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Objective: To identify food acquisition patterns in Brazil and relate them to the sociodemographic characteristics of the household.Design: A cross-sectional national Household Budget Survey (HBS). Principal component factor analysis was used to derive food patterns (factors) on the basis of the acquisition of food classified into thirty-two food groups.Setting: The source of data originates from the 2002-2003 HBS carried out by the Brazilian Institute of Geography and Statistics between June 2002 and July 2003 using a representative sample of all Brazilian households.Subject: A total of 48 470 households allocated into 443 strata of households that were geographically and socio-economically homogeneous as a study unit.Results: We identified two patterns of food acquisition. The first, named 'dual', was characterized by dairy, fruit, fruit juice, vegetables, processed meat, soft drinks, sweets, bread and margarine, and by inverse correlations with Brazilian staple foods. In contrast, the second pattern, named 'traditional', was characterized by rice, beans, manioc, flour, milk and sugar. The 'dual' pattern was associated with higher household educational level, income and the average age of adults on the strata, whereas the 'traditional' presented higher loadings in less-educated households and in the rural setting.Conclusions: Dietary patterns described here suggest that policies and programmes to promote healthy eating need to consider that healthy and non-healthy foods may be integrated within [corrected] the same pattern. [ABSTRACT FROM AUTHOR]

Objective: To study the role of energy derived from sugar (both table sugar and sugar added to processed foods) in the total energy content of food purchases in Brazil.Design: Food purchase data were collected during a national household budget survey carried out between June 2002 and July 2003 on a probabilistic sample representative of all households in the country. The amount of food purchased in this 12-month period was transformed into energy and energy from sugar using food composition tables. Multiple linear regression models were used to study the association between amount of energy from sugar and total energy content of food purchases, controlling for sociodemographic variables and potential interactions between these variables and sugar purchases.Results: There was a positive and significant association between energy from sugar and total household energy purchases. A 1 kJ increase in sugar purchase corresponded to a 3.637 kJ increase in total energy. In the absence of expenditure on meals outside the home, i.e. when household food purchases tend to approximate actual food consumption by household members, sugar purchase of 1926.35 kJ/d (the 90th percentile of the distribution of sugar purchases in Brazil) was associated, depending on income strata, with total energy purchase over 40-60 % of the recommended daily value for energy intake in Brazil.Conclusions: The present results corroborate the recommendations of the WHO and the Brazilian Ministry of Health regarding limiting the consumption of sugar. [ABSTRACT FROM AUTHOR]

Many reports about breastfeeding prevalence and factors associated with weaning have been published in the scientific literature. However, the influence of newborn feeding practices on the duration of exclusive breastfeeding has received less attention. This study provides information about the introduction of liquids, other than the mother's milk, to infants in the first 6 months and factors associated with this practice. J Hum Lact. 24(2):168-174. [ABSTRACT FROM AUTHOR]

Mouse NK cells may use both cytokine, e.g. IFN-γ, tumor necrosis factor (TNF)-α and IL-12, and cytotoxic, e.g. perforin and Fas-FasL, pathways to reject incompatible bone marrow cell (BMC) grafts. To begin a dissection of these two major pathways, mice bearing deletional mutations of IFN-γ, TNF-RI/II or perforin, or mice treated with mAb to IL-12, IFN-γ or NK1.1 were irradiated and challenged with class I-deficient BMC grafts, a system in which only NK cells are the effector cells. Proliferation of the donor-derived cells was judged in terms of splenic incorporation of [125I]iododeoxyuridine 5 or 7 days after cell transfer. All of these mice maintained in a specific pathogen-free (s.p.f.) environment were able to reject the BMC, except those treated with anti-NK1.1 mAb. However, perforin deficient mice maintained in a conventional breeding facility failed to reject class 1 (Tap-1)-deficient marrow cells. Transfer of mice from the pathogen-free to the conventional facility resulted in a slow and incomplete loss of the ability to reject marrow cells. Thus, the breeding colony environment can elicit otherwise undetectable defects in the rejection ability of perforin-deficient NK cells. This report will hopefully alert those investigators who have only studied immune gene knockout mice in s.p.f. facilities and found no significant abnormalities. [ABSTRACT FROM PUBLISHER]

Objective: To describe two low-burden diet quality scores and evaluate their performance in reflecting the dietary share of the least and most processed foods defined within the Nova food system classification., Methods: This cross-sectional study included data from the NutriNet-Brasil cohort. Participants answered the Nova24hScreener, a 3-minute self-administered questionnaire measuring the consumption of a set of foods on the day before. Food items included in this tool belong to two main groups of the Nova classification: unprocessed or minimally processed whole plant foods (WPF, 33 items) and ultra-processed foods (UPF, 23 items). Two scores were obtained by summing the number of items checked: the Nova-WPF and the Nova-UPF. We compared the scores, respectively, with the dietary intake (% of total energy) of all unprocessed or minimally processed whole plant foods and all ultra-processed foods obtained from a full self-administered web-based 24-hour recall performed on the same day., Results: The approximate quintiles of each score had a direct and linear relationship with the corresponding % of energy intake (p-value for linear trend < 0.001). We found a substantial agreement between the intervals of each score and the corresponding % of energy intake (Nova-WPF score: Prevalence-Adjusted and Bias-Adjusted Kappa (PABAK) 0.72, 95%CI 0.64-0.81; Nova-UPF score: PABAK 0.79, 95%CI 0.69-0.88)., Conclusions: These two scores performed well against the dietary share of unprocessed or minimally processed whole plant foods and ultra-processed foods in Brazil and can be used to evaluate and monitor diet quality.

