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Determinants of ultra-processed food consumption in Brazilian children and adolescents with type 1 diabetes mellitus: a cross-sectional study

  • Karine Lopes da Rocha , Raquel Nascimento Chanca Silvério , Roberta Ferreira Fortins , Mayara Silva dos Santos , Cleber Nascimento do Carmo , Veronica Medeiros da Costa , Jorge Luiz Luescher and Patricia de Carvalho Padilha EMAIL logo
Published/Copyright: August 6, 2021
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 34 Issue 11

Abstract

Objectives

To analyze the determinants of UPP consumption among children and adolescents with type 1 diabetes mellitus.

Methods

Cross-sectional study at a reference hospital for the treatment of diabetes in Rio de Janeiro, Brazil. The sociodemographic, anthropometric, dietary, and clinical factors associated with the percentage of total energy intake (TEI) consumed in the form of UPP were investigated. Food consumption was assessed by 24 h recall and the foods were classified according to the degree of processing as described in the NOVA classification, after which the TEI of each food group was calculated. Multiple linear regression was adopted in the analysis, and associations with p<0.05 were considered significant.

Results

The study included 120 children and adolescents with a mean age of 11.74 ± 2.88 years, 53.3% female. Body mass index z-score was 0.65 (± 0.89) and 31.7% (n=38) were overweight. The average total energy consumption was 1,756.38 kcal (± 518.38). The mean percentage of TEI from UPP was 24.2% ± 17.9, meaning that 425.59 kcal (± 380.15) of all calories ingested came from such foods. The independent variables associated with the percentage of ultra-processed foods (UPP) in TEI were: per capita household income up to one the minimum wage (β: −22.03; CI 95% −35.24 to −8.82); and parents/guardians schooling of the up to nine years in formal education (β: 19.86; CI 95% 8.27–31.45).

Conclusions

Lower household income and fewer years in formal education seem to determine a preference for UPP over fresh and minimally processed foods.

Highlights

  • – Lower household income and education of parents/guardians seem to result in a preference for ultra-processed foods over fresh and minimally processed foods.

  • – Low education may result in reduced adherence to treatment of children and adolescents with T1DM and may cause difficulty in understanding medication use and nutritional treatment focused on healthy eating.

Keywords: adolescent; child; diet; food; nutrition; type 1 diabetes mellitus; ultra-processed foods
Corresponding author: Patricia de Carvalho Padilha, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Av. Carlos Chagas Filho, 373/ Centro de Ciências da Saúde, bloco J2, sala 007, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ , 21941-590, Brazil; and Martagão Gesteira Child Care and Pediatrics Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil, Phone: 55 (21) 2562-6432, Fax: 55 (21) 2280-8343, E-mail

Acknowledgments

PCP would like to acknowledge National Council for Scientific and Technological Development (CNPq, Portuguese: Conselho Nacional de Desenvolvimento Científico e Tecnológico).

  1. Research funding: None declared.

  2. Author contributions: All authors accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: The authors have no conflicts of interest to declare.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The local Institutional Review Board deemed the study exempt from review.

References

1. American Diabetes Association (ADA). Standards of medical care in diabetes. J Clin Appl Res Educ 2019;42:1. https://doi.org/10.2337/cd19-0002.Search in Google Scholar PubMed PubMed Central

2. International Diabetes Federation. IDF diabetes atlas, 9th ed. Brussels, Belgium: International Diabetes Federation; 2019.Search in Google Scholar

3. Sociedade Brasileira de Diabetes (SBD). Diretrizes da Sociedade Brasileira de Diabetes. São Paulo: A.C. Farmacêutica; 2017.Search in Google Scholar

4. Nansel, TR, Haynie, DL, Lipsky, LM, Laffel, LM, Mehta, SN. Multiple indicators of poor diet quality in children and adolescents with type 1 diabetes are associated with higher body mass index percentile but not glycemic control. J Acad Nutr Diet 2012;112:1728–35. https://doi.org/10.1016/j.jand.2012.08.029.Search in Google Scholar PubMed PubMed Central

