Current Obesity Reports

, Volume 3, Issue 2, pp 256–272 | Cite as

Food Classification Systems Based on Food Processing: Significance and Implications for Policies and Actions: A Systematic Literature Review and Assessment

  • Jean-Claude Moubarac
  • Diana C. Parra
  • Geoffrey Cannon
  • Carlos A. Monteiro
Obesity Treatment (CM Apovian, Section Editor)

Abstract

This paper is the first to make a systematic review and assessment of the literature that attempts methodically to incorporate food processing into classification of diets. The review identified 1276 papers, of which 110 were screened and 21 studied, derived from five classification systems. This paper analyses and assesses the five systems, one of which has been devised and developed by a research team that includes co-authors of this paper. The quality of the five systems is assessed and scored according to how specific, coherent, clear, comprehensive and workable they are. Their relevance to food, nutrition and health, and their use in various settings, is described. The paper shows that the significance of industrial food processing in shaping global food systems and supplies and thus dietary patterns worldwide, and its role in the pandemic of overweight and obesity, remains overlooked and underestimated. Once food processing is systematically incorporated into food classifications, they will be more useful in assessing and monitoring dietary patterns. Food classification systems that emphasize industrial food processing, and that define and distinguish relevant different types of processing, will improve understanding of how to prevent and control overweight, obesity and related chronic non-communicable diseases, and also malnutrition. They will also be a firmer basis for rational policies and effective actions designed to protect and improve public health at all levels from global to local.

Keywords

Food classification systems Processing Processed food Unprocessed food Artisanal food Minimally processed food Highly processed Ultra-processed food products Industrial food processing NOVA food processing classification Food processing and obesity 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Wrangham R. The evolution of human nutrition. Curr Biol. 2013;23(9):354–5.CrossRefGoogle Scholar
  2. 2.
    Hotz C, Gibson RS. Traditional food-processing and preparation practices to enhance the bioavailability of micronutrients in plant-based diets. J Nutr. 2007;137(4):1097–100.PubMedGoogle Scholar
  3. 3.
    Jacob H. Six thousand years of bread. Its holy and unholy history. Garden City: Doubleday; 1944.Google Scholar
  4. 4.
    Giedion S. Mechanization encounters the organic. Mechanization takes command. A contribution to anonymous history. New York: Oxford University Press; 1948.Google Scholar
  5. 5.
    Brock W. Liebig on toast. The chemistry of food. Justus von Liebig. The chemical gatekeeper. Cambridge: Cambridge University Press; 1997.Google Scholar
  6. 6.
    Drummond J, Wilbraham A. The Englishman’s food. Five centuries of english diet. London: Jonathan Cape; 1939.Google Scholar
  7. 7.
    Pyke M. Food science and technology. 3rd ed. London: John Murray; 1970.Google Scholar
  8. 8.
    Pyke M. Technological eating. Or, where does the fish finger point? London: John Murray; 1972.Google Scholar
  9. 9.
    Van Stuyvenberg J. Margarine. An economic, social and scientific history, 1869–1969. Liverpool: Liverpool University Press; 1969.Google Scholar
  10. 10.
    Fogel R. The escape from hunger and premature death, 1700-2100. Europe, america and the third world. Cambridge: Cambridge University Press; 2004.CrossRefGoogle Scholar
  11. 11.
    McCollum E. A history of nutrition. Cambridge: Houghton Mifflin; 1957.Google Scholar
  12. 12.
    World Health Organization. Handbook on nutritional requirements. Monograph series 61. Geneva: WHO; 1974.Google Scholar
  13. 13.
    Omran AR. The epidemiologic transition. A theory of the epidemiology of population change. Milbank Mem Fund Q. 1971;49(4):509–38.PubMedCrossRefGoogle Scholar
  14. 14.
    Popkin BM. An overview on the nutrition transition and its health implications: the Bellagio meeting. Public Health Nutr. 2002;5(1A):93–103.PubMedCrossRefGoogle Scholar
  15. 15.
    World Health Organization. Diet, nutrition and the prevention of chronic diseases. Report of a WHO study group. WHO technical report series 797. Geneva: WHO; 1990.Google Scholar
  16. 16.