Background: Dietary shift towards more plant-based options is increasingly popular, but the quantity of ultra-processed foods (UPFs) they contain is largely unknown. This study assessed the level of UPF and minimally processed food consumption among regular and low red meat eaters, flexitarians, pescatarians, vegetarians and vegans in a large dataset of United Kingdom (UK) adults., Methods: This is a cross-sectional analysis of the UK Biobank participants recruited between December 19, 2006, and October 1, 2010. Responses to food frequency questions were used to identify diet types for vegans (never eating any animal-based foods); vegetarians (never eating meat/fish); pescatarians (never eating meat); flexitarians (consumed fish/meat under twice a week); low red meat eaters (consumed fish/poultry more than once a week but red/processed meat under twice a week); and regular red meat eaters (consumed red/processed meat more than once a week). Consumption of all food and drinks collected in 24-h recalls between April 29, 2009, and June 28, 2012, were categorised using the Nova classification. The primary outcomes are the consumption of UPFs and minimally processed foods, expressed as a percentage of daily food intake (grams/day). Multivariable linear regression assessed the mean percentage point difference in UPF and minimally processed food consumption between diet types., Findings: This study included 199,502 UK Biobank participants (mean age 58.2 [standard deviation 7.9] years; 55.1% women). The mean UPF consumption was 24.2%, 21.9%, 22.0%, 20.4%, 23.8%, and 22.7% among 75,091 regular red meat eaters, 70,144 low red meat eaters, 45,057 flexitarians, 4932 pescatarians, 4119 vegetarians and 159 vegans, respectively. The adjusted results suggested that compared with regular red meat eaters, UPF consumption was 1.3 percentage points higher among vegetarians (95% confidence interval [CI]: 0.9, 1.7) and lower among low red meat eaters (-1.3, 95% CI: -1.4, -1.1), flexitarians (-0.8, 95% CI: -1.0, -0.7), and pescatarians (-1.6, 95% CI: -1.9, -1.2). The UPF consumption in vegans were not significantly different from regular red meat eaters (1.2 percentage points, 95% CI: -0.7, 3.2). Minimally processed food consumption was higher in all other types of diet than regular red meat eaters, with an adjusted percentage point difference ranged from 0.4 (95% CI: 0.005, 0.9) for vegetarians to 3.2 (95% CI: 1.0, 5.5) for vegans compared with regular red meat eaters., Interpretation: This UK-based study found higher UPF consumption in vegetarian diets and lower in diets with a modest amount of meat or fish. It is important that policies which encourage the urgently needed transition to more sustainable dietary patterns also promote rebalancing diets towards minimally processed foods., Funding: National Institute for Health and Care Research (NIHR) School for Public Health Research, World Cancer Research Fund., Competing Interests: All authors declare no conflict of interest., (© 2024 The Authors. Published by Elsevier Ltd.)

Background: The Universal Infant Free School Meal (UIFSM) policy was introduced in 2014/15 in England and Scotland for schoolchildren aged 4-7 years, leading to an increase in school meal uptake. UK school meals are known to be healthier and less industrially processed than food brought from home (packed lunches). However, the impact of the UIFSM policy on the quantity of ultra-processed food (UPF) consumed at school during lunchtime is unknown. This study aimed to evaluate the impact of the UIFSM policy on lunchtime intakes of UPF in English and Scottish schoolchildren., Methods: Data from the UK National Diet and Nutrition Survey (2008-2019) were used to conduct a difference-in-difference (DID) natural experiment. Outcomes included school meal uptake and the average intake of UPF (% of total lunch in grams (%g) and % total lunch in Kcal (%Kcal)) during school lunchtime. The change in the outcomes before and after the introduction of UIFSM (September 2014 in England, January 2015 in Scotland) in the intervention group (4-7 years, n = 835) was compared to the change in an unexposed control group (8-11 years, n = 783), using linear regression. Inverse probability weights were used to balance characteristics between intervention and control groups., Results: Before UIFSM, school meal uptake and consumption of UPFs were similar in the intervention and control groups. The DID model showed that after UIFSM, school meal uptake rose by 25%-points (pp) (95% CI 14.2, 35.9) and consumption of UPFs (%g) decreased by 6.8pp (95% CI -12.5,-1.0). Analyses indicated this was driven by increases in minimally processed dairy and eggs, and starchy foods, and decreases in ultra-processed salty snacks, bread and drinks. The differences were larger in the lowest-income children (-19.3 UPF(%g); 95% CI -30.4,-8.2) compared to middle- and high-income children. Analyses using UPF %Kcal had similar conclusions., Conclusions: This study builds on previous evidence suggesting that UIFSM had a positive impact on dietary patterns, showing that it reduced consumption of UPFs at school lunchtime, with the greatest impact for children from the lowest-income households. Universal free school meals could be an important policy for long term equitable improvements in children's diet., (© 2024. The Author(s).)

Background and Aims: Population-based studies suggest an inverse relationship between the dietary share of ultra-processed foods (UPF), as defined by NOVA classification, and the overall dietary nutritional quality. However, few studies have evaluated the impact of ultra-processed foods on the fatty acid profile of the diet. The aim of this study was to assess the association between consumption of UPF and the fatty acids profile of the diet in Portugal., Methods and Results: Cross-sectional data from IAN-AF 2015-2016 were used for this study. Food consumption data were collected through two 24-h food recalls, and food items were classified according to the NOVA system. For both adults and elderly, the contents of total fatty acids (TFA), saturated fatty acids (SFA) and trans fatty (TRFA) were higher in the fraction of UPF, compared to the other three NOVA groups, while [monounsaturated fatty acids (MUFA)+, polyunsaturated fatty acids (PUFA)/SFA] ratio was lower. The UPF population attributable fraction (PAF) demonstrated that if the dietary contribution of UPF was reduced to levels observed in the first quintile, statistically significant reductions in the prevalence of inadequate intakes of fatty acids would be observed for adults [TRFA (PAF 98.37%, 95% CI 87.27-99.79) and SFA (PAF 37.26%, 95% CI 25.46-47.19)] and for elderly [TRFA (PAF 94.61%, 95% CI 77.59-98.71) and PUFA (PAF 98.28, 95% CI 48.22-99.94)]., Conclusions: In this study the consumption of UPF was associated with a worse fatty acids profile in the Portuguese diet, adding evidence regarding the negative impact of UPF on diet quality., Competing Interests: Conflicts of interest All authors declare that they do not have any conflict of financial interests or personal relationships that could cause bias in this work., (Copyright © 2024 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Background: Ultraprocessed foods (UPF) consumption has been associated with depression risk, but its association with depression persistence is unclear., Objective: The objective of this study was to evaluate the association of UPF consumption with depression persistence and incidence., Design: The Brazilian Longitudinal Study of Adult Health is a multicenter prospective cohort study with 3 waves (2008-2010, 2012-2014, and 2017-2019). Baseline percentage of energy from UPF, measured using a food frequency questionnaire, was divided into quartiles., Participants/setting: Civil servants aged 35 to 74 years at baseline were included in the Brazilian Longitudinal Study of Adult Health. Participants with Parkinson disease, dementia, stroke history, extreme energy intake, and missing dietary or depression data at baseline were excluded., Main Outcome Measures: Depression was based on the Clinical Interview Schedule-Revised, depression persistence on depression status at each wave and depression incidence on time to first depression diagnosis., Statistical Analyses Performed: Clustering large applications algorithm, multinomial logistic regression, Cox proportional-hazard models, and partition substitution model were performed., Results: Among 13 870 participants free from depression at baseline, 731 (5.3%) had depression after 8 years of follow-up. Participants in Cluster 1 did not have depression in any wave, in Cluster 2 had depression in 1 wave, and in Cluster 3 had persistent depression in 2 or more waves. Compared with the first quartile of UPF consumption, participants in Quartiles 2, 3, and 4 had a 1.30 (95% CI 1.29 to 1.31), 1.39 (95% CI 1.38 to 1.40), and 1.58 (95% CI 1.56 to 1.60) higher odds of persistent depression (P = .019), respectively. Compared with the first UPF quartile, participants in Quartiles 3 and 4 had a 1.32 (95% CI 1.07 to 1.64) and 1.30 (95% CI 1.04 to 1.61) higher risk of incident depression (P = .017), respectively. Substituting 5%, 10%, and 20% of UPF with unprocessed/minimally processed foods and culinary ingredients was associated with a 6%, 11%, and 22% decreased depression incidence, respectively., Conclusions: Higher consumption of UPF at baseline was associated with higher odds of persistent depression and higher risk of incident depression over 8 years of follow-up., (Copyright © 2024 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