5. Nansel, TR, Lipsky, LM, Liu, A. Greater diet quality is associated with more optimal glycemic control in a longitudinal study of youth with type 1 diabetes. Am J Clin Nutr 2016;104:81–7. https://doi.org/10.3945/ajcn.115.126136.Search in Google Scholar PubMed PubMed Central

6. Tavares, LF, Fonseca, SC, Garcia Rosa, ML, Yokoo, EM. Relationship between ultra-processed foods and metabolic syndrome in adolescents from a Brazilian family doctor program. Publ Health Nutr 2012;15:82–7. https://doi.org/10.1017/s1368980011001571.Search in Google Scholar

7. Rauber, F, Campagnolo, PD, Hoffman, DJ, Vitolo, MR. Consumption of ultra-processed food products and its effects on children’s lipid profiles: a longitudinal study. Nutr Metabol Cardiovasc Dis 2015;25:116–22. https://doi.org/10.1016/j.numecd.2014.08.001.Search in Google Scholar PubMed

8. Rinaldi, AE, Gabriel, GF, Moreto, F, Corrente, JE, KC, ML, Burini, RC. Dietary factors associated with metabolic syndrome and its components in overweight and obese Brazilian schoolchildren: a cross-sectional study. Diabetol Metab Syndrome 2016;8:58. https://doi.org/10.1186/s13098-016-0178-9.Search in Google Scholar PubMed PubMed Central

9. Corrêa, EN, Retondario, A, Alves, MA, Bricarello, LP, Rockenbach, G, Hinnig, PF, et al.. Utilization of food outlets and intake of minimally processed and ultra-processed foods among 7–14-year-old school children. A cross-sectional study. São Paulo Med J 2018;136:200–7. https://doi.org/10.1590/1516-3180.2017.0211061217.Search in Google Scholar PubMed

10. Alves, MN, Muniz, LC, Vieira, MFA. Consumo alimentar entre crianças brasileiras de dois a cinco anos de idade: Pesquisa Nacional de Demografia e Saúde (PNDS), 2006. Ciência Saúde Coletiva 2013;18:3369–77. https://doi.org/10.1590/s1413-81232013001100026.Search in Google Scholar PubMed

11. Brasil. Pesquisa de orçamentos familiares 2008–2009: análise do consumo alimentar pessoal no Brasil/IBGE. Rio de Janeiro: IBGE; 2011:150 p.Search in Google Scholar

12. Karnopp, EVN, Vaz, JS, Schafer, AA, Muniz, LC, Souza, RLV, Santos, I, et al.. Food consumption of children younger than six years according to the degree of food processing. J Pediatr 2017;93:70–8. https://doi.org/10.1016/j.jped.2016.04.007.Search in Google Scholar PubMed

13. Wilkin, TJ. Point/counterpoint article. The convergence of type 1 and type 2 diabetes in childhood. The accelerator hypothesis. Pediatr Diabetes 2011;13:334–9. https://doi.org/10.1111/j.1399-5448.2011.00831.x.Search in Google Scholar PubMed

14. Priya, G, Kalra, S. A review of insulin resistance in type 1 diabetes: is there a place for adjunctive metformin? Diabetes Ther 2018;9:349–61. https://doi.org/10.1007/s13300-017-0333-9.Search in Google Scholar PubMed PubMed Central

15. Hyppönen, E, Virtanen, SM, Kenward, MG, Knip, M, Åkerblom, HK. Obesity, increased linear growth, and risk of type 1 diabetes in children. Diabetes Care 2000;23:1755–60. https://doi.org/10.2337/diacare.23.12.1755.Search in Google Scholar PubMed

16. Monteiro, CA, Levy, RB, Claro, RM, Castro, IR, Cannon, G. A new classification of foods based on the extent and purpose of their processing. Cad Saúde Pública 2010;26:2039–49. https://doi.org/10.1590/s0102-311x2010001100005.Search in Google Scholar PubMed

17. Davison, KAK, Negrato, CA, Cobas, R, Matheus, A, TannusL, Palma, CS, et al.. Relationship between adherence to diet, glycemic control and cardiovascular risk factors in patients with type 1 diabetes: a nationwide survey in Brazil. Nutr J 2014;7:13–9. https://doi.org/10.1186/1475-2891-13-19.Search in Google Scholar PubMed PubMed Central

