Processed and ultra-processed food consumption among children aged 13 to 35 months and associated factors

Batalha, Mônica Araujo; França, Ana Karina Teixeira da Cunha; Conceição, Sueli Ismael Oliveira da; Santos, Alcione Miranda dos; Silva, Francelena de Sousa; Padilha, Luana Lopes; Silva, Antônio Augusto Moura da

doi:10.1590/0102-311X00152016

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ARTICLE • Cad. Saúde Pública 33 (11) • Nov 2017 • https://doi.org/10.1590/0102-311X00152016 copy

Processed and ultra-processed food consumption among children aged 13 to 35 months and associated factors

Consumo de alimentos processados e ultraprocessados e fatores associados em crianças entre 13 e 35 meses de idade

Consumo de alimentos procesados y ultraprocesados y factores asociados en niños entre 13 y 35 meses de edad

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

The aim of this study was to evaluate the consumption of processed and ultra-processed foods among children aged 13-35 months and its associated factors. We studied 1,185 children within the BRISA cohort in São Luís, Maranhão State, Brazil. The food consumption was investigated using a 24-hour recall, and the percentages of daily caloric intake and nutrients were estimated by food groups according to “NOVA” classification. We chose to categorize children belonging to the upper tertile of the distribution as having a high consumption of processed and ultra-processed food products. The Poisson regression model with robust variance estimation using a hierarchical modeling approach was used to calculate the prevalence ratios (PRs) of variables associated with high consumption of processed and ultra-processed food products. The mean energy intake was 1,226Kcal/day. After adjustments, there was a higher proportion of high consumption of processed and ultra-processed food products among children whose mothers had < 12 years of education and among children who were older than 16 months. Mothers with low schooling and children older than 16 months should be the targets of interventions aimed at reducing consumption of these food products and preventing adverse health outcomes in later life.

Keywords:
Industrialized Foods; Food Consumption; Child; Socioeconomics Factors

Variables	n *	% **
Maternal
Age (years)
< 20	234	21.4
≥ 20 to 34	849	70.1
≥ 35	102	8.5
Education (years of school)
≤ 8	139	16.0
9-11	272	23.8
≥12	756	60.2
Marital status
Married	251	20.8
Consensual union	708	59.9
Without a partner	226	19.3
Remunerated activity
No	783	67.3
Yes	402	32.7
Parity
Primiparous	581	47.8
Multiparous	604	52.2
Alcohol consumption
No	919	77.9
Yes	252	22.1
Smoking
No	1128	95.9
Yes	44	4.1
Body mass index
Underweight	101	8.4
Normal weight	621	54.2
Overweight/Obese	442	37.4
Family
Socioeconomic class ***
A/B	221	20.3
C	696	53.7
D/E	268	26.0
Number of people residing in the house
1-3	595	48.5
4-5	368	31.6
> 5	222	19.9
Beneficiary of the Bolsa Família program (cash transfer)
No	822	68.6
Yes	362	31.4
Registered with the Family Health Strategy
No	935	78.5
Yes	248	21.5
Child
Gender
Female	578	48.8
Male	607	51.2
Age (months)
13 to ≤16	563	46.5
> 16 to ≤ 20	249	21.5
> 20 to 35	373	32.0
Child birthweight (g)
≤ 2,500	187	9.5
> 2,500 to 3,999	930	84.0
≥ 4,000	68	6.5
Introduction of solid and semi-solid foods (months)
≥ 6	977	82.1
< 6	208	17.9