The aim of this study was to describe the dietary intake of British vegetarians according to the Nova classification and to evaluate the association between the consumption of ultra-processed foods and the nutritional quality of the diet. We used data from the UK national survey (2008/2019). Food collected through a 4-d record were classified according to the Nova system. In all tertiles of the energy contribution of ultra-processed foods, differences in the average nutrient intake, as well as in the prevalence of inadequate intake, were analysed, considering the values recommended by international authorities. Ultra-processed foods had the highest dietary contribution (56·3 % of energy intake), followed by fresh or minimally processed foods (29·2 %), processed foods (9·4 %) and culinary ingredients (5 %). A positive linear trend was found between the contribution tertiles of ultra-processed foods and the content of free sugars ( β 0·25, P < 0·001), while an inverse relationship was observed for dietary fibre ( β -0·26, P = 0·002), potassium ( β -0·38, P < 0·001), Mg ( β -0·31, P < 0·001), Cu ( β -0·22, P < 0·003), vitamin A ( β -0·37, P < 0·001) and vitamin C ( β -0·22, P < 0·001). As the contribution of ultra-processed foods to total energy intake increased (from the first to the last tertile of consumption), the prevalence of inadequate intake of free sugars increased (from 32·9 % to 60·7 %, respectively), as well as the prevalence of inadequate fibre intake (from 26·1 % to 47·5 %). The influence of ultra-processed foods on the vegetarian diet in the UK is of considerable magnitude, and the consumption of this food was associated with poorer diet quality.

The objective of this study was to describe the evolution of household purchase of added sugars and their main food sources in Brazil. Nationally representative data from the Household Budget Surveys from 2002-2003, 2008-2009 and 2017-2018 were used. Energy and added sugar quantities were estimated by means of per capita food quantities. The items considered as food sources were: (1) table sugar: refined sugar and other energetic sweeteners and (2) processed and ultra-processed foods with added sugar: soft drinks; other drinks; sweets, candies and chocolates; cookies; cakes and pies and other foods. The parameters estimated were: mean share of added sugar in total energy and, for food sources, the share of added sugar in total sugar intake and the impact of variations in sources of added sugar between 2008 and 2017. There was a regular share of energy from added sugar to total energy intake between 2002 and 2008 but a reduced share in 2017. Between 2008 and 2017, there was a decrease in the share of refined sugar and other sweeteners and soft drinks to total sugar intake and an increased share of all other items. High-income households had a lower share of refined sugar and other energetic sweeteners, but a higher share of soft drinks, sweets, candies and chocolates. The decrease in added sugar in 2017 was mainly due to the lower share of soft drinks. In conclusion, Brazilians' total intake of added sugar was decreased, mostly owing to reduced consumption of sugar from soft drinks.

Background: Ultra-processed foods have been associated with several negative outcomes, but it is not clear whether they are related to bullying perpetration. Moreover, no previous study has investigated the potential role of deviant behaviors as a mediator of this association. Our objective was to evaluate the association between ultra-processed dietary pattern and bullying, and the mediating effect of deviant behaviors in this association, among school adolescents., Methods: We used data from a representative sample of 9th grade Brazilian adolescents ( N  = 2,212) from the São Paulo Project for the social development of children and adolescents (SP-PROSO). Exploratory factor analysis was used to obtain the dietary patterns, through questions of frequency of consumption in the last week of several foods. The ultra-processed dietary pattern was considered as exposure. The outcomes were the types of bullying (any type, social exclusion, psychological/verbal aggression, physical aggression, property destruction, and sexual harassment). Deviant behaviors (mediator) were assessed through a score. Mediation analyses were carried out using logistic regression based on the KHB method., Results: After adjusting for covariates, the mediating effect of deviant behaviors was found in the association between ultra-processed dietary pattern and all the types of bullying perpetration, especially for psychological/verbal aggression (39.4%). A small mediating effect of deviant behaviors in the association of ultra-processed dietary pattern with physical aggression (17.7%) and property destruction (18.5%) was observed, but this effect explained only a small portion of the total effect of such association (significant direct effect)., Conclusion: The ultra-processed dietary pattern was associated with bullying, and the association was mediated through deviant behaviors. Policies and actions for improving the adolescent's diet and managing the adoption of deviant and bullying behaviors by this public are required., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Okada, Marques, Levy, Gonçalves, Peres and Azeredo.)