18. Onis, M, Onyango, AW, Borghi, E, Siyam, A, Nishida, C, Siekmann, J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 2007;85:660–7. https://doi.org/10.2471/blt.07.043497.Search in Google Scholar PubMed PubMed Central

19. Pinheiro, ABV, Lacerda, EMA, Benzecry, EH, Gomes, MCS, Costa, VM. Tabela para avaliação de consumo alimentar em medidas caseiras, 5a edição. São Paulo: EditoraAtheneu; 2005.Search in Google Scholar

20. Tabela Brasileira de Composição de Alimentos (TACO). Núcleo de Estudos e Pesquisa em Alimentação – UNICAMP, 4th ed. Campinas: Rev. e ampl; 2011:161 p.Search in Google Scholar

21. Relvas, GRB, Buccini, GS, Venancio, SI. Ultra-processed food consumption among infants in primary health care in a city of the metropolitan region of São Paulo, Brazil. J Pediatr 2019;95:584–92. https://doi.org/10.1016/j.jped.2018.05.004.Search in Google Scholar PubMed

22. Monteiro, CA, Cannon, G, Levy, R, Moubarac, JC, Jaime, P, Martins, AP, et al.. NOVA. The star shines bright. World Nutr 2016;7:28–38.Search in Google Scholar

23. Monteiro, CA, Cannon, G, Moubarac, JC, Levy, RB, Louzada, MLC, Jaime, PC. The UN decade of nutrition, the NOVA food classification and the trouble with ultra-processing. Publ Health Nutr 2018;21:5–17. https://doi.org/10.1017/s1368980017000234.Search in Google Scholar

24. Conway, JM, Ingwersen, LA, Vinyard, BT, Moshfegh, AJ. Effectiveness of the US Department of Agriculture five-step multiple-pass method in assessing food intake in obese and nonobese women. Am J Clin Nutr 2003;77:1171–8. https://doi.org/10.1093/ajcn/77.5.1171.Search in Google Scholar PubMed

25. Miqueleiz, E, Lostao, L, Ortega, P, Santos, JM, Astasio, P, Regidor, E. Patrón socioeconómico enlaalimentación no saludable em ninos y adolescentes en Espana. Atencion Primaria 2014;46:433–9. https://doi.org/10.1016/j.aprim.2013.05.010.Search in Google Scholar PubMed PubMed Central

26. Giesta, JM, Zoche, E, Corrêa, RS, Bosa, VL. Fatores associados à introdução precoce de alimentos ultraprocessados na alimentação de crianças menores de dois anos. Ciência Saúde Coletiva 2019;24:2387–97. https://doi.org/10.1590/1413-81232018247.24162017.Search in Google Scholar PubMed

27. D’Avila, HF, Kirsten, VR. Consumo energético proveniente de alimentos ultraprocessados por adolescentes. Rev Paul Pediatr 2017;35:54–60.10.1590/1984-0462/;2017;35;1;00001Search in Google Scholar

28. Barcelos, GT, Rauber, F, Vitolo, MR. Produtos processados e ultraprocessados e ingestão de nutrientes em crianças. Rev Ciência Saúde Coletiva 2014;7:155–61. https://doi.org/10.15448/1983-652x.2014.3.19755.Search in Google Scholar

29. Monteiro, CA, Levy, BR, Claro, RM, Castro, IRR, Cannon, G. Increasing consumption of ultra-processed foods and likely impact on human health: evidence from Brazil. Publ Health Nutr 2010;14:5–13. https://doi.org/10.1017/s1368980010003241.Search in Google Scholar

30. Poti, JM, Mendez, MA, Ng, SW, Popkin, BM. Is the degree of food processing and convenience linked with the nutritional quality of foods purchased by US households? Am J Clin Nutr 2015;101:1251–62. https://doi.org/10.3945/ajcn.114.100925.Search in Google Scholar

31. Sparrenberger, K, Friedrich, RR, Schiffner, MD, Schuch, I, Wagner, MB. Ultra-processed food consumption in children from a basic health unit. J Pediatr 2015;91:535–42. https://doi.org/10.1016/j.jped.2015.01.007.Search in Google Scholar

