CONCLUSION:This study found a weak yet significant association between higher UPF consumption and increased risk of MS in middle-aged and older adults. Given the modest effect size and inconsistency of statistical significance across sensitivity analyses, these findings should be interpreted with caution. Research to confirm these findings in other population groups and contexts is needed.

Regulatory measures on the sale of food at schools can influence consumption by students. The aims of the present cross-sectional study were to determine whether attending schools with norms that regulate the sale of food is associated with the consumption of ultra-processed foods by students in Brazilian state capitals and investigate the association between the availability and consumption of ultra-processed foods in school cafeterias. A systematic survey was performed of Brazilian norms in force up to 2019 that regulate the sale of food and beverages in school cafeterias. In terms of regulatory coverage, schools were categorized as covered/not covered. The availability and consumption of ultra-processed foods were assessed using data from the 2019 Brazilian National Survey of School Health. Multilevel linear regression analyses were adjusted by sociodemographic variables and school characteristics to test the association between regulatory coverage and the consumption of ultra-processed foods by students (n = 81,362). A second analysis restricted to students at schools with cafeterias (n = 53,137) investigated the association between the availability and consumption of these foods. Attending schools with regulatory coverage on the sale of food and beverages was associated with a reduction of -0.10 points (95%CI: -0.16; -0.03) in the consumption score of ultra-processed foods by students in Brazilian capital cities, whereas the availability of ultra-processed foods in school cafeterias was associated with an increase of 0.02 points (95%CI: 0.00; 0.03) in the consumption score in the adjusted analyses. These findings can assist in the establishment of a national Law on the offer of ultra-processed foods at schools.

Medidas regulatórias sobre a venda de alimentos nas escolas podem influenciar o consumo alimentar dos estudantes. Este estudo transversal teve como objetivos: investigar se frequentar escolas cobertas por normas que regulamentam a venda de alimentos está associado ao consumo de ultraprocessados por estudantes de capitais brasileiras; e verificar se há associação entre a disponibilidade de ultraprocessados em cantinas escolares e seu consumo. Foi realizado um levantamento sistemático de normas brasileiras vigentes até 2019 que regulamentam a venda de alimentos e bebidas em cantinas escolares. A cobertura normativa das escolas foi avaliada por uma variável dicotômica (cobertas/não cobertas). A disponibilidade e o consumo de ultraprocessados foram avaliados por meio de escores com dados da Pesquisa Nacional de Saúde do Escolar de 2019. Foram realizadas análises de regressão linear multinível, ajustadas por variáveis sociodemográficas e características das escolas, para avaliar associação entre a cobertura normativa das escolas e o consumo de ultraprocessados pelos estudantes (n = 81.362). Uma segunda análise, restrita a alunos de escolas com cantinas (n = 53.137), avaliou a associação entre a disponibilidade desses alimentos e seu consumo. Frequentar escolas com cobertura normativa sobre a venda de alimentos e bebidas esteve associado a uma redução de -0,10 (IC95%: -0,16; -0,03) pontos no escore de consumo de ultraprocessados por estudantes de capitais brasileiras, enquanto a disponibilidade de ultraprocessados nas cantinas escolares foi associada ao aumento de 0,02 (IC95%: 0,00; 0,03) pontos no escore de consumo, nas análises ajustadas. Os achados podem fundamentar uma lei nacional sobre a oferta de ultraprocessados nas escolas.

Little is known about the association between low- and no-calorie sweetened (LCS) product consumption and children’s dietary quality, despite the promotion of these products as sugar alternatives. This study examines the trends and associations between LCS product consumption and intakes of free sugar, ultra-processed food and beverages (UPFB), and other key dietary components among UK children. Repeated annual cross-sectional data from the National Diet and Nutrition Survey (2008/09-2018/19) for children aged 4–18 years (N = 5,922) were analysed. Children were categorized into No-LCS (0