Background: Comprehensive research evidence is lacking on the role of ultra-processed foods (UPF) in the relationship between the consumption of plant-sourced foods and their impact on cardiovascular disease (CVD) outcomes. This study aims to assess CVD risk associated with the dietary contribution of food groups that consider both plant or animal origin and food processing categories, within a large cohort of British adults., Methods: Data from the UK Biobank participants (40-69 y) who completed at least two 24-h dietary recalls between 2009 and 2012 (n = 126,842; median follow-up: 9 y), with subsequent data linkage to hospital and mortality records, were used. Food groups were classified as either plant-sourced or non-plant/animal-sourced foods. These groups were further divided into non-UPF and UPF, and expressed as a percentage of total energy intake., Findings: Every 10 percentage points increase in plant-sourced non-UPF consumption was associated with a 7% lower risk of CVD (95% CI 0.91-0.95) and a 13% lower risk of CVD mortality (0.80-0.94). Conversely, plant-sourced UPF consumption was associated with a 5% increased risk (1.03-1.07) and a 12% higher mortality (1.05-1.20). The contribution of all UPF was linked to higher CVD risk and mortality, and no evidence for an association between contribution of all plant-sourced foods and CVD incidence and mortality was observed., Interpretation: The dietary contribution of plant-sourced non-UPF inversely linked to CVD risk, while plant-sourced UPF contribution showed a positive association. Recognizing the role of food processing is crucial for favourable CVD outcomes, even in plant-sourced diets., Funding: World Cancer Research Fund., Competing Interests: We have no competing interests to declare., (© 2024 The Authors.)

Purpose: Ultra-processed food may play a role in facilitating snacking behavior because of their convenience and low satiety potential. This study aimed to describe the association between consumption of ultra-processed foods and frequency of snacking., Methods: We analyzed data from 46,164 participants (≥ 10 years old) in the 2017-2018 Brazilian Household Budget Survey. Dietary data were collected by 24-h dietary recalls over one or two days for each participant. We estimated energy intake, ultra-processed food consumption, and level of snacking. We measured the association between ultra-processed food consumption and level of snacking using multinomial logistic regression, stratified by age group (adolescents, 10-19 years old; adults, 20-64 years old; elders, 65 or older)., Results: We found a statistically significant tendency of increased daily energy intake and consumption of snacks and that ultra-processed food consumption was positively associated with the level of snacking for all age groups. For adolescents, adults, and elders in the highest quintile of ultra-processed food consumption as a share of their entire diet, the relative risk ratio (95% CI) of having more than two snacks per day compared to no snacks was 14.21 (9.09-22.21), 4.44 (3.54-5.57), and 4.21 (2.67-6.64), respectively, when compared to the lowest quintile., Conclusion: Higher consumption of ultra-processed food was associated with snacking behavior, and the strength of this association was stronger among adolescents. Efforts to mitigate ultra-processed food attributes that facilitate snacking should be incorporated into strategies to promote healthier food choices, especially among adolescents., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Background & Aims: We aimed to analyze the prospective association between adherence to the ultra-processed dietary pattern and risk of depressive outcomes using original data from the NutriNet Brasil cohort and via a systematic review and meta-analysis of observational studies that have investigated the same association., Methods: In our original research analysis, we used data from 15,960 adults (≥18 y) participating in the NutriNet Brasil cohort study, free of depression or depressive symptoms during the baseline (77.5% women, 45.8 ± 13.0 y). The mean dietary share of ultra-processed foods (%Kcal/d), calculated from two baseline 24-h dietary recalls, was used to measure the adherence to the ultra-processed dietary pattern. New cases of depressive symptoms were assessed using the Patient Health Questionnaire-9 over the follow-up period (mean: 18.3 months). Cox proportional hazards models were used for the main analyses. In our systematic review and meta-analysis, we incorporated effect estimates from six prospective cohort studies that have examined the same association, including ours., Results: In the adjusted model, each 10% increase in the dietary share of ultra-processed foods was associated with a 10% increase in the hazard of incident cases of depressive symptoms (HR:1.10; 95%CI: 1.07-1.14). This association was slightly attenuated in the models including potential mediators. In our meta-analysis of six prospective studies, high versus low exposure to ultra-processed foods was associated with a summary hazard ratio of depressive outcomes of 1.32; 95%CI: 1.19-1.46; I 2 : 71%., Conclusion: A higher adherence to the ultra-processed dietary pattern was associated with a higher risk of developing depressive outcomes in the NutriNet Brasil cohort and in the meta-analysis., Competing Interests: Conflict of interest None declared., (Copyright © 2024 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Allogeneic hematopoietic stem cell transplantation (aHSCT) can cure patients with otherwise fatal leukemias and lymphomas. However, the benefits of aHSCT are limited by graft-versus-host disease (GVHD). Minnelide, a water-soluble analog of triptolide, has demonstrated potent antiinflammatory and antitumor activity in several preclinical models and has proven both safe and efficacious in clinical trials for advanced gastrointestinal malignancies. Here, we tested the effectiveness of Minnelide in preventing acute GVHD as compared with posttransplant cyclophosphamide (PTCy). Strikingly, we found Minnelide improved survival, weight loss, and clinical scores in an MHC-mismatched model of aHSCT. These benefits were also apparent in minor MHC-matched aHSCT and xenogeneic HSCT models. Minnelide was comparable to PTCy in terms of survival, GVHD clinical score, and colonic length. Notably, in addition to decreased donor T cell infiltration early after aHSCT, several regulatory cell populations, including Tregs, ILC2s, and myeloid-derived stem cells in the colon were increased, which together may account for Minnelide's GVHD suppression after aHSCT. Importantly, Minnelide's GVHD prevention was accompanied by preservation of graft-versus-tumor activity. As Minnelide possesses anti-acute myeloid leukemia (anti-AML) activity and is being applied in clinical trials, together with the present findings, we conclude that this compound might provide a new approach for patients with AML undergoing aHSCT.

