Background The consumption of some food groups is associated with the risk of diabetes. However, there is no evidence from meta-analysis which evaluates the consumption of ultra-processed products in the risk of diabetes. This study aimed to review the literature assessing longitudinally the association between consumption of ultra-processed food and the risk of type 2 diabetes and to quantify this risk through a meta-analysis. Methods We conducted a systematic review and meta-analysis with records from PubMed, Latin American and Caribbean Literature in Health Sciences (LILACS), Scielo, Scopus, Embase, and Web of Science. We included longitudinal studies assessing ultra-processed foods and the risk of type 2 diabetes. The review process was conducted independently by two reviewers. The Newcastle Ottawa scale assessed the quality of the studies. A meta-analysis was conducted to assess the effect of moderate and high consumption of ultra-processed food on the risk of diabetes. Results In total 2272 records were screened, of which 18 studies, including almost 1.1 million individuals, were included in this review and 72% showed a positive association between ultra-processed foods and the risk of diabetes. According to the studies included in the meta-analysis, compared with non-consumption, moderate intake of ultra-processed food increased the risk of diabetes by 12% [relative risk (RR): 1.12; 95% confidence interval (CI): 1.06–1.17, I2 = 24%], whereas high intake increased risk by 31% (RR: 1.31; 95% CI: 1.21–1.42, I2 = 60%). Conclusions The consumption of ultra-processed foods increased the risk for type 2 diabetes as dose-response effect, with moderate to high credibility of evidence.

OBJECTIVE: To systematically review the evidence for the association between food consumption according to processing and cardiometabolic factors in adults and/or the elderly. METHOD: Two independent evaluators analyzed the electronic databases PubMed, Web of Science and Lilacs until December 2018. We used the following terms: (convenience foods OR food processing OR highly-processed OR industrialized foods OR minimally-processed OR prepared foods OR processed foods OR ultra-processed OR ultraprocessed OR ultra processed OR unprocessed) AND (metabolic syndrome OR hypertension OR blood pressure OR diabetes mellitus OR glucose OR glycaemia OR insulin OR cholesterol OR triglycerides OR blood lipids OR overweight OR obesity) AND (adult OR adults OR adulthood OR aged OR elderly OR old). We assessed methodological and evidence qualities, and also extracted information for the qualitative synthesis from the selected studies. RESULTS: Of the 6,423 studies identified after removing duplicates, eleven met the eligibility criteria. The main food classification we used was Nova. The consumption of ultra-processed foods was positively associated with overweight and obesity, high blood pressure and metabolic syndrome. All articles included met more than 50% of the methodological quality criteria. The quality of evidence was considered moderate for the outcome overweight and obesity and weak for hypertension and metabolic syndrome. CONCLUSIONS: The Nova food classification stands out in the area of nutritional epidemiology when assessing the effects of food processing on health outcomes. Although caution is required in the interpretation, the results indicated that the consumption of ultra-processed foods can have an unfavorable impact in the health of individuals.

Resumo Este artigo avalia o conhecimento dos agentes comunitários de saúde em alimentação complementar e sua associação com características sociodemográficas, rotinas de trabalho e descreve os recursos disponíveis nas unidades básicas de saúde para que tenham domínio neste tema. Foi aplicado um questionário ao responsável do serviço de saúde e outro aos agentes comunitários de saúde, este último composto pelo teste de conhecimento que permitiu o cálculo de escores conforme o número de acertos em questões de múltipla escolha. Houve associação positiva com idade, tempo de profissão, visitas domiciliares a crianças com até 24 meses, realizar orientações e buscar informações sobre alimentação complementar com o conhecimento em alimentação nos primeiros 24 meses de vida. Evidenciou-se desacordo entre as respostas do serviço de saúde e dos agentes comunitários de saúde quanto a treinamentos, materiais governamentais e acompanhamento do crescimento infantil. Verificou-se maior domínio em aleitamento materno em relação à alimentação complementar, portanto, a unidade básica de saúde deve oferecer respaldo e recursos que ampliem o conhecimento em alimentação complementar, mediante treinamentos e acesso facilitado aos materiais governamentais.

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This study aimed to evaluate the association between ultra-processed foods (UPF) on serum interleukin-6 (IL-6), and to investigate the mediation role of adiposity. Participants were 524 adults from the EPITeen Cohort (Porto, Portugal) and 2888 participants from the 1982 Pelotas Birth Cohort (Pelotas, Brazil). Dietary intake was collected using food frequency questionnaires (FFQ) when participants were 21 years of age in the EPITeen and 23 years in the Pelotas Cohort. Serum IL-6 and body fat mass were evaluated when participants were 27 and 30 years old in the EPITeen and Pelotas, respectively. Generalized linear models were fitted to test main associations. Mediation of body fat mass was estimated using G-computation. After adjustment for socio-economic and behavior variables, among females from the EPITeen, the concentration of IL-6 (pg/mL) increased with increasing intake of UPF from 1.31 (95% CI 0.95; 1.82) in the first UPF quartile to 2.20 (95% CI 1.60; 3.01) and 2.64 (95% CI 1.89; 3.69) for the third and fourth UPF quartiles, respectively. A similar result was found among males in the Pelotas Cohort, IL-6 increased from 1.40 (95% CI 1.32; 1.49) in the first UPF quartile to 1.50 (95% CI 1.41; 1.59) and 1.59 (95% CI 1.49; 1.70) in the two highest UPF quartiles. The p-value for the linear trend was <0.01 in both findings. The indirect effect through fat mass was not significant. Our findings suggest that the consumption of UPF was associated with an increase in IL-6 concentration, however, this association was not explained by adiposity.