Background:Diet may modify colorectal cancer risk. We investigated the associations of three dietary patterns, ultra-processed food (UPF) consumption, healthy plant-based food consumption, and food biodiversity, separately and combined into a "3V" score with risk of colorectal cancer. Methods:This study used data from the prospective European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, which recruited participants between 1992, and 2000, from 23 centres in ten European countries. The 3V score was developed by standardising and summing the healthy plant diet index (hPDI) and dietary species richness per year (DSR) and subtracting UPF (Nova category 4) intake in % g/day. Associations with colorectal cancer risk were assessed among 450,111 middle-aged participants of the EPIC cohort using multivariable-adjusted Cox regression models. Independent associations of each 3V component were assessed using mutually adjusted models. Data-driven thresholds were applied to assess adherence to the 3V components, set at the minimum value of the fourth quintile for hPDI, DSR and low UPF. Findings:During mean (standard deviation (SD)) follow-up of 14.9 (4) years, absolute colorectal cancer rates were 8.59 and 10.37 cases/10,000 person-years for the highest and lowest quintiles of the 3V score, respectively. Inverse associations were found for colorectal (hazard ratio (HR) comparing highest vs lowest quintile: 0.84; 95% confidence interval (CI): 0.76-0.94), colon (HR: 0.82; 95% CI: 0.72-0.93), and distal colon cancer (HR: 0.81; 95% CI: 0.67-0.99), with significant linear trends observed across quintiles. UPF intake was positively associated with colon cancer risk (HR per 1 SD increment: 1.06; 95% CI: 1.02-1.11) when mutually adjusted for the other 3V components. Adherence to low UPF, high hPDI, and high DSR was inversely associated with colorectal (HR: 0.73; 95% CI: 0.61-0.88), colon (HR: 0.72; 95% CI: 0.57-0.91), and rectal cancer (HR: 0.65; 95% CI: 0.46-0.91) compared to adhering to none. Interpretation:Adherence to the 3V diet is associated with lower risk of colorectal cancers. Funding:Cancer Research UK, World Cancer Research Fund.

OBJECTIVE:To describe the food categorization method of the 2017-2018 Household Budget Survey as per the Nova classification, bringing transparency and replicability to the process of monitoring adherence to the recommendations of the Dietary Guidelines for the Brazilian Population. METHODS:The foods reported in the Survey were classified in four stages, namely: identification of culinary preparations and items composed of more than one food; determination of the recipe for culinary preparations and items to be disaggregated; application of the Nova classification; sensitivity analysis. RESULTS:After disaggregation, 1,856 items were classified according to the Nova classification, consisting of 1,050 unprocessed or minimally processed foods, 54 processed culinary ingredients, 160 processed foods and 592 ultra-processed foods. Foods whose classification raised questions during the accounted for 4% of the total dietary energy. The contribution of ultra-processed food to total caloric intake varied from 19.7% (95% confidence interval [95%CI] 19.3; 20.1) to 17.7% (95%CI 17.4; 18.1) after conducting sensitivity analysis. CONCLUSION:Using a standardized method to apply the Nova classification to the Household Budget Survey was effective and led to estimates whose uncertainties minimally affected the overall results. The methodology presented can be replicated in future editions of the Household Budget Survey and other food consumption studies, strengthening food and nutritional surveillance as applied to the Dietary Guidelines.

OBJECTIVE:To describe the development and validation of the Nova FFQ (NovaFFQ) for Brazilian adults. DESIGN:The NovaFFQ is a self-administered, semi-quantitative questionnaire. The food list includes the most consumed foods and drinks based on 2017-2018 National Food Intake Survey data. We identified and differentiated foods that could be classified into multiple Nova groups. We assessed reproducibility and criterion validity using the percent energy contribution of each Nova group. Reproducibility was assessed by comparing NovaFFQ estimates on two occasions. Criterion validity was assessed by comparing the first NovaFFQ estimate against the mean of two Nova24h recalls. We estimated the intraclass correlation coefficients (ICC) for both analyses and assessed the agreement of classification into quintiles using the prevalence-and-bias-adjusted kappa coefficients for criterion validity analysis. SETTING:Nationwide Brazilian study, the NutriNet-Brasil cohort. PARTICIPANTS:There were 243 participants in the reproducibility analysis and 376 in the criterion validity analysis. RESULTS:Strong reproducibility was observed, with an ICC of 0·91 for all the Nova groups. Criterion validity showed a moderate ICC, ranging from 0·61 for processed and ultra-processed foods (UPF) to 0·65 for unprocessed and minimally processed foods. Substantial agreement in ranking individuals across quintiles was found, as indicated by the prevalence-and-bias-adjusted kappa (PABAK = 0·74, 0·72, 0·70 and 0·73 for unprocessed and minimally processed foods, culinary ingredients and processed and ultra-processed foods, respectively). CONCLUSIONS:The NovaFFQ is a valid instrument for assessing food consumption by processing level, especially for discriminating individuals according to the magnitude of consumption in all Nova groups.

