| Louzada et al.99 Louzada M.L., Baraldi L.G., Steele E.M., Martins A.P., Canella D.S., Moubarac J.C., et al. Consumption of ultra-processed foods and obesity in Brazilian adolescents and adults. Prev Med. 2015;81:9-15. (2015) |
Cross-sectional |
7534 Brazilian individuals aged 10-19 years in 2008/2009. |
To evaluate the relationship between the consumption of ultraprocessed foods and obesity indicators in Brazilian adults and adolescents. |
Adolescents in the highest quintile of ultraprocessed food consumption had a higher mean BMI (adjusted coefficient: 0.84; 95 % CI: −0.16; 1.85) and a higher chance of having excess weight (adjusted OR = 1.52; 95 % CI: 0.75; 3.07) and obesity (adjusted OR = 2.74; 95 % CI: 0.78; 9.60) when compared to those in the lowest quintile. |
The findings support the role of ultra-processed foods in the obesity epidemic in Brazil. |
| Araújo et al.1010 Araujo D.A., de Carvalho R.B., de Oliveira A.S., Oliveira E.A., Machado A.L., Lima L.H. Temporal trend of simultaneous risk factors for chronic non-communicable diseases: national School Health Survey 2009, 2012, 2015. Rev Bras Epidemiol. 2022;25:e220013. (2022) |
Ecological |
173,310 school adolescents, from PeNSE 2009, 2012 and 2015. |
To analyze the temporal trend of the simultaneous occurrence of behavioral risk factors (RF) for NCDs in Brazilian school adolescents. |
The isolated analysis of RF demonstrated that the insufficient level of leisure-time physical activity and the regular consumption of processed and ultraprocessed foods were the most prevalent during the three editions. |
Health actions represented by official national health and education bodies must foster health promotion and the prevention of NCDs in adolescents, especially in dealing the different factors that compromise the full development of this population. |
| Zhao et al.1111 Zhao W., Su D., Mo L., Chen C., Ye B., Qin S., Liu J., Pang Y. Lifestyle clusters and cardiometabolic risks in adolescents: a Chinese school-based study using a latent class analysis approach. Front Pediatr. 2021;9:728841. (2021) |
Cross-sectional |
895 Chinese adolescents aged 15 to 19 years. |
To identify modifiable lifestyle behaviors and explore the best intervention in Chinese adolescents. |
13.7 and 5.6 % of the participants were overweight and obese, respectively, and 8.4 and 14.1 % reported having prehypertension and hypertension, respectively. A two-class model identified by the authors reveals the prevalence of a healthy lifestyle pattern (65.8 %) and an unhealthy lifestyle pattern (34.2 %). The increased risk of cardiometabolic abnormality was not significant across lifestyle patterns, except for waist circumference. There was no significant difference in physical activity and fruit and vegetable consumption between the two patterns. |
Primary prevention based on lifestyle modification should target high-risk behavior patterns in adolescents. |
| Bogea et al.1212 Bogea E.G., Martins M.L., do Carmo C.D., Nascimento J.X., Arruda S.P., Ribeiro C.C., et al. Factors associated with inflammatory biomarkers in adolescents: analysis by structural equation modeling. Cad Saude Publica. 2021;37:e00212220. (2021) |
Cross-sectional |
391 Brazilian adolescents |
To evaluate factors associated with inflammatory biomarkers in adolescents. |
Three dietary patterns were identified (Western, basic Brazilian and healthy), with the Western pattern making the greatest contribution. No associations were found between the patterns and the latent inflammation variable. Excess weight was positively associated with the latent inflammation variable. |
The extraction of the three patterns shows greater consumption of foods rich in carbohydrates and fats, which are nutrients directly related to the increase in NCDs. Excess weight was associated with higher levels of inflammatory biomarkers. |
| Ricardo et al.1313 Ricardo C.Z., Azeredo C.M., Machado de Rezende L.F., Levy R.B. Co-occurrence and clustering of the four major non-communicable disease risk factors in Brazilian adolescents: analysis of a national school-based survey. PLoS One. 2019;14:e0219370. (2021) |
Cross-sectional |
101,607 adolescents from the National School Health Survey (PeNSE) 2015. |
