Higher consumption of ultra-processed foods and a pro-inflammatory diet are associated with the normal-weight obesity phenotype in Brazilian children

Objectives: The aim of this study was to evaluate the relationship of ultra-processed food (UPF) consumption and the Children's Dietary Inflammatory Index (C-DII) with the normal-weight obesity (NWO) phenotype in school-aged children. Methods: This cross-sectional study was carried out with a representative sample of 364 children ages 8 to 9 y in Vi,cosa, Minas Gerais, Brazil. The NWO phenotype was defined as normal weight according to body mass index and high body fat, assessed by dual-energy x-ray absorptiometry. Three 24-h dietary recalls were performed to evaluate NOVA classification groups and to calculate the C-DII score. Results: Among normal-weight children (NWO and "no NWO"), higher consumption of UPF (second tercile [T2]: prevalence ratio [PR], 1.9; 95% confidence interval [CI], 1.1-3.4; T3: PR, 1.8; 95% CI, 1.01-3.1) and a diet consisting of high proinflammatory foods (T2: PR, 1.7; 95% CI, 1.04,2.8) were associated with a higher prevalence of NWO, in relation to the first tercile. Similarly, among children with excess body fat independent of body mass index (NWO and excess of weight), higher consumption of UPF was associated with a higher prevalence of NWO (T2: PR, 2; 95% CI, 1.2-3.3) in relation to T1. Conclusion: Higher UPF consumption and a diet consisting of high proinflammatory foods were associated with the NWO phenotype in children.