Objective: To evaluate the association of ultra-processed food (UPF) consumption with gains in weight and waist circumference, and incident overweight/obesity, in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort.Design: We applied FFQ at baseline and categorized energy intake by degree of processing using the NOVA classification. Height, weight and waist circumference were measured at baseline and after a mean 3·8-year follow-up. We assessed associations, through Poisson regression with robust variance, of UPF consumption with large weight gain (1·68 kg/year) and large waist gain (2·42 cm/year), both being defined as ≥90th percentile in the cohort, and with incident overweight/obesity.Setting: Brazil.Participants: Civil servants of Brazilian public academic institutions in six cities (n11 827), aged 35–74 years at baseline (2008–2010).Results: UPF provided a mean 24·6 (sd9·6) % of ingested energy. After adjustment for smoking, physical activity, adiposity and other factors, fourth (>30·8 %)v. first (17·8 % of energy as UPF.Conclusions: Greater UPF consumption predicts large gains in overall and central adiposity and may contribute to the inexorable rise in obesity seen worldwide.

Introduction: Alzheimer's disease (AD) is a neurodegeneration disorder characterized by progressive impairments of memory, language, reasoning, and other cognitive functions. Evidence suggests that omega-3 fatty acids may act as a possible protection factor in AD. Objective: To evaluate the results available in the literature involving omega-3 fatty acids supplementation and its effect on cognitive function in AD patients. Methods: A systematic review of MEDLINE (from PubMed), Excerpta Medica Database, and Cochrane Library databases was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria consisted in original intervention studies, controlled by placebo, that assessed the impact of supplementation or dietary intake of omega-3 fatty acids on cognitive function, in humans with AD, without limitation for prime date of publication. Results: Initial search resulted in 361 articles. Seven studies fully met the inclusion criteria. Most studies did not find statistically significant results for the omega-3 fatty acids supplementation compared to placebo, and those who show some benefit do it only in a few cognitive assessment scales. However, the effects of omega-3 fatty acids appear to be most effectively demonstrated in patients with very mild AD. Conclusion: The effects of omega-3 fatty acids supplementation in mild AD corroborate epidemiological observational studies showing that omega-3 fatty acids may be beneficial in disease onset, when there is slight impairment of brain function. Although some studies have shown changes in scales of cognitive function in more severe cases, they are not enough to support omega-3 fatty acids supplementation in the treatment of AD.

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.

Background: Ultra-processed food (UPF) consumption increases the risk of type 2 diabetes in various high-income countries, with some variation in the magnitude across studies. Our objective was to investigate the association of UPF consumption and specific subgroups with incident type 2 diabetes in Brazilian adults.Methods: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a multicenter cohort study of 15,105 adults (35–74 years) enrolled in public institutions in Brazil (2008–2010). We followed participants with two clinic visits (2012–2014; 2017–2019) and annual telephone surveillance. After excluding those with diabetes at baseline, who died or were lost in the follow-up, with missing data, with implausible energy food intake, or reporting bariatric surgery, there were 10,202 participants. We used the NOVA classification to assess UPF consumption based on a food frequency questionnaire. We defined type 2 diabetes by self-report, medication use, or comprehensive laboratory tests. We estimated relative risks (RR) and 95% confidence intervals (95% CI) using robust Poisson regression.Results: Median UPF consumption was 372 g/day. Over 8.2 (0.7) years of follow-up, we detected 1799 (17.6%) incident cases. After adjustment for socio-demographics, family history of diabetes, and behavioral risk factors, comparing the fourth (≥ 566 g/day) with the first (< 236 g/day) quartile of UPF distribution, RR was 1.24 (1.10–1.39); every 150 g/day increments in UPF consumption resulted in a RR of 1.05 (1.03–1.07). Reclassifying natural beverages with added sweeteners as UPF increased risk (RR 1.40; 1.25–1.58). Among UPF subgroupings, consumption of processed meats and sweetened beverages increased diabetes risk, while yogurt and dairy sweets decreased the risk (p < 0.05).Conclusions: UPF consumption increased the incidence of type 2 diabetes in Brazilian adults, with heterogeneity across specific food items. These findings add to previous evidence for the role of UPFs in the development of diabetes and other chronic diseases, supporting recommendations to avoid their intake in diabetes prevention and management.