Previous studies have assessed the association between food consumption and bullying perpetration, but most of them have not broadly assessed food consumption, neither the distinction between forms of bullying. The aim of the study was to evaluate the association between dietary patterns with bullying roles and its different types of bullying perpetration among adolescents. Data on a representative sample of ninth-grade students ( N  = 2,163; mean age = 14.8 years) taken from Sao Paulo Project for the social development of children and adolescents (SP-PROSO) were used. The independent variables were healthy and unhealthy dietary patterns obtained by exploratory factor analysis. The dependent variables were bullying role (victim-only, bully-only, bully-victim) and bullying perpetration (any type, social exclusion, psychological/verbal aggression, physical aggression, property destruction, sexual harassment). Multinomial and logistic regression models were performed for the total sample and stratified by sex (only for association with sexual harassment), adjusting for covariates. Adolescents who engaged in a healthy dietary pattern were less likely to be bullies (RR 0.67 [0.49, 0.92]), while adolescents with an unhealthy dietary pattern were more likely to be bully-victims (RR 1.29 [1.12, 1.48]). Unhealthy dietary pattern was associated with any type of bullying perpetration ( OR 1.24 [1.12, 1.38]), mainly with sexual harassment and physical aggression. Boys who had an unhealthy dietary pattern were more likely to sexually harass another adolescent ( OR 2.10 [1.20, 3.66]). In conclusion, adolescents who had a healthy dietary pattern were less likely to perpetrate bullying. Unhealthy dietary pattern was associated with bullying perpetration, especially with sexual harassment by boys., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Excessive sodium intake is a major global public health issue and the identification of dietary sources and temporal trends in its consumption are a key to effective sodium reduction policies. This study aims to update estimates of sodium intake and its dietary sources in Brazil according to the NOVA food classification system. Records of 7-day food purchases of households from the Brazilian Household Budgets Survey of 2002-2003, 2008-2009, and 2017-2018 were converted into nutrients using food composition tables and the mean availability was estimated per 2,000kcal/day. Mean daily sodium available for consumption in Brazilian households has increased from 3.9 to 4.7g per 2,000kcal, from 2002-2003 to 2017-2018, over twice the recommended levels of sodium intake. From 2002-2003 to 2017-2018, the processed culinary ingredients, including table salt, represented the largest dietary source of sodium, although their participation in dietary sodium was reduced by 17% (66.6% to 55%), while the percentage of dietary sodium from processed foods increased by 20.3% and from ultra-processed foods increased by 47.6% (11.3% to 13.6% and 17% to 25.1%, respectively). In conclusion, the total household sodium availability remains high and has increased over time in Brazil, yet the participation of different dietary sources of sodium have gradually changed.

The analysis of food using a perspective centred on nutrients seems inadequate for understanding the dietary transition and its impact on the growth of obesity and chronic diseases. Industrial food processing is now proposed as the key to explain the relationship between food and health. The NOVA food classification considers the degree and the purpose of food processing, which includes physical, biological and chemical processes used after foods are separated from nature, and before being consumed or prepared as dishes and meals. NOVA has four food groups: (1) unprocessed and minimally processed foods; (2) processed culinary ingredients; (3) processed foods and (4) ultra-processed foods, which are formulations made mostly or entirely from substances derived from group 1 foods and additives, with little if any intact group 1 food. Many investigations linking high ultra-processed food consumption with deterioration of diets and adverse health outcomes are reinforced by prospective studies, systematic reviews and meta-analyses. There are various plausible explanations of why diets high in ultra-processed foods are harmful. Their production and consumption continue to rise worldwide. Efficient and effective public policies and actions that reduce production and consumption of ultra-processed products are needed, to protect human health now and in future.

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.

Recent epidemiological studies have suggested a positive association between ultra-processed food consumption and breast cancer risk, although some studies also reported no association. Furthermore, the evidence regarding the associations between intake of food with lower degrees of processing and breast cancer risk is limited. Thus, we investigated the associations between dietary intake by degree of food processing and breast cancer risk, overall and by breast cancer subtypes in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Dietary intake of EPIC participants was assessed via questionnaires at baseline. More than 11,000 food ingredients were classified into four groups of food processing levels using the NOVA classification system: unprocessed/minimally processed (NOVA 1), culinary ingredients (NOVA 2), processed (NOVA 3) and ultra-processed (NOVA 4). Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of breast cancer per standard deviation increase in daily consumption (grams) of foods from each NOVA group. The current analysis included 14,933 breast cancer cases, diagnosed among the 318,686 EPIC female participants, (median follow-up of 14.9 years). No associations were found between breast cancer risk and the level of dietary intake from NOVA 1 [HR per 1 SD =0.99 (95% CI 0.97 - 1.01)], NOVA 2 [HR per 1 SD =1.01 (95% CI 0.98 - 1.03)] and NOVA 4 [HR per 1 SD =1.01 (95% CI 0.99 - 1.03)] foods. However, a positive association was found between NOVA 3 and breast cancer risk [HR per 1 SD =1.05 (95% CI 1.03 - 1.07)] which became non-significant after adjustment for alcohol intake [HR per 1 SD =1.01 (95% CI 0.98 - 1.05)] or when beer and wine were excluded from this group [HR per 1 SD =0.99 (95% CI 0.97 - 1.01)]. The associations did not differ by breast cancer subtype, menopausal status or body mass index. Findings from this large-scale prospective study suggest that the positive association between processed food intake and breast cancer risk was likely driven by alcoholic beverage consumption., Supplementary Information: The online version contains supplementary material available at 10.1186/s43014-024-00264-2., Competing Interests: Competing interestsThe authors declare no potential conflicts of interest., (© The Author(s) 2024.)

Objective: To assess the prospective association of two diet quality scores based on the Nova food classification with BMI gain., Design: The NutriNet-Brasil cohort is an ongoing web-based prospective study with continuous recruitment of participants aged ≥ 18 years since January 2020. A short 24-h dietary recall screener including 'yes/no' questions about the consumption of whole plant foods (WPF) and ultra-processed foods (UPF) was completed by participants at baseline. The Nova-WPF and the Nova-UPF scores were computed by adding up positive responses regarding the consumption of thirty-three varieties of WPF and twenty-three varieties of UPF, respectively. Participants reported their height at baseline and their weight at both baseline and after approximately 15 months of follow-up. A 15-month BMI (kg/m 2 ) increase of ≥5 % was coded as BMI gain., Setting: Brazil., Participants: 9551 participants from the NutriNet-Brasil cohort., Results: Increasing quintiles of the Nova-UPF score were linearly associated with higher risk of BMI gain (relative risk Q5/Q1 = 1·34; 95 % CI 1·15, 1·56), whereas increasing quintiles of the Nova-WPF score were linearly associated with lower risk (relative risk Q5/Q1 = 0·80; 95 % CI 0·69, 0·94). We identified a moderate inverse correlation between the two scores (-0·33) and a partial mediating effect of the alternative score: 15 % for the total effect of the Nova-UPF score and 25 % for the total effect of the Nova-WPF score., Conclusions: The Nova-UPF and Nova-WPF scores are independently associated with mid-term BMI gain further justifying their use in diet quality monitoring systems.