To evaluate the co-occurrence and grouping of the main risk factors for NCDs in Brazilian adolescents. |
There is a strong correlation between alcohol consumption and smoking, which were found together in 8 of the 13 identified clusters. The most frequent combinations of risk factors involved unhealthy eating and insufficient physical activity. |
The main risk factors for NCDs are frequent and not randomly distributed among Brazilian adolescents. |
| Sena et al.1414 Sena E.M., Muraro A.P., Rodrigues P.R., Fiuza R.F., Ferreira M.G. Risk behavior patterns for chronic diseases and associated factors among adolescents. Nutr Hosp. 2017;34:914-22. (2017) |
Cohort |
1716 adolescents aged 10 to 17 from Cuiabá. Initially evaluated between 1999 and 2000, and again after 10 years. |
Identify patterns of risk behavior for NCDs in adolescents and analyze associated factors. |
The most prevalent risk behaviors for NCDs were sedentary lifestyle (58.1 %), insufficient physical activity (49.7 %) and skipping breakfast (36.2 %). 27.7 % of the adolescents were overweight. From the division of three risk behaviors for NCDs, a sedentary lifestyle and a qualitatively low diet, in addition to skipping breakfast were associated with obesity, age and economic and social class. |
This study confirmed the hypothesis that the main risk factors for NCDs tend to occur simultaneously in adolescents and are associated with sociodemographic, economic and body weight factors. Two main dietary markers (skipping breakfast and quality diet), vaguely explored as components of the risk pattern to date, were considered in this study. |
| Khashayar et al.1515 Khashayar P., Kasaeian A., Heshmat R., Motlagh M.E., Mahdavi Gorabi A., Noroozi M., et al. Childhood overweight and obesity and associated factors in Iranian children and adolescents: a multilevel analysis; the CASPIAN-IV study. Front Pediatr. 2018;6:393. (2018) |
Cross-sectional |
13,486 Iranian students (6 to 18 years old) from urban and rural areas. |
To explore multidimensional factors related to childhood overweight and obesity and determine the degree to which each ecological context contributes to childhood overweight and obesity. |
32.8 % of students did not eat breakfast (eating breakfast < 5 days/week). Daily consumption of fruits, vegetables and sugary drinks was reported by 55.74 %, 35.84 %, and 20.12 % of students, respectively. Around 9.7 % of students were overweight and 11.9 % were obese. Family history of obesity was reported by 45.47 % of the participants. Regular practice of physical activity was reported by 24 % of boys and 13 % of girls. |
The results show a high prevalence of childhood overweight and obesity in Iranian children and adolescents. Associated factors are sociodemographic characteristics, birth weight classification, skipping breakfast and family history of obesity. Therefore, developing strategies that consider the effects of several sociodemographic factors would be the most effective methods. |
| Tandon et al.1616 Tandon K., Adhikari N., Adhikari B., Pradhan P.M. Co-occurrence of non-communicable disease risk factors and its determinants among school-going adolescents of Kathmandu Metropolitan City. PLoS One. 2022;17:e0272266. (2022) |
Cross-sectional |
1108 adolescents aged 13 to 19 years attending grades 9 to 12 in public and private schools in Kathmandu, Nepal. |
To determine the pattern of co-occurrence of NCD risk factors and associated factors in adolescents. |
This study showed that 41 % of the adolescents attending school had unhealthy eating habits - more than half did not consume vegetables/fruit more than five times a day and consumed carbonated products. The findings of this study showed that 40.7 % of the adolescents had co-occurring NCD risk factors and 45.0 % had a risk factor for NCD - among them, an unbalanced diet. |
The co-occurrence of NCD risk factors was prevalent in two-fifths of adolescents. Almost seven in ten adolescents reported physical inactivity and two-fifths of the adolescents had an unhealthy diet, followed by alcohol and tobacco consumption. Maternal ethnicity, religion and level of schooling were significantly and independently associated with the co-occurrence of NCD risk factors. |