BACKGROUND:The distribution of energy intake and types of food consumed throughout the day may influence health. OBJECTIVE:This study investigated the association of energy intake and ultra-processed food (UPF) consumption in the morning, at midday, and in the evening with indicators of obesity. DESIGN:A pooled cross-sectional analysis of the National Diet and Nutrition Survey (2008-2019) of adults residing in England, Wales, Scotland, and Northern Ireland was conducted. Food consumption was assessed using 4-day food diaries. UPFs intake was assessed based on the Nova food classification. The 3 time periods were classified as morning (5:00 am to 10:59 am), midday (11:00 am to 4:59 pm), and evening (5:00 pm to 4:59 am). PARTICIPANTS/SETTING:This study included 5749 adults aged 19 to 64 years residing in private households in the United Kingdom. MAIN OUTCOME MEASURES:The main outcome measures were overweight, obesity, and abdominal obesity. Body mass index (calculated as kg / m2) values ≥25 and ≥30 were used to classify overweight (including obesity) and obesity, respectively. Abdominal obesity was defined as a waist circumference ≥102 cm for men and ≥88 cm for women. STATISTICAL ANALYSES PERFORMED:Multivariable logistic regression assessed the associations between the percentage of energy intake and the percentage of energy intake from UPFs in the morning, at midday, and in the evening, and indicators of obesity. Models were adjusted for sociodemographic variables (ie, sex, age, ethnicity, region, year of the survey, and social class occupation), behavioral variables (ie, physical activity, smoking status, frequency of alcohol consumption, sleep duration, and weight-loss diet), and variables related to food consumption. RESULTS:The highest percentage of energy intake in the morning (third tertile) was associated with a 19% reduction in the odds of being overweight (95% CI, 0.68 to 0.96), and the highest percentage in the evening was associated with a 21% higher odds of being overweight (95% CI, 1.01 to 1.44). A 10% increase in the percentage of energy intake from UPFs at midday and in the evening was associated with an 11% (95% CI, 1.02 to 1.20) and 10% (95% CI, 1.02 to 1.18) higher odds of overweight, respectively. The highest percentage of energy intake from UPFs in the morning, at midday, and in the evening (third tertile) was associated with a 26%, 25%, and 45% higher odds of obesity, respectively. A 10% increase in the percentage of energy intake from UPFs in the evening was associated with a 12% (95% CI, 1.03 to 1.22) higher odds of abdominal obesity. CONCLUSIONS:The timing of energy intake was associated with overweight, and higher consumption of UPFs at all times of day was associated with obesity. The strength of the association between UPFs consumption and indicators of obesity was greater in the evening compared with the morning and midday.

INTRODUCTION:Ultraprocessed foods are becoming dominant in the global food supply. Prospective cohort studies have consistently found an association between high consumption of ultraprocessed foods and increased risk of several noncommunicable diseases and all-cause mortality. The study aimed to (1) estimate the risk of all-cause mortality for ultraprocessed foods consumption and (2) estimate the attributable epidemiologic burden of ultraprocessed food consumption in 8 select countries. METHODS:First, a dose-response meta-analysis of observational cohort studies was performed to assess the association between ultraprocessed food consumption and all-cause mortality and estimated the pooled RR for all-cause mortality per each 10% increment in the percentage ultraprocessed food. Then, the population attributable fractions for premature all-cause mortality attributable to the ultraprocessed foods in consumption were estimated in 8 select countries with relatively low (Colombia and Brazil), intermediate (Chile and Mexico), and high (Australia, Canada, United Kingdom, and the U.S.) ultraprocessed food consumption. Analysis was conducted in November 2023-July 2024. RESULTS:The meta-analysis showed a linear dose-response association between the ultraprocessed food consumption and all-cause mortality (RR for each 10% increase in percentage ultraprocessed food=1.03; 95% CI=1.02, 1.04). Considering the magnitude of the association between ultraprocessed foods intake and all-cause mortality and the ultraprocessed food dietary share number (percentage ultraprocessed food) in each of the 8 selected countries, estimations varied from 4% (Colombia) to 14% (United Kingdom and U.S.) of premature deaths attributable to ultraprocessed food intake. CONCLUSIONS:The findings support that ultraprocessed food intake contributes significantly to the overall burden of disease in many countries, and its reduction should be included in national dietary guideline recommendations and addressed in public policies.