We aimed to investigate and compare the distribution of establishments that sell food near municipal, state, and private schools in the municipality of São Paulo, Brazil. This cross-sectional, exploratory, and census study was conducted in 3,121 schools. Circular buffers were traced around schools and concentrations or dispersions of food stores (in absolute numbers and densities) were analyzed. A p-trend was calculated to analyze how food stores density behaved as the buffer radius distance increased. Stratified regression models were built to analyze the characteristics of the food environment. Snack bars and street vendors are the most common types of establishments surrounding schools. Some categories of food stores are concentrated (such as candy stores around municipal and private schools, mini markets around municipal schools, and snack bars around private schools), whereas others (such as super and hypermarkets and fruit and vegetable stores) are dispersed around public schools. The food environment around schools shows differences regarding the instance that administers them and private schools have more food stores around them. Poor-quality food environment around schools exposes students to risk factors regarding excessive unhealthy food consumption.

Objective: This paper describes the first web-based self-completed 24-h recall designed to categorise food intake according to Nova groups - Nova24h - and its agreement with a reference tool in estimating the dietary relative contribution of the four Nova food groups (% of total energy intake)., Design: Comparisons of estimates of dietary relative contributions of Nova groups obtained by Nova24h and one standard interviewer-led 24-h recall., Setting: Nationwide adult cohort study in Brazil., Participants: The subjects were 186 participants of the NutriNet Brasil Cohort Study ( n 186)., Results: No statistically significant differences were observed between the Nova24h and the reference tool mean contributions of unprocessed or minimally processed foods (52·3 % v . 52·6 %), processed culinary ingredients (11·6 % v . 11·9 %), processed foods (17·1 % v . 14·7 %) and ultra-processed foods (19·0 % v . 20·9 %). Intraclass correlation coefficients between individual estimates obtained for each Nova group showed moderate to good agreement (0·54-0·78). Substantial or almost perfect agreement between the tools was seen regarding the ability to rank participants according to quintiles of contribution of each Nova group (PABAK 0·69-0·81)., Conclusions: Nova24h is a suitable tool for estimating the dietary relative energy contribution of Nova food groups in the NutriNet Brasil cohort. New studies are necessary to verify its adequacy in other populations.

Objective: Evaluate changes in the Brazilian population's diet and its determinants during the covid-19 pandemic., Methods: We used diet data collected by the Datafolha Institute in 2019 (n = 1,384), 2020 (n =1,214), and 2021 (n = 1,459) from independent and representative samples of the adult population (aged 18 to 55 years) from all socioeconomic classes and geographic regions of Brazil. Food consumption was measured by checking the consumption of 22 sets of food on the day before the survey. The third cycle also included questions about changes in eating habits during the pandemic. We estimated the prevalence of consumption of the food sets in each cycle of the survey and used statistical tests for comparisons of proportions between the three cycles., Results: Between 2019 and 2020, we observed a significant increase in the consumption of cereals, milk, packaged snacks or salty cookies, and industrialized sauces, as opposed to a decrease in the consumption of eggs. Between 2019 and 2021 and between 2020 and 2021, on the other hand, there was a significant decrease in the consumption of cereals, vegetables, fruits, and industrialized fruit juices and an increase in the consumption of soda, sweets, cookies, sausages, industrialized sauces, and ready meals. When asked about the main changes in the purchase and preparation of meals, 46.3% of the respondents reported consuming more food prepared at home during the pandemic. Regarding changes in eating habits, 48.6% of the respondents reported a change in their eating habits during the pandemic. The main reasons for such changes were greater concern with health (39.1%) and self-reported decreased family income (30.2%)., Conclusions: The covid-19 pandemic had a negative impact on the diet of the population, and increased consumption of ultra-processed foods was reported for that period.

Although ultra-processed foods represent more than half of the total energy consumed by the UK population, little is known about the trend in food consumption considering the degree of food processing. We evaluated the trends of the dietary share of foods categorised according to the NOVA classification in a historical series (2018-2019) among the UK population. Data were acquired from the NDNS, a survey that collects diet information through a 4-d food record. We used adjusted linear regression to estimate the dietary participation of NOVA groups and evaluated the linear trends over the years. From 2008 to 2019, we observed a significant increase in the energy share of culinary ingredients (from 3·7 to 4·9 % of the total energy consumed; P -trend = 0·001), especially for butter and oils; and reduction of processed foods (from 9·6 to 8·6 %; P -trend = 0·002), especially for beer and wine. Unprocessed or minimally processed foods (≅30 %, P -trend = 0·505) and ultra-processed foods (≅56 %, P -trend = 0·580) presented no significant change. However, changes in the consumption of some subgroups are noteworthy, such as the reduction in the energy share of red meat, sausages and other reconstituted meat products as well as the increase of fruits, ready meals, breakfast cereals, cookies, pastries, buns and cakes. Regarding the socio-demographic characteristics, no interaction was observed with the trend of the four NOVA groups. From 2008 to 2019 was observed a significant increase in culinary ingredients and a reduction in processed food. Furthermore, it sheds light on the high share of ultra-processed foods in the contemporary British diet.

Background & Aims: Industrial foods have been associated with increased risks of several chronic conditions. We investigated the relationship between the degree of food processing and risks of Crohn's disease (CD) and ulcerative colitis (UC) in the European Prospective Investigation into Cancer and Nutrition cohort., Methods: Analyses included 413,590 participants (68.6% women; mean baseline age, 51.7 y) from 8 European countries. Dietary data were collected at baseline from validated country-specific dietary questionnaires. Associations between proportions of unprocessed/minimally processed and ultraprocessed food intake and CD and UC risks were estimated using Cox models to obtain hazard ratios (HRs) and 95% CIs. Models were stratified by center, age, and sex, and adjusted for smoking status, body mass index, physical activity, energy intake, educational level, and alcohol consumption., Results: During a mean follow-up period of 13.2 years, 179 incident cases of CD and 431 incident cases of UC were identified. The risk of CD was lower in people consuming high proportions of unprocessed/minimally processed foods (adjusted HR for the highest vs lowest quartile: 0.57; 95% CI, 0.35-0.93; P trend < .01), particularly fruits and vegetables (adjusted HRs, 0.54; 95% CI, 0.34-0.87 and 0.55; 95% CI, 0.34-0.91, respectively). There was no association between unprocessed/minimally processed food intake and the risk of UC. No association was detected between ultraprocessed food consumption and CD or UC risks., Conclusions: In the European Prospective Investigation into Cancer and Nutrition cohort, consumption of unprocessed/minimally processed foods was associated with a lower risk of CD. No association between UC risk and food processing was found., (Copyright © 2023. Published by Elsevier Inc.)