    Cannon G. Food and health: the experts agree. An analysis of one hundred authoritative scientific reports on food, nutrition and public health published throughout the world in thirty years, between 1961 and 1991. London: Consumers’ Association; 1992.Google Scholar
  17. 17.
    Ludwig DS. Technology, diet, and the burden of chronic disease. JAMA. 2011;305(13):1352–3.PubMedCrossRefGoogle Scholar
  18. 18.
    Goody J. Industrial food. Towards the development of a world cuisine. In: Counihan C, Van Esterik P, editors. Food and culture. New York: Routledge; 1997.Google Scholar
  19. 19.
    Castells M. The new economy: informationalism, globalization, networking. The rise of the network society: The information age: Economy. Society and culture, vol. 1. Oxford: Blackwell; 2000.Google Scholar
  20. 20.
    Food and Agriculture Organization of the United Nations. Globalization of food systems in developing countries: impact on food security and nutrition. Rome: FAO; 2004.Google Scholar
  21. 21.
    Popkin BM. Global nutrition dynamics: the world is shifting rapidly toward a diet linked with non-communicable diseases. Am J Clin Nutr. 2006;84(2):289–98.PubMedGoogle Scholar
  22. 22.
    Popkin BM, Slining MM. New dynamics in global obesity facing low- and middle-income countries. Obes Rev. 2013;14 Suppl 2:11–20.PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Wahlqvist M. Food and nutrition systems in Australia and New Zealand. 3rd ed. Sydney: Allen and Unwin; 2011.Google Scholar
  24. 24.
    Monteiro CA. Nutrition and health. The issue is not food, nor nutrients, so much as processing. Public Health Nutr. 2009;12(5):729–31.PubMedCrossRefGoogle Scholar
  25. 25.
    Monteiro C. The big issue is ultra-processing. World Nutr. 2010;1(6):237–69.Google Scholar
  26. 26.
    Monteiro CA, Levy RB, Claro RM, Castro IRR, Cannon G. A new classification of foods based on the extent and purpose of their processing. Cad Saúde Publica. 2010;26(11):2039–49.PubMedCrossRefGoogle Scholar
  27. 27.••
    Monteiro CA, Cannon G, Levy RB, Claro RM, Moubarac J-C. The food system. Processing. The big issue for disease, good health, well-being. World Nutr. 2012;3(12):527–69. A full account of the general NOVA theory, its classification of foods, and the implications for dietary patterns, and policies and actions to protect health. Google Scholar
  28. 28.
    Rivera JA, de Cossio TG, Pedraza LS, Aburto TC, Sanchez TG, Martorell R. Childhood and adolescent overweight and obesity in Latin America: a systematic review. Lancet. 2013. doi:10.1016/S2213-8587(13)70173-6.PubMedGoogle Scholar
  29. 29.••
    Moodie R, Stuckler D, Monteiro C, Sheron N, Neal B, Thamarangsi T, et al. Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. Lancet. 2013;381(9867):670–9. A summary of the NOVA theory and its implications for product reformulation in the context of a paper in a Lancet series on prevention of chronic diseases. PubMedCrossRefGoogle Scholar
  30. 30.
    Monteiro CA, Cannon G. The impact of transnational “Big Food” companies on the South: a view from Brazil. PLoS Med. 2012;9(7):e1001252. doi:10.1371/ journal.pmed.1001252.PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Stuckler D, McKee M, Ebrahim S, Basu S. Manufacturing epidemics: the role of global producers in increased consumption of unhealthy commodities including processed foods, alcohol, and tobacco. PLoS Med. 2012;9(6):e1001235. doi:10.1371/journal.pmed.1001235.PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Stuckler D, Siegel K. Sick societies. Responding to the global challenge of chronic disease. Oxford: Oxford University Press; 2011.CrossRefGoogle Scholar
  33. 33.••
    Monteiro CA, Moubarac JC, Cannon G, Ng SW, Popkin B. Ultra-processed products are becoming dominant in the global food system. Obes Rev. 2013;14 Suppl 2:21–8. This paper shows that ultra-processed products dominate the food supplies of high-income countries, and that their consumption is now rapidly increasing in middle-income countries. PubMedCrossRefGoogle Scholar
  34. 34.