Industrial food processing has been linked to various health outcomes including cancer. To examine associations between the degree of food processing and risk of colorectal cancer (CRC) and its sub-sites, data from the European Prospective Investigation into Cancer (EPIC) including 6155 incident CRC cases (n = 450,111 participants), were analyzed. Dietary intakes were assessed using baseline food frequency questionnaires. Foods were classified into culinary ingredients, unprocessed, processed (PFs), and ultra-processed foods (UPFs) according to the Nova classification. Cox proportional hazards models, adjusted for established CRC risk factors, were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) associated with a 10% increase in proportion of consumption (%g/d) of each Nova group. Substitution analysis examined the effect of replacing UPFs and PFs with unprocessed foods on CRC risk. A 10% increase in proportion of UPFs was associated with 6% higher CRC risk (95% CI:1.02-1.10). A positive association was also found between PFs and CRC risk (HR per 10% increase: 1.10 [95% CI, 1.05-1.15]). Conversely, unprocessed food consumption was inversely associated with CRC risk (HR per 10% increase: 0.93[95% CI, 0.90-0.95]). Substitution of 10% of the overall proportion of the diet comprising UPFs or PFs with 10% unprocessed foods was associated with a decreased risk of CRC (HRUPFs: 0.94 [95% CI, 0.90-0.97]; HRPFs: 0.90 [95% CI, 0.86-0.94]). In conclusion, UPF was positively associated with CRC risk while diets richer in unprocessed foods were associated with lower CRC risk. Further studies are needed to understand the mechanisms by which food processing affects CRC risk.

Purpose Non-communicable diseases (NCDs), such as diabetes, cardiovascular diseases and cancer, are major global public health concerns. Diet quality—particularly the consumption of ultra-processed foods—has been associated with increased risk of NCDs. Traditional cohort studies are often expensive and logistically complex. The NutriNet-Brasil cohort leverages a web-based approach, offering a cost-effective and practical solution for comprehensive data collection and long-term follow-up.Participants Recruitments began in January 2020 through mass media, social media campaigns and collaborations with health organisations. Eligible participants are adults (aged ≥18 years) living in Brazil with internet access. Participants complete self-administered online questionnaires covering dietary intake, health status and other health determinants. Dietary assessment is based on the Nova classification system, which categorises foods by their level of processing.Findings to date Over 88 000 participants have completed the initial questionnaire. The cohort is predominantly women (79.9%) and highly educated (67.9% had completed higher education). The web-based design enabled the development and application of innovative dietary assessment tools, including the Nova24h and the Nova24hScreener, specifically designed to evaluate food processing levels. These tools have shown good performance in capturing dietary patterns and are central to the cohort’s aim. The online platform facilitates efficient recruitment, data collection and participant retention.Future plans NutriNet-Brasil is pioneering the development of web-based cohort methodologies and instruments tailored to food processing research. Future work includes leveraging collaborations with national and international research centres to conduct multidisciplinary analyses and inform public health policies.