The present studies examined experimental transplant outcomes using mobilized peripheral blood from mice and humans together with FoxP3+Treg cells. Donor mice were treated with filgrastim and / or plerixafor and their peripheral blood (PB) displayed significant elevations in hematopoietic stem and progenitor populations. Some of these PB donors were concurrently administered a Treg expansion strategy consisting of a TL1A-Ig fusion protein low dose rIL-2. A significant increase (4-5x) in the frequency Tregs occurred during mobilization. C3H.SW PB was collected from mobilized and Treg unexpanded ("TrUM") or mobilized and Treg expanded ("TrEM") donors and transplanted into MHC-matched B6 (H2b) recipients. Recipients of TrEM, exhibited significantly reduced weight loss and clinical GVHD scores compared to recipients of TrUM. Notably, recipients of TrEM exhibited comparable GVL activity to TrUM recipients against leukemia levels. Next, huTregs (CD4+CD25+CD127lo) from a healthy human PB mobilized donor were expanded ex-vivo prior to transplant into NSG/ NOD-scid IL2Rgammanull mice. We found that treatment with ex-vivo expanded huTregs resulted in significant reduction of lethality and clinical xGVHD scores. Notably, post-transplant, PB huTregs levels remained elevated and the frequency of huCD4+Tconv and CD8+ cells was diminished supporting the improved xGVHD outcomes. These findings demonstrated that the use of mPB containing elevated Treg levels significantly reduced GVHD following "MUD" and MHC-mismatched mouse HSCT without loss of GVL activity. Moreover, utilizing ex-vivo expanded huTregs from a mobilized PB donor and added back to donor PB ameliorated xGVHD. In total, these studies support the notion that in vivo or ex-vivo manipulation of donor Tregs together with mobilized peripheral blood could provide therapeutic approaches to improve aHSCT outcomes., (Copyright © 2023 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.)

This study is to identify victimization patterns and analyze the association between the experience of polyvictimization and overweight or obesity among adolescent girls and boys. The sample consisted of 2680 Brazilian ninth-graders enrolled in public and private schools, taken from the São Paulo Project for the social development of children and adolescents (SP-PROSO). Victimization was explored in two ways: (i) as per Finkelhor and (ii) by latent class analysis (LCA). The interest outcomes were overweight and obesity. Multinomial logistic regression models were used to study the relationship between victimization and overweight or obesity, controlling for confounders. LCA grouped boys and girls adolescents into three classes. These classes received the same labels, but the patterns differed between sexes. Class 1 was characterized by fewer types of victimization suffered and lower endorsement values in the analyzed items and was named bullying and indirect victimization (♀: 42.7%, n = 546; ♂: 21.6%, n = 293). Class 2 included more victimization types than Class 1 and less than Class 3. This class was labeled family violence and peer victimization (♀: 29.1%, n = 356; ♂: 47.9%, n = 652). Class 3 was named high polyvictimization (♀: 28.2%, n = 345; ♂: 30.5%, n = 418). According to Finkelhor, polyvictimization was not associated with overweight or obesity in both sexes. Only the class of high polyvictimization was associated with being overweight (OR adj : 1.60, 95%CI: 1.01-2.54) in girls. In this study, polyvictimization was associated with being overweight only among adolescent girls. Longitudinal studies in different contexts and populations are needed to understand this relationship., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The authors declare the following financial interests/personal relationships which may be considered as potential competing interests., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: To evaluate sociodemographic factors associated with the consumption of ultra-processed foods and the temporal evolution of their consumption in Brazil between 2008 and 2018., Methods: The study used food consumption data of individuals aged ≥ 10 years from 2008-2009 and 2017-2018 Pesquisas de Orçamentos Familiares (POF - Household Budget Surveys), grouping the foods according to the Nova classification. We used crude and adjusted linear regression models to assess the association between sociodemographic characteristics and consumption of ultra-processed foods in 2017-2018 and the temporal variation in their consumption between 2008 and 2018., Results: Ultra-processed foods accounted for 19.7% of calories in 2017-2018. The adjusted analysis showed that their consumption was higher in women (versus men) and the South and Southeast regions (versus North) and lower in blacks (versus whites) and rural areas (versus urban), in addition to decreasing with the increased age and increasing with higher education and income. Consumption of ultra-processed foods increased by 1.02 percentage points (pp) from 2008-2009 to 2017-2018. This increase was significantly higher among men (+1.59 pp), black people (+2.04 pp), indigenous (+5.96 pp), in the rural area (+2.43 pp), those with up to 4 years of schooling (+1.18 pp), in the lowest income quintile (+3.54 pp), and the North (+2.95 pp) and Northeast (+3.11 pp) regions. On the other hand, individuals in the highest level of schooling (-3.30 pp) and the highest income quintile (-1.65 pp) reduced their consumption., Conclusions: The socioeconomic and demographic segments with the lowest relative consumption of ultra-processed foods in 2017-2018 are precisely those that showed the most significant increase in the temporal analysis, pointing to a trend towards national standardization at a higher level of consumption.