| Nicolau et al.1717 Nicolau D.A., Castro A.G. Characterization of adolescents’ diet with the Dietary Guidelines for the Brazilian population. Mundo Saude 2018;42:98-122. (2018) |
Cross-sectional |
111 incoming students from all Integrated Technical High School Courses in 2017, of both sexes, up to 19 years old. |
To characterize the diet of adolescent students from two technical schools in the east zone of the city of São Paulo according to the GAPB |
An important number of the adolescents do not consume fresh foods (fruits, vegetables) or minimally processed foods (rice and beans) daily. The daily presence of the “fruits and vegetables” set is low among adolescents, with daily intake of fruits being more frequent than vegetables. In contrast, the daily consumption of ultraprocessed foods was 64 % and 16.2 % of soft drinks. |
The diet of the adolescents in this group still does not fully meet the GAPB recommendations. It is observed that the consumption of ultraprocessed foods is still frequent. Therefore, nutritional education work aimed at disseminating GAPB recommendations is important for the adoption of healthier eating practices. |
| Souza et al.1818 Souza P., Meira J.B., Fernandes B.G., Moreira L.L., Ferreira V.A., Guimaraes O.S., et al. Obesity and overweight in schools: the importance of diagnosis to subsidiate health promotion initiatives in school space. Braz J Obes Nutr Weight Loss. 2018;12:786-95. (2018) |
Cross-sectional |
40 overweight or obese students, enrolled full-time in a public educational institution |
To investigate the lifestyle of students with excess weight from a public educational institution in the city of Diamantina, MG. |
The daily fruit consumption was low (35 %); however, more than half consumed vegetables and green vegetables daily (55 %). When evaluating the lunch boxes, UP foods were predominant: yogurt (55.88 %); pre-packaged chocolate milk (41.18 %); stuffed cookies or snacks (50 % and 35.29 %, respectively). BMI ranged between 18.63 (minimum) and 32.08 kg/m2 (maximum); 40 % were classified as overweight and 60 % as obese. The analysis of biochemical tests indicated glucose levels in the appropriate range, while cholesterol and triglyceride values were high. |
It was evident that the investigated group had excess weight, lipid alterations, unhealthy eating habits and physical activity practices. These results reaffirm the importance of carrying out interventions to address the problem of overweight and obesity at the local level. |
| Choy et al.1919 Choy M.J., Brownlee I., Murphy A.M. Data-driven dietary patterns, nutrient intake and body weight status in a cross-section of Singaporean children aged 6-12 years. Nutrients. 2021;13:1335. (2021) |
Cross-sectional |
561 children from Singapore aged 6 to 12 years in 2016 |
To analyze dietary patterns, estimated nutrient provision and association between BMI and demographic factors. |
Three dietary patterns were identified among the participants according to data from the 24HR. Each of the three groups had a high number of processed foods and low consumption of dietary fiber. Each dietary cluster was characterized by at least one risk food group: bakery products, red meat, local desserts and snacks, sweets, sweetened beverages and processed foods. |
The cluster analysis supported the definition of dietary patterns in this multiethnic group of children. Of the three dietary patterns defined, all tended to provide an inadequate balance of nutrients and none were identified as presenting healthy food choices. |
| Kelishadi et al.2020 Kelishadi R., Heidari-Beni M., Esmaeil-Motlagh M., Pourmasoumi M., Malekshah A.F., Qorbani M. Association of nutrient patterns with anthropometric indices in children and adolescents: the weight disorders survey of the CASPIAN-IV study. Mediterranean J Nutr Metab. 2019;12: 223-34. (2019) |
Transversal |
4288 Iranian students from urban and rural areas. |
To determine the main nutritional patterns in Iranian children and adolescents and evaluate their relationship with anthropometric indices. |
