1 Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo ,Brazil; 2 Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de São Paulo, São Paulo, Brazil; 3 Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Background: Rates of obesity, diabetes, and other diet-related chronic diseases have significantly increased worldwide while micronutrient deficiencies remains a serious public health problem, particularly in low- and middle-income countries. This scenarium is paralleled with recent transformations in the dietary patterns, mainly characterized by displacement of natural or minimally processed foods and handmade dishes based on these foods by readyto- consume, ultra-processed food and drink products. Objective: To evaluate the impact of the consumption of ultra-processed foods on the overall dietary quality in Brazil. Methods: This study comprised the analysis of data from a dietary survey carried out in Brazil along with the 2008–2009 National Household Budget Survey. Data analyzed came from two 24-hour food records applied to a probabilistic sample of 32, 898 Brazilians aged 10 and older. All food items were classified into three groups: natural or minimally processed foods (including handmade dishes based on these foods), processed foods and ultra-processed foods (drinks included). Results: Mean daily per capita energy intake was 1866 kcal, of which 69.5% came from natural or minimally processed foods, 9.0% from processed foods and 21.5% from ultra-processed foods. The nutrient profile of ultra-processed foods, compared to natural or minimally processed foods, revealed higher energy density, higher content in total fat, saturated fat, trans fats, and added sugar and lower in fiber, protein and most vitamins and minerals. Higher contribution of ultra-processed foods to the total diet was associated with an overall deterioration of the dietary quality. The 20% lowest consumers of ultra-processed foods were anywhere near reaching international nutrient goals for the prevention of obesity and chronic non-communicable diseases. Conclusions: Our findings indicate that the reduction of the consumption of ultra-processed foods is a natural pathway to prevent diet-related chronic diseases and micronutrient deficiencies and, therefore, support the recommendation to avoid these foods.