Purpose: This study aims to describe micronutrient intake according to food processing degree and to investigate the association between the dietary share of ultra-processed foods and micronutrient inadequacies in a representative sample of Portuguese adult and elderly individuals., Methods: Cross-sectional data from the National Food, Nutrition and Physical Activity Survey (2015/2016) were used. Food consumption data were collected through two 24-h food recalls, and food items were classified according to the NOVA system. Linear regression models were used to assess the association between the micronutrient density and the quintiles of ultra-processed food consumption-crude and adjusted. Negative Binomial regressions were performed to measure the prevalence ratio of micronutrient inadequacy according to ultra-processed food quintiles., Results: For adults, all evaluated vitamins had significantly lower content in the fraction of ultra-processed foods compared to unprocessed or minimally processed foods, except vitamin B2. For the elderly, out of ten evaluated vitamins, seven presented significantly less content in ultra-processed foods compared to non-processed ones. The higher energy contribution of ultra-processed foods in adults was associated with a lower density of vitamins and minerals. This association was not observed in the elderly. For adults, compared with the first quintile of ultra-processed food consumption, the fifth quintile was positively associated with inadequate intakes of vitamin B6 (PR 1.51), vitamin C (PR 1.32), folate (PR 1.14), magnesium (PR 1.21), zinc (PR 1.33), and potassium (PR 1.19)., Conclusion: Our results corroborate the importance of public health actions that promote a reduction in the consumption of ultra-processed foods., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Purpose: To investigate the role of aggressive meibomian gland dysfunction (MGD) in the immune pathogenesis of ocular graft-vs-host disease (GVHD)., Methods: In mice, an allogeneic GVHD model was established by transferring bone marrow (BM) and purified splenic T cells from C57BL/6J mice into irradiated C3-SW.H2b mice (BM+T). Control groups received BM only. Mice were scored clinically across the post-transplantation period. MGD severity was categorized using the degree of atrophy on harvested lids. Immune disease was analyzed using flow cytometry of tissues along with fluorescent tracking of BM cells onto the ocular surface. In humans, parameters from 57 patients with ocular GVHD presenting to the Duke Eye Center were retrospectively reviewed. MGD was categorized using the degree of atrophy on meibographs. Immune analysis was done using high-parameter flow cytometry on tear samples., Results: Compared with BM only, BM+T mice had higher systemic disease scores that correlated with tear fluid loss and eyelid edema. BM+T had higher immune cell infiltration in the ocular tissues and higher CD4+-cell cytokine expression in draining lymph nodes. BM+T mice with worse MGD scores had significantly worse corneal staining. In patients with ocular GVHD, 96% had other organs affected. Patients with ocular GVHD had abnormal parameters on dry eye testing, high matrix metalloproteinase-9 positivity (92%), and abundance of immune cells in tear samples. Ocular surface disease signs were worse in patients with higher MGD severity scores., Conclusions: Ocular GVHD is driven by a systemic, T-cell-dependent process that causes meibomian gland damage and induces a robust form of ocular surface disease that correlates with MGD severity. NOTE: Publication of this article is sponsored by the American Ophthalmological Society., (Copyright © 2022. Published by Elsevier Inc.)

Objective: To investigate the association between ultra-processed food (UPF) consumption and the incidence of metabolic syndrome (MetS)., Research Design and Methods: From 2008 to 2010, we enrolled 15,105 adults, aged 35-74 years, who were employees from six public education and research institutions to assemble the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). We used a food frequency questionnaire to assess UPF consumption (measured in grams per day) at baseline. We then assessed the outcomes of those returning to visits between 2012 and 2014 and between 2017 and 2019. We defined incident MetS by the presence of at least three of the following five abnormalities: high fasting glucose level, high triglyceride level, low HDL cholesterol level, high blood pressure, and abdominal obesity, after excluding those meeting such criteria at baseline. We also excluded those who had missing data or an implausible energy intake, leaving 8,065 participants in the study., Results: The median age was 49 years, 59% of participants were women, and the median consumption of UPFs was 366 g/day. After 8 years, there were 2,508 new cases of MetS. In robust Poisson regression, adjusting for sociodemographics, behavioral factors, and energy intake, we found a 7% (relative risk [RR] 1.07; 95% CI 1.05-1.08) higher risk of incident MetS for an increase of 150 g/day in UPF consumption. Similarly, those in the fourth quartile (compared with the first quartile) had a 33% increased risk (RR 1.33; 95% CI 1.20-1.47). Further adjustment for BMI attenuated these associations (for 150 g/day increases in UPF consumption and for the fourth quartile compared to the first one, respectively, RR = 1.04, 95% CI 1.02-1.06; RR = 1.19, 95% CI 1.07-1.32)., Conclusions: Greater consumption of UPFs is associated with an increased risk of MetS. These findings have important implications for diabetes and cardiovascular disease prevention and management., (© 2023 by the American Diabetes Association.)

Background: Global dietary patterns are increasingly dominated by relatively cheap, highly palatable, and ready-to-eat ultra-processed foods (UPFs). However, prospective evidence is limited on cancer development and mortality in relation to UPF consumption. This study examines associations between UPF consumption and risk of cancer and associated mortality for 34 site-specific cancers in a large cohort of British adults., Methods: This study included a prospective cohort of UK Biobank participants (aged 40-69 years) who completed 24-h dietary recalls between 2009 and 2012 (N = 197426, 54.6% women) and were followed up until Jan 31, 2021. Food items consumed were categorised according to their degree of food processing using the NOVA food classification system. Individuals' UPF consumption was expressed as a percentage of total food intake (g/day). Prospective associations were assessed using multivariable Cox proportional hazards models adjusted for baseline socio-demographic characteristics, smoking status, physical activity, body mass index, alcohol and total energy intake., Findings: The mean UPF consumption was 22.9% (SD 13.3%) in the total diet. During a median follow-up time of 9.8 years, 15,921 individuals developed cancer and 4009 cancer-related deaths occurred. Every 10 percentage points increment in UPF consumption was associated with an increased incidence of overall (hazard ratio, 1.02; 95% CI, 1.01-1.04) and specifically ovarian (1.19; 1.08-1.30) cancer. Furthermore, every 10 percentage points increment in UPF consumption was associated with an increased risk of overall (1.06; 1.03-1.09), ovarian (1.30; 1.13-1.50), and breast (1.16; 1.02-1.32) cancer-related mortality., Interpretation: Our UK-based cohort study suggests that higher UPF consumption may be linked to an increased burden and mortality for overall and certain site-specific cancers especially ovarian cancer in women., Funding: The Cancer Research UK and World Cancer Research Fund., Competing Interests: All authors declare no conflict of interest., (© 2023 The Author(s).)

Objective: To analyze the dietary patterns of Brazilian children under two years of age and assess their association with sociodemographic characteristics and health service use., Methods: This is a cross-sectional study with data from the 2013 National Health Survey (PNS). Patterns were found for two age groups by principal component analysis and their correlation with characteristics of interest was tested by linear regression models., Results: We found two dietary patterns for our groups. The first consisted of the consumption of fresh or minimally processed foods and the second, of ultra-processed foods. The greater adherence of children between six and 11 months to the first pattern was associated with higher per capita family income and urban residences in the most developed regions of Brazil. At 12 months or more, adherence related to white race/color, higher per capita family incomes, residence in more developed regions, and visits to private childcare. Adherence to the second pattern among children under one year of age was inversely associated with Yellow or Indigenous race/color, residence in the Brazilian Northeast, and childcare in specialized public or private services. At 12 months or more, greater adherence was directly associated with Black or Brown children who resided in more developed regions, and inversely associated with those living in the Brazilian Northeast., Conclusion: We found two opposite dietary patterns in Brazilian children under two years of age and that several social determinants modify their chance of adhering to these patterns.