    Swinburn BA, Sacks G, Hall KD, McPherson K, Finegood DT, Moodie ML, et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet. 2011;378:804–14.PubMedCrossRefGoogle Scholar
  35. 35.
    World Health Organization. Diet, nutrition and the prevention of chronic diseases. Report of a joint WHO/FAO expert consultation. WHO technical report series 916. Geneva: WHO; 2003.Google Scholar
  36. 36.
    Mozaffarian D, Katan MB, Ascherio A, Stampfer MJ, Willett WC. Trans fatty acids and cardiovascular disease. N Engl J Med. 2006;354(15):1601–13.PubMedCrossRefGoogle Scholar
  37. 37.
    Monteiro C. The big issue is ultra-processing. The hydrogenation bomb. World Nutr. 2011;2(4):176–94.Google Scholar
  38. 38.
    World Cancer Research Fund/American Institute for Cancer Research. Food, nutrition and the prevention of cancer. A global perspective. Washington, DC: AICR; 1997.Google Scholar
  39. 39.
    World Cancer Research Fund/American Institute for Cancer Research. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Washington, DC: AICR; 2007.Google Scholar
  40. 40.
    Brunner TA, van der Horst K, Siegrist M. Convenience food products. Drivers for consumption. Appetite. 2010;55:498–506.PubMedCrossRefGoogle Scholar
  41. 41.
    Appelhans BM, Waring ME, Schneider KL, Pagoto SL, DeBiasse MA, Whited MC, et al. Delay discounting and intake of ready-to-eat and away-from-home foods in overweight and obese women. Appetite. 2012;59(2):576–84.PubMedCentralPubMedCrossRefGoogle Scholar
  42. 42.
    Brownell KD, Gold MS. Food and addiction: a comprehensive handbook. New York: Oxford University Press; 2012.Google Scholar
  43. 43.
    Gearhardt AN, Grilo CM, DiLeone RJ, Brownell KD, Potenza MN. Can food be addictive? Public health and policy implications. Addiction. 2011;106(7):1208–12.PubMedCentralPubMedCrossRefGoogle Scholar
  44. 44.
    Salt MM, Fat S. How the food giants hooked us. New York: Random House; 2013.Google Scholar
  45. 45.
    Bermudez OI, Hernandez L, Mazariegos M, Solomons NW. Secular trends in food patterns of Guatemalan consumers: new foods for old. Food Nutr Bull. 2008;29(4):278–87.PubMedGoogle Scholar
  46. 46.
    Soto-Méndez MJ, Campos R, Hernández L, Orozco M, Vossenaar M, Solomons NW. Food variety, dietary diversity, and food characteristics among convenience samples of Guatemalan women. Salud Publica Mex. 2011;53(4):288–98.PubMedCrossRefGoogle Scholar
  47. 47.
    Enneman A, Hernandez L, Campos R, Vossenaar M, Solomons NW. Dietary characteristics of complementary foods offered to Guatemalan infants vary between urban and rural settings. Nutr Res. 2009;29(7):470–9.PubMedCrossRefGoogle Scholar
  48. 48.
    Kuhnlein H, Erasmus B, Spigelski D, Burlingame B. Indigenous people’s food systems and well-being. Interventions and policies for healthy communities. Rome: FAO; 2013.Google Scholar
  49. 49.
    Kuhnlein HV, Receveur O. Local cultural animal food contributes high levels of nutrients for Arctic Canadian Indigenous adults and children. J Nutr. 2007;137(4):1110–4.PubMedGoogle Scholar
  50. 50.
    Kuhnlein HV, Receveur O, Soueida R, Egeland GM. Arctic indigenous peoples experience the nutrition transition with changing dietary patterns and obesity. J Nutr. 2004;134(6):1447–53.PubMedGoogle Scholar
  51. 51.
    Pelto GH, Vargas LA. Perspectives in dietary change. Ecol Food Nutr. 1992;27:159–61.CrossRefGoogle Scholar
  52. 52.
    Trichopoulou A, Soukara S, Vasilopoulou E. Traditional foods: a science and society perspective. Trends Food Sci Tech. 2007;18:420–7.CrossRefGoogle Scholar
  53. 53.
