Consumption of ultra-processed food and obesity: cross sectional results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort (2008-2010)

Public Health Nutr. 2018 Aug;21(12):2271-2279. doi: 10.1017/S1368980018000861. Epub 2018 Apr 12.


Objective: To verify if the intake of ultra-processed foods is associated with higher BMI and waist circumference (WC) among participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort.

Design: Cross-sectional analysis of the ELSA-Brasil baseline (2008-2010). Dietary information obtained through an FFQ was classified according to characteristics of food processing (NOVA) and used to estimate the percentage energy contribution from ultra-processed foods (i.e. industrial formulations, elaborated from food processing, synthetic constituents and food additives) to individuals' total energy intake. BMI and WC and their respective cut-off points served as response variables. Associations were estimated through linear and multinomial logistic regression models, after adjusting for confounders and total energy intake.

Setting: Six Brazilian capital cities, 2008-2010.

Subjects: Active and retired civil servants, aged 35-64 years, from universities and research organizations (n 8977).

Results: Ultra-processed foods accounted for 22·7 % of total energy intake. After adjustments, individuals in the fourth quartile of percentage energy contribution from ultra-processed foods presented (β; 95 % CI) a higher BMI (0·80; CI 0·53, 1·07 kg/m2) and WC (1·71; 1·02, 2·40 cm), and higher chances (OR; 95 % CI) of being overweight (1·31; 1·13, 1·51), obese (1·41; 1·18, 1·69) and having significantly increased WC (1·41; 1·20, 1·66), compared with those in the first quartile. All associations suggest a dose-response gradient.

Conclusions: Results indicate the existence of associations between greater energy contribution from ultra-processed foods and higher BMI and WC, which are independent of total energy intake. These findings corroborate public policies designed to reduce the intake of this type of food.

Keywords: ELSA-Brasil; Food consumption; Obesity; Ultra-processed foods; Waist circumference.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Body Mass Index
  • Brazil / epidemiology
  • Cross-Sectional Studies
  • Diet / statistics & numerical data*
  • Energy Intake
  • Fast Foods*
  • Feeding Behavior
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Obesity / epidemiology*
  • Waist Circumference