32. Wijtzes, AI, Jansen, W, Jansen, PW, Jaddoe, VWV, Hofman, A, Raat, H. Maternal educational level and preschool children’s consumption of high-calorie snacks and sugar-containing beverages: mediation by the family food environment. Prev Med 2013;57:607–12. https://doi.org/10.1016/j.ypmed.2013.08.014.Search in Google Scholar

33. Momm, N, Höfelmann, DA. Qualidade da dieta e fatores associados em crianças matriculadas em uma escola municipal de Itajaí, Santa Catarina. Cad Saúde Coletiva 2014;22:32–9. https://doi.org/10.1590/1414-462x201400010006.Search in Google Scholar

34. Martins, APB, Levy, RB, Claro, RF, Moubarac, JC, Monteiro, CA. Participação crescente de produtos ultraprocessados na dieta brasileira (1987–2009). Rev Saude Publica 2013;47:656–65. https://doi.org/10.1590/s0034-8910.2013047004968.Search in Google Scholar

35. Enes, CC, Camargo, CM, Justino, MIC. Ultra-processed food consumption and obesity in adolescents. Rev Nutr 2019;32:e18170. https://doi.org/10.1590/1678-9865201932e180170.Search in Google Scholar

36. Da Costa, VM, Padilha, PC, Lima, GCF, Ferreira, AA, Luescher, JL, Porto, L, et al.. Overweight among children and adolescent with type I diabetes mellitus: prevalence and associated factors. Diabetol Metab Syndrome 2016;8:39. https://doi.org/10.1186/s13098-016-0154-4.Search in Google Scholar

37. Liu, LL, Lawrence, JM, Davis, C, Liese, DA, Pettitt, DJ, Pihoker, C, et al.. Prevalence of overweight and obesity in youth with diabetes in USA: the SEARCH for diabetes in youth study. Pediatr Diabetes 2010;11:4–11. https://doi.org/10.1111/j.1399-5448.2009.00519.x.Search in Google Scholar PubMed

38. Chillarón, JJ, Benaiges, D, Mañé, L, Pedro-Botet, J, Flores Le-Roux, JA. Obesity and type 1 diabetes mellitus management. Minerva Endocrinol 2015;40:53–60.Search in Google Scholar

39. Ferranti, SD, Boer, IH, Fonseca, V, Fox, CS, Golden, SH, Lavie, CJ, et al.. Type 1 diabetes mellitus and cardiovascular disease. A scientific statement from the American Heart Association and American Diabetes Association. Circulation 2014;130:1110–30. https://doi.org/10.1161/cir.0000000000000034.Search in Google Scholar PubMed

40. Valerio, L, Iafusco, D, Zucchini, S, Maffeis, C, Study-Group on Diabetes of Italian Society of Pediatric Endocrinology and Diabetology. Abdominal adiposity and cardiovascular risk factors in adolescents with type 1 diabetes. Diabetes Res Clin Pract 2012;97:99–104. https://doi.org/10.1016/j.diabres.2012.01.022.Search in Google Scholar PubMed

41. Brasil. Cadernos de atenção básica. Guia alimentar para a população brasileira/Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Atenção Básica. Brasília: Ministério da Saúde; 2014:156 p.Search in Google Scholar

42. Patton, SR. Adherence to diet in youth with type 1 diabetes. J Am Diet Assoc 2011;111:550–5. https://doi.org/10.1016/j.jada.2011.01.016.Search in Google Scholar PubMed PubMed Central

43. Meissner, T, Wolf, J, Kersting, M, Reiterer, EF, Mors, MF, Salgin, B, et al.. Carbohydrate intake in relation to BMI, HbA1c and lipid profile in children and adolescents with type 1 diabetes. Clin Nutr 2014;33:75–8. https://doi.org/10.1016/j.clnu.2013.03.017.Search in Google Scholar PubMed