    Willett W. Eat, drink and be healthy. The Harvard medical school guide to healthy eating. New York: Free Press; 2001.Google Scholar
  54. 54.
    Bach-Faig A, Berry EM, Lairon D, Requant J, Trichopoulou A, Dernini S, et al. Mediterranean diet pyramid today: science and cultural updates. Public Health Nutr. 2001;14(12A):2274–84.CrossRefGoogle Scholar
  55. 55.
    Tudge C. Future cook. London: Mitchell Beazley; 1980.Google Scholar
  56. 56.
    AiZhen Z, YuHong W, MacLennan R. Cuisine: the concept and its health and nutrition implications – a Hangzhou perspective. Asia Pac J Clin Nutr. 2004;13(2):136–40.PubMedGoogle Scholar
  57. 57.
    Eaton SB, Shostak M, Konner M. The paleolithic prescription. A program of diet and exercise and a design for living. New York: Harper and Row; 1988.Google Scholar
  58. 58.
    Lappé FM. Diet for a small planet. New York: Ballantine; 1971.Google Scholar
  59. 59.
    Smith A, MacKinnon J. The 100 mile diet. A year of local eating. Toronto: Vintage; 2007.Google Scholar
  60. 60.
    Okubo H, Sasaki S, Murakami K, Kim MK, Takahashi Y, Hosoi Y, et al. Three major dietary patterns are all independently related to the risk of obesity among 3760 Japanese women aged 18–20 years. Int J Obes. 2008;32(3):541–9.CrossRefGoogle Scholar
  61. 61.
    Deshmukh-Taskar PR, O’Neil CE, Nicklas TA, Yang SJ, Liu Y, Gustat J, et al. Dietary patterns associated with metabolic syndrome, sociodemographic and lifestyle factors in young adults: the Bogalusa Heart Study. Public Health Nutr. 2009;12(12):2493–503.PubMedCentralPubMedCrossRefGoogle Scholar
  62. 62.
    Dugee O, Khor GL, Lye MS, Luvsannyam L, Janchiv O, Jamyan B, et al. Association of major dietary patterns with obesity risk among Mongolian men and women. Asia Pac J Clin Nutr. 2009;18(3):433–40.PubMedGoogle Scholar
  63. 63.
    Malik VS, Fung TT, van Dam RM, Rimm EB, Rosner B, Hu FB. Dietary patterns during adolescence and risk of type 2 diabetes in middle-aged women. Diabetes Care. 2012;35(1):12–8.PubMedCentralPubMedCrossRefGoogle Scholar
  64. 64.
    Rezazadeh A, Rashidkhani B. The association of general and central obesity with major dietary patterns of adult women living in Tehran, Iran. J Nutr Sci Vitaminol. 2010;56(2):132–8.PubMedCrossRefGoogle Scholar
  65. 65.
    Mishra GD, McNaughton SA, Ball K, Brown WJ, Giles GG, Dobson AJ. Major dietary patterns of young and middle aged women: results from a prospective Australian cohort study. Eur J Clin Nutr. 2010;64(10):1125–33.PubMedCrossRefGoogle Scholar
  66. 66.
    Paradis AM, Godin G, Pérusse L, Vohl MC. Associations between dietary patterns and obesity phenotypes. Int J Obes. 2009;33(12):1419–26.CrossRefGoogle Scholar
  67. 67.
    Iqbal R, Anand S, Ounpuu S, Islam S, Zhang X, Rangarajan S, et al. Dietary patterns and the risk of acute myocardial infarction in 52 countries: results of the INTERHEART study. Circulation. 2008;118(19):1929–37.PubMedCrossRefGoogle Scholar
  68. 68.
    Hu FB, Rimm EB, Stampfer MJ, Ascherio A, Spiegelman D, Willett WC. Prospective study of major dietary patterns and risk of coronary heart disease in men. Am J Clin Nutr. 2000;72(4):912–21.PubMedGoogle Scholar
  69. 69.
    Heidemann C, Schulze MB, Franco OH, van Dam RM, Mantzoros CS, Hu FB. Dietary patterns and risk of mortality from cardiovascular disease, cancer, and all causes in a prospective cohort of women. Circulation. 2008;118(3):230–7.PubMedCentralPubMedCrossRefGoogle Scholar
  70. 70.