Three dietary patterns were defined; students in the fourth quartile of the first nutritional pattern tend to have higher weight, body mass index (BMI), waist circumference (WC) and hip circumference than those in the first quartile. Individuals in the fourth quartile of the second nutritional pattern had significantly lower average weight, WC and hip circumference than those in the first quartile. The third nutritional pattern did not correlate with any changes in BMI and wrist circumference in boys and girls. |
The results indicated that a nutritional pattern characterized mainly by high consumption of monounsaturated and polyunsaturated fatty acids, potassium, calcium, vitamin E and biotin was associated with a lower prevalence of obesity, while a nutrient intake pattern with large amounts of carbohydrates, thiamine, iron and manganese was associated with greater obesity. Prospective studies are needed to evaluate any causal correlation between nutrients, patterns and obesity and confirm the present findings.. |
| Cunha et al.2121 Cunha D.B., Costa T.H., Veiga G.V., Pereira R.A., Sichieri R. Ultra-processed food consumption and adiposity trajectories in a Brazilian cohort of adolescents: ELANA study. Nutr Diabetes. 2018;8:28. (2018) |
Cohort |
1035 Brazilian adolescents enrolled in the 1st year of High School between 2010 and 2012 |
To evaluate the trajectories of body mass index (BMI) and percentage of body fat (%BF) in adolescents over 3 years of follow-up according to the frequency of UP food consumption. |
The consumption of ultraprocessed foods was not significantly associated with the outcomes. |
This study confirmed that higher UPF intake is a marker of an unhealthy diet, but did not support the hypothesis of a high rate of change in BMI associated with higher UPF consumption, even after adjustment for physical activity. |
| D'Avila et al.2222 D'Avila H.F., Kirsten V.R. Energy intake from ultra-processed foods among adolescents. Rev Paul Pediatr. 2017;35:54-60. (2017) |
Cross-sectional |
784 Brazilian adolescents aged between 12 and 19 years old in 2013/2014. |
To evaluate the consumption of ultra-processed foods and related factors in adolescents. |
Adolescents with normal weight had a higher average consumption of ultraprocessed foods when compared to those with excess weight. |
The consumption of ultra-processed foods was associated with socioeconomic level, level of physical activity and nutritional status. As this is a cross-sectional study, there is a temporal limitation; no association was found between the consumption of ultraprocessed foods and overweight/obesity in adolescence, but it is possible that such outcomes appear in adulthood. |
| Sparrenberger et al.2323 Sparrenberger K., Friedrich R.R., Schiffner M.D., Schuch I., Wagner M.B. Ultra-processed food consumption in children from a Basic Health Unit. J Pediatr. 2015;91:535-42 (2015) |
Cross-sectional |
204 children, between two and 10 years old, from southern Brazil. |
To evaluate the contribution of ultraprocessed foods to the food consumption of children inside the coverage area of a Basic Health Unit, and the associated factors. |
The frequency of excess weight was 34 %. Average energy consumption was 1672.3 kcal/day, 47 % coming from ultraprocessed foods. In the multiple linear regression model, maternal level of schooling and the child's age were associated with the highest percentage contribution of ultraprocessed foods to the diet (weak magnitude associations r= 0.23; r= 0.40, respectively). Additionally, a significant linear trend was observed for greater consumption of ultraprocessed foods when the data were stratified by the child's age and maternal level of schooling. |
The contribution of ultraprocessed foods is significant in children's nutrition and the child's age showed to be the most important associated factor for the consumption of these products. |
| De Melo et al.2424 de Melo I.S., Costa C., dos Santos J.V., Santos A.F., Florencio T., Bueno N.B. Consumption of minimally processed food is inversely associated with excess weight in adolescents living in an underdeveloped city. PLoS One. 2017;12:e0188401. (2017) |
Cross-sectional |
249 Brazilian adolescents aged between 14 and 19 years old. |
To evaluate the consumption of minimally processed, processed and ultraprocessed foods by adolescents in a city with a low average per capita income, and verify the association with anthropometric measurements and arterial hypertension. |