Background Ultra-processed food (UPF) consumption has been linked with higher risk of mortality. This multi-centre study investigated associations between food intake by degree of processing, using the Nova classification, and all-cause and cause-specific mortality. Methods This study analyzed data from the European Prospective Investigation into Cancer and Nutrition. All-cause mortality and cause-specific mortality due to cancer, circulatory diseases, digestive diseases, Parkinson’s disease, and Alzheimer’s disease served as endpoints. Hazard ratios (HRs) and 95% CIs were estimated using multivariable Cox proportional hazards regression models. Substitution analyses were also performed. Findings Overall, 428,728 (71.7% female) participants were included in the analysis and 40,016 deaths were documented after 15.9 years of follow-up. UPFs (in percentage grams per day [g/d]) were positively associated with all-cause mortality (HRs per 1-SD: 1.04; 95% CI: 1.02,1.05), as well as mortality from circulatory diseases (1.09; 95% CI: 1.07,1.12), cerebrovascular disease (1.11; 95% CI: 1.05,1.17), ischemic heart disease (1.10; 95% CI: 1.06,1.15), digestive diseases (1.12; 95% CI: 1.05,1.20), and Parkinson’s disease (1.23; 95% CI: 1.06,1.42). No associations were found between UPFs and mortality from cancer or Alzheimer’s disease. Replacing processed and UPFs with unprocessed/minimally processed foods was associated with lower mortality risk. Interpretation In this pan-European analysis, higher UPF consumption was associated with greater mortality from circulatory diseases, digestive diseases, and Parkinson’s disease. The results support growing evidence that higher consumption of UPFs and lower consumption of unprocessed foods may have a negative impact on health. Funding l’Institut National du Cancer, and World Cancer Research Fund International.

Resumo Objetivo Descrever o método de categorização dos alimentos da Pesquisa de Orçamentos Familiares 2017-2018 conforme a classificação Nova, trazendo transparência e replicabilidade ao processo de monitoramento da adesão às recomendações do Guia Alimentar para a População Brasileira. Métodos Tratou-se de classificação dos alimentos reportados na pesquisa em quatro fases. Foram elas: identificação das preparações culinárias e itens compostos por mais de um alimento, determinação do receituário das preparações culinárias e dos itens a serem desagregados, aplicação da classificação Nova e análise de sensibilidade. Resultados Após a desagregação, 1.856 itens foram classificados segundo a classificação Nova, sendo 1.050 alimentos in natura ou minimamente processados, 54 ingredientes culinários processados, 160 alimentos processados e 592 alimentos ultraprocessados. Alimentos cuja classificação gerou dúvidas representaram 4% da energia da dieta. A participação calórica de ultraprocessados variou de 19,7% (intervalo de confiança de 95% [IC95%] 19,3; 20,1) para 17,7% (IC95% 17,4; 18,1) após análise de sensibilidade. Conclusão O uso de método padronizado para aplicar a classificação Nova à Pesquisa de Orçamentos Familiares foi efetivo e levou a estimativas cujas dúvidas impactaram minimamente o resultado. A metodologia apresentada pode ser replicada em futuras edições da pesquisa e demais estudos de consumo alimentar, fortalecendo a vigilância alimentar e nutricional aplicada ao guia alimentar.

Objective: This study evaluated the independent and combined environmental impacts of the consumption of beef and ultra-processed foods in Brazil. Design: Cross-sectional study. Setting: Brazil. Participants: We used food purchases data from a national household budget survey conducted between July 2017 and July 2018, representing all Brazilian households. Food purchases were converted into energy, carbon footprints and water footprints. Multiple linear regression models were used to assess the association between quintiles of beef and ultra-processed foods in total energy purchases and the environmental footprints, controlling for sociodemographic variables. Results: Both beef and ultra-processed foods had a significant linear association with carbon and water footprints ( P < 0·01) in crude and adjusted models. In the crude upper quintile of beef purchases, carbon and water footprints were 47·7 % and 30·8 % higher, respectively, compared to the lower quintile. The upper quintile of ultra-processed food purchases showed carbon and water footprints 14·4 % and 22·8 % higher, respectively, than the lower quintile. The greatest reduction in environmental footprints would occur when both beef and ultra-processed food purchases are decreased, resulting in a 21·1 % reduction in carbon footprint and a 20·0 % reduction in water footprint. Conclusions: Although the environmental footprints associated with beef consumption are higher, dietary patterns with lower consumption of beef and ultra-processed foods combined showed the greatest reduction in carbon and water footprints in Brazil. The high consumption of beef and ultra-processed foods is harmful to human health, as well as to the environment; thus, their reduction is beneficial to both.