    Esposito K, Kastorini CM, Panagiotakos DB, Giugliano D. Prevention of type 2 diabetes by dietary patterns: a systematic review of prospective studies and meta-analysis. Metab Syndr Relat Disord. 2010;8(6):471–6.PubMedCrossRefGoogle Scholar
  71. 71.
    van Dam RM, Rimm EB, Willett WC, Stampfer MJ, Hu FB. Dietary patterns and risk for type 2 diabetes mellitus in US men. Ann Intern Med. 2002;136(3):201–9.PubMedCrossRefGoogle Scholar
  72. 72.
    Mattei J, Noel SE, Tucker KL. A meat, processed meat, and French fries dietary pattern is associated with high allostatic load in Puerto Rican older adults. J Am Diet Assoc. 2011;111(10):1498–506.PubMedCentralPubMedCrossRefGoogle Scholar
  73. 73.
    Smith AD, Emmett PM, Newby PK, Northstone K. A comparison of dietary patterns derived by cluster and principal components analysis in a UK cohort of children. Eur J Clin Nutr. 2011;65(10):1102–9.PubMedCrossRefGoogle Scholar
  74. 74.
    Olinto MT, Gigante DP, Horta B, Silveira V, Oliveira I, Willett W. Major dietary patterns and cardiovascular risk factors among young Brazilian adults. Eur J Nutr. 2012;51(3):281–91.PubMedCentralPubMedCrossRefGoogle Scholar
  75. 75.
    Brunner EJ, Mosdol A, Witte DR, Martikainen P, Stafford M, Shipley MJ, et al. Dietary patterns and 15-y risks of major coronary events, diabetes, and mortality. Am J Clin Nutr. 2008;87(5):1414–21.PubMedGoogle Scholar
  76. 76.
    Fung TT, Willett WC, Stampfer MJ, Manson JE, Hu FB. Dietary patterns and the risk of coronary heart disease in women. Arch Intern Med. 2001;161(15):1857–62.PubMedCrossRefGoogle Scholar
  77. 77.
    Newby PK, Muller D, Hallfrisch J, Qiao N, Andres R, Tucker KL. Dietary patterns and changes in body mass index and waist circumference in adults. Am J Clin Nutr. 2003;77(6):1417–25.PubMedGoogle Scholar
  78. 78.
    Schulze MB, Fung TT, Manson JE, Willett WC, Hu FB. Dietary patterns and changes in body weight in women. Obesity. 2006;14(8):1444–53.PubMedCrossRefGoogle Scholar
  79. 79.
    Slimani N, Deharveng G, Southgate DA, Biessy C, Chajes V, van Bakel MM, et al. Contribution of highly industrially processed foods to the nutrient intakes and patterns of middle-aged populations in the European Prospective Investigation into Cancer and Nutrition study. Eur J Clin Nutr. 2009;63 Suppl 4:S206–25.PubMedCrossRefGoogle Scholar
  80. 80.
    Chajes V, Biessy C, Byrnes G, Deharveng G, Saadatian-Elahi M, Jenab M, et al. Ecological-level associations between highly processed food intakes and plasma phospholipid elaidic acid concentrations: results from a cross-sectional study within the European prospective investigation into cancer and nutrition (EPIC). Nutr Cancer. 2011;63(8):1235–50.PubMedCrossRefGoogle Scholar
  81. 81.
    International Food Information Council Foundation. Understanding Our Food Communications Tool Kit. Available at http://www.foodinsight.org/; 2010.
  82. 82.•
    Eicher-Miller HA, Fulgoni III VL, Keast DR. Contributions of processed foods to dietary intake in the US from 2003-2008: a report of the Food and Nutrition Science Solutions Joint Task Force of the Academy of Nutrition and Dietetics, American Society for Nutrition, Institute of Food Technologists, and International Food Information Council. J Nutr. 2012;142(11):2065S–72. This paper is the first to apply the classification system based on food processing devised by the International Food Information Council Foundation (IFIC) to 24-hour recall data from the US National Health and Nutrition Examination Survey (NHANES) 2003-2008. PubMedCentralPubMedCrossRefGoogle Scholar
  83. 83.