The consumption of ultraprocessed foods was not associated with the studied outcomes. |
The consumption of minimally-processed foods is inversely associated with excess weight in adolescents. Investments in nutritional education are needed to prevent chronic diseases associated with the consumption of these foods. |
| Dantas et al.2525 Dantas C.D., Cavalcanti R.D. Consumption of ultra-processed foods and nutritional status of schoolchildren in the state of Pernambuco. Braz J Obes Nutr Weight Loss. 2021;15:669-77. (2021) |
Cross-sectional |
248 children aged 5 to 10, attended at Primary Care in the state of Pernambuco; 3663 were submitted to anthropometric assessment. |
To analyze the prevalence of consumption of ultraprocessed foods and nutritional status in children in the state of Pernambuco. |
High consumption of fruits and vegetables, but also high consumption of ultraprocessed foods among schoolchildren. The analysis of SISVAN reports between January and December showed that 33.84 % of the students were overweight and obese according to the BMI/A index. |
The prevalence of the consumption of ultraprocessed foods is high among schoolchildren. It was also possible to observe that the number of overweight and obese children was higher than underweight ones, according to the BMI/age assessment. Therefore, nutritional education in the schools is shown as an important initiative to contribute to a healthier lifestyle. |
| Carmo et al.2626 Carmo C.D., Ribeiro M.R., Teixeira J.X., Alves C.M., Franco M.M., França A.K., et al. Added sugar consumption and chronic oral disease burden among adolescents in Brazil. J Dent Res. 2018;97:508-14. (2018) |
Cross-sectional |
405 adolescents enrolled in public schools in São Luís, Brazil |
To assess the association between added sugar consumption and the burden of chronic oral disease among adolescents, considering obesity and systemic inflammation pathways through structural equation modeling. |
The majority of the sample comprised women, and most adolescents were classified as having normal weight based on BMI, followed by overweight and obese. Greater consumption of added sugar, higher levels of IL-6, and lower socioeconomic status have been linked to higher values of chronic oral disease burden. Obesity was not directly associated with the burden of chronic oral diseases. However, excess weight signaled a borderline indirect association with chronic oral disease and an association with elevated IL-6 levels. |
Dental caries and periodontal diseases are associated with each other and with the consumption of added sugar, obesity and systemic inflammation, reinforcing the World Health Organization recommendations that any approach aimed at preventing non-communicable diseases must target common risk factors . |
| Silva et al.2727 Silva J.B., Elias B.C., Warkentin S., Mais L.A., Konstantyner T. Factors associated with the consumption of ultra-processed food by Brazilian adolescents: National Survey of School Health, 2015. Rev Paul Pediatr. 2021;40:e2020362. (2021) |
Cross-sectional |
16,324 students who comprised sample 2 of PeNSE-2015 were studied. |
To identify the prevalence and factors associated with the consumption of ultraprocessed foods in Brazilian adolescents. |
The prevalence of excessive UPF consumption estimated in Brazil was 75.4 % (95 %CI 73.3-77.3) - the highest and lowest consumption were estimated in the Southeast and North regions of the country, respectively. Regarding nutritional status, 2.2 % were underweight, 63.6 % had normal weight and 34.2 % had excess weight. Nine factors were associated with excessive consumption of UPF, described in three categories - biological, behavioral, socioeconomic and demographic factors. |
The results of the present study indicate that excessive consumption of UPF is very prevalent among Brazilian adolescents. The identification of the nine associated factors suggests the need to implement actions to regulate UPF advertising and promote the adoption of healthy lifestyle habits focused on reducing sedentary behaviors and food and nutritional education in the school and family environment. |
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