44. Fortins, RF, Lacerda, EMA, Silverio, RNC, Carmo, CN, Ferreira, AA, Felizardo, C, et al.. Predictor factors of glycemic control in children and adolescents with type 1 diabetes mellitus treated at a referral service in Rio de Janeiro, Brazil. Diabetes Res Clin Pract 2019;154:138–45. https://doi.org/10.1016/j.diabres.2019.05.027.Search in Google Scholar PubMed

45. Smart, CE, Ross, K, Edge, JA, King, BR, McElduff, P, Collins, CE. Can children with Type 1 diabetes and their caregivers estimate the carbohydrate content of meals and snacks? Diabet Med 2010;27:348–53. https://doi.org/10.1111/j.1464-5491.2010.02945.x.Search in Google Scholar PubMed

46. Mehta, SN, Quinn, N, Volkening, LK, Laffel, LM. Impact of carbohydrate counting on glycemic control in children with type 1 diabetes. Diabetes Care 2009;32:1014–6. https://doi.org/10.2337/dc08-2068.Search in Google Scholar PubMed PubMed Central

47. Louzada, MLDC, Ricardo, CZ, Steele, EM, Levy, RB, Cannon, G, Monteiro, CA. The share of ultra-processed foods determines the overall nutritional quality of diets in Brazil. Publ Health Nutr 2018;21:94–102. https://doi.org/10.1017/s1368980017001434.Search in Google Scholar

48. Claro, RM, Santos, MAS, Oliveira, TP, Pereira, CA, Szwarcwald, CL, Malta, DC. Consumo de alimentos não saudáveis relacionados a doenças crônicas não transmissíveis no Brasil: Pesquisa Nacional de Saúde, 2013. Epidemiol Serv Saúde 2015;24:257–65. https://doi.org/10.5123/s1679-49742015000200008.Search in Google Scholar

49. Gomes, MB, Santos, DC, Pizarro, MH, Melo, LGN, Barros, BSV, Junior, RM, et al.. Relationship between health care insurance status, social determinants and prevalence of diabetes-related microvascular complications in patients with type 1 diabetes: a nationwide survey in Brazil. Acta Diabetol 2019;56:697–705. https://doi.org/10.1007/s00592-019-01308-7.Search in Google Scholar PubMed

Received: 2020-12-25
Accepted: 2021-06-20
Published Online: 2021-08-06
Published in Print: 2021-11-25

© 2021 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/jpem-2020-0739
Keywords for this article
adolescent; child; diet; food; nutrition; type 1 diabetes mellitus; ultra-processed foods

Articles in the same Issue

  1. Frontmatter
  2. Review Article
  3. An endocrine perspective on menstrual suppression for adolescents: achieving good suppression while optimizing bone health
  4. Original Articles
  5. Anthropometric, metabolic, and reproductive outcomes of patients with central precocious puberty treated with leuprorelin acetate 3-month depot (11.25 mg)
  6. Evaluation of the resilience of the girls with central precocious puberty treated with gonadotropin-releasing hormone analog
  7. The effect of GnRH stimulation on AMH regulation in central precocious puberty and isolated premature thelarche
  8. Association of the apoptotic marker APO1/Fas with children’s predisposing factors for metabolic syndrome and with mean platelet volume
  9. Serum adiponectin, body adiposity and metabolic parameters in obese Egyptian children with Down syndrome
  10. Urinary iodine and thyroglobulin are useful markers in infants suspected of congenital hypothyroidism based on newborn screening
  11. Comparison of plasmapheresis with medical apheresis in terms of efficacy and cost in the acute treatment of hypertriglyceridemia in children with lipoprotein lipase deficiency
  12. Clinical, biochemical and genotypical characteristics in biotinidase deficiency
  13. High uric acid levels in overweight and obese children and their relationship with cardiometabolic risk factors: what is missing in this puzzle?
  14. Optimizing pediatric histrelin implantation to improve success rates in clinic without sedation
  15. Determinants of ultra-processed food consumption in Brazilian children and adolescents with type 1 diabetes mellitus: a cross-sectional study
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  21. A novel synonymous homozygous variant [c.2538G>A (p.Thr846Thr)] in TRPM6 in a patient with hypomagnesemia with secondary hypocalcemia
  22. Idiopathic juvenile osteoporosis in a child: a four-year follow-up with review of literature
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