OBJECTIVE Glycemic regression is common in real-world settings, but the contribution of regression to the mean (RTM) has been little investigated. We aimed to estimate glycemic regression before and after adjusting for RTM in a free-living cohort of adults with newly ascertained diabetes and intermediate hyperglycemia (IH). RESEARCH DESIGN AND METHODS The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a cohort study of 15,105 adults screened between 2008 and 2010 with standardized oral glucose tolerance test and HbA_1c, repeated after 3.84 ± 0.42 years. After excluding those receiving medical treatment for diabetes, we calculated partial or complete regression before and after adjusting baseline values for RTM. RESULTS Regarding newly ascertained diabetes, partial or complete regression was seen in 49.4% (95% CI 45.2–53.7); after adjustment for RTM, in 20.2% (95% CI 12.1–28.3). Regarding IH, regression to normal levels was seen in 39.5% (95% CI 37.9–41.3) or in 23.7% (95% CI 22.6–24.3), depending on use of the World Health Organization (WHO) or the American Diabetes Association (ADA) definition, respectively; after adjustment, corresponding frequencies were 26.1% (95% CI 22.4–28.1) and 19.4% (95% CI 18.4–20.5). Adjustment for RTM reduced the number of cases detected at screening: 526 to 94 cases of diabetes, 3,118 to 1,986 cases of WHO-defined IH, and 6,182 to 5,711 cases of ADA-defined IH. Weight loss ≥2.6% was associated with greater regression from diabetes (relative risk 1.52, 95% CI 1.26–1.84) and IH (relative risk 1.30, 95% CI 1.17–1.45). CONCLUSIONS In this quasi–real-world setting, regression from diabetes at ∼4 years was common, less so for IH. Regression was frequently explained by RTM but, in part, also related to improved weight loss and homeostasis over the follow-up.

Background/Objectives: Avoidance of ultra-processed foods (UPFs) has been recommended to achieve a healthy diet, but whether it applies equally to all UPFs is uncertain. We evaluated individual UPF subgroups in the prediction of cardiometabolic and mental health outcomes. Methods: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is an occupational cohort study of 15,105 adults (35–74 years) recruited in 2008–2010. We followed participants up to 2018 to ascertain elevated weight and waist gains and the onset of metabolic syndrome, hypertension, metabolic dysfunction-associated steatotic liver disease, diabetes, common mental disorders, depressive episodes, and anxiety disorders. Results: In adjusted robust Poisson regression, greater overall UPF intake at the baseline predicted all studied outcomes. Various subgroups of UPF, most frequently processed meat and sweetened beverages, individually conferred a greater risk, and nearly all predicted at least one studied outcome. Considering all subgroups and outcomes, a broad pattern of overall risk was present. When subgroups not individually predictive of these outcomes were aggregated, increased risk (for a one-standard deviation change) was observed for elevated weight (RR = 1.05; 95% CI 1.01–1.11) and waist (RR = 1.05; 95% CI 1.00–1.10) gains, and for the incidence of common mental (RR = 1.06; 95% CI 1.01–1.12), and anxiety (RR = 1.09; 95% CI 1.02–1.16) disorders. Conclusions: UPFs overall and their subgroups predicted future cardiometabolic and mental health outcomes. The pattern of individual UPF subgroup associations varied across outcomes, and the aggregate of subgroups not individually predicting risk also predicted large gains in overall and central adiposity and the incidence of mental health disorders. While additional studies investigating other outcomes are needed, these findings justify avoidance of overall UPF intake in health promotion and disease prevention.