Food groups	Kcal/day	Total energy intake (%)
Unprocessed or minimally processed foods and culinary preparations	910.1	74.2
Eggs	2.1	0.2
Coffee	4.1	0.3
Beans	9.0	0.7
Fish	19.7	1.6
Breast milk	20.5	1.7
Vegetables	22.2	1.8
Other cereals *	24.9	2.0
Roots and tubers	40.7	3.3
Poultry	54.5	4.4
Beef	66.8	5.6
Fruits and natural juices	87.4	7.1
Rice	91.0	7.4
Other foods and culinary preparations **	116.9	9.5
Cow’s milk	350.3	28.6
Processed foods	15.6	1.3
Salted meat	0.2	0.0
Cheese	0.2	0.0
Other ***	0.3	0.0
Bread	14.9	1.2
Ultra-processed foods	300.3	24.5
Reconstituted meat products (sausage, ham)	1.2	0.1
Fast food	2.6	0.2
Bakery products	8.2	0.7
Other ^#	9.2	0.7
Carbonated drinks and artificial fruit drinks	14.3	1.2
Dairy-sweetened beverages	15.9	1.3
Crackers and packaged snacks	17.9	1.5
Instant soups and noodles	23.1	1.9
Cookies (biscuits), pastries and cakes	28.7	2.3
Petit suisse cheese	45.2	3.7
Infant and child food products ^##	134.0	10.9
Total	1,226.0	100.0

	Total food consumption	Unprocessed or minimally processed foods	Processed and ultra-processed foods
Sodium (mg/day)
Absolute	1627.2	360.4	1266.8
%	100.0	22.2	77.8
Fiber (g/day)
Absolute	6.8	5.9	0.9
%	100.0	86.8	13.2
Contribution in total energy per group
Carbohydrate (%)	49.8	43.5	54.4
Protein (%)	19.5	28.2	13.1
Total fat (%)	30.8	28.3	32.5
Saturated fat (%)	10.3	9.3	10.9

Variables	Unadjusted			Adjusted
Variables	PR (95%CI)	p-value	PR (95%CI)	p-value
Level 1
Mother’s age (years)		0.07
< 20	1.66 (1.08-2.56)
20-34	1.54 (1.02-2.31)
≥ 35	1.00
Mother’s education (years of school)		< 0.01		0.03
≤ 8	1.37 (1.08-1.73)		1.31 (1.04-1.66)
9-11	1.25 (1.03-1.52)		1.22 (1.00-1.49)
> 12	1.00		11.00
Mother’s remunerated activity		0.12
No	1.00
Yes	0.87 (0.72-1.04)
Mother’s marital status		0.36
Married	1.00
Consensual union	1.17 (0.94-1.47)
Without a partner	1.09 (0.83-1.45)
Number of people residing in the house		0.05
1 to 3	0.79 (0.64-0.97)
4 to 5	0.79 (0.63-0.99)
> 5	1.00
Family socioeconomic class *		0.92
A/B	1.00
C	0.99 (0.79-1.24)
D/E	1.03 (0.80-1.34)
Child gender		0.98
Female	1.00
Male	1.00 (0.85-1.19)
Child’s age (in months)
13 to ≤ 16	1.00	< 0.01	1.00	< 0.01
> 16 to ≤ 20	1.42 (1.15-1.76)		1.37 (1.10-1.70)
> 20 to 35	1.32 (1.08-1.61)		1.30 (1.07-1.59)
Level 2
Registered with the Family Health Strategy
No	1.00	0.23
Yes	1.13 (0.92-1.37)
Beneficiary of the Bolsa Familia program (cash transfer)		0.83
No	1.00
Yes	0.98 (0.81-1.18)
Level 3
Parity		0.83
Primiparous	1.00
Multiparous	1.02 (0.86-1.21)
Maternal consumption of alcohol		0.09
No	1.00
Yes	1.21 (0.97-1.52)
Maternal smoking		0.43
No	1.00
Yes	1.18 (0.78-1.78)
Level 4
Child birthweight (g)		0.12
≤ 2,500	0.90 (0.70-1.16)
> 2,500 to < 4,000	1.00
≥ 4,000	1.31 (0.98-1.76)
Level 5
Introduction of solid and semi-solid foods (months)		0.07
≥ 6	1.00
< 6	1.21 (0.98-1.48)
Level 6
Mother’s body mass index		0.97
Underweight	1.03 (0.76-1.41)
Normal weight	1.00
Overweight/Obese	1.00 (0.84-1.20)

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[1] * Correspondence M. A. Batalha Programa de Pós-graduação em Saúde Coletiva, Universidade Federal do Maranhão. Av. Barão de Itapary 227, São Luís, MA 65020-070, Brasil. monicaabatalha@gmail.com