    Dwyer JT, Fulgoni III VL, Clemens RA, Schmidt DB, Freedman MR. Is “processed” a four-letter word? The role of processed foods in achieving dietary guidelines and nutrient recommendations. Adv Nutr. 2012;3(4):536–48.PubMedCentralPubMedCrossRefGoogle Scholar
  84. 84.
    González-Castell D, González-Cossío T, Barquera S, Rivera JA. Contribution of processed foods to the energy, macronutrient and fiber intakes of Mexican children aged 1 to 4 years. Salud Publica Mex. 2007;49(5):345–56.PubMedCrossRefGoogle Scholar
  85. 85.
    Perez Izquierdo O, Nazar Beutelspacher N, SalvatierraIzaba S, Pérez-Gil Romo SE, Rodríguez L, Castillo Burguete MT, et al. Frequency of the consumption of industrialized modern food in the habitual diet in Mayan communities of Yucatan, Mexico. Estud Soc. 2011;20:157–84.Google Scholar
  86. 86.•
    Asfaw A. Does consumption of processed foods explain disparities in the body weight of individuals? The case of Guatemala. Health Econ. 2011;20(2):184–95. This paper describes the classification system based on food processing devised in Guatemala and identifies degrees of food processing as relevant to body weight. PubMedCrossRefGoogle Scholar
  87. 87.
    Hawkes C. The role of foreign direct investment in the nutrition transition. Public Health Nutr. 2005;8(4):357–65.PubMedCrossRefGoogle Scholar
  88. 88.
    Monteiro CA, Mondini L, Levy-Costa RB. Secular changes in dietary patterns in the metropolitan areas of Brazil (1988-1996). Rev Saude Publica. 2000;34(3):251–8.PubMedCrossRefGoogle Scholar
  89. 89.
    Levy-Costa RB, Sichieri R, Pontes NS, Monteiro CA. Household food availability in Brazil: distribution and trends (1974–2003). Rev Saude Publica. 2005;39(4):530–40.PubMedCrossRefGoogle Scholar
  90. 90.•
    Monteiro CA, Levy RB, Claro RM, Castro IRR, Cannon G. Increasing consumption of ultra-processed foods and likely impact on human health: evidence from Brazil. Public Health Nutr. 2011;14(1):5–13. This paper shows the replacement of foods and ingredients used in the preparation of dishes and meals, by ready-to-consume products, mostly ultra-processed. It also shows the the impact of industrial food processing on the overall quality of diets in Brazil. PubMedCrossRefGoogle Scholar
  91. 91.
    Martins APB, Levy RB, Claro RM, Moubarac J-C, Monteiro CA. Participação crescente de produtos ultraprocessados na dieta brasileira (1987–2009)/ Increased contribution of ultra-processed food products in the Brazilian diet (1987–2009). Rev Saude Publica. 2013;47(4):656–65.PubMedCrossRefGoogle Scholar
  92. 92.•
    Moubarac JC, Martins APB, Claro RM, Levy RB, Cannon G, Monteiro CA. Consumption of ultra-processed foods and likely impact on human health. Evidence from Canada. Public Health Nutr. 2013;16(12):2240–8. This paper is the first application of the NOVA classification in a high-income country It shows the the impact of industrial food processing on the overall quality of diets in Canada. Google Scholar
  93. 93.
    Moubarac JC, Batal M, Martins APB, Claro R, Levy R, Cannon G, et al. Processed and ultra-processed food products: Consumption trends in Canada from 1938 to 2011. Can J Diet Pract Res. 2014; 75(1):15–21.Google Scholar
  94. 94.
    Moubarac J-C, Claro R, Baraldi L, Martins AP, Levy R, Cannon G, et al. International differences in cost and consumption of ready-to-consume food and drink products: United Kingdom and Brazil, 2008–2009. Glob Public Health. 2013;8(7):245–56.CrossRefGoogle Scholar
  95. 95.
    Crovetto M, Uauy R. Changes in processed food expenditure in the population of Metropolitan Santiago in the last twenty years. Rev Med Chil. 2012;140(3):305–12.PubMedCrossRefGoogle Scholar
  96. 96.
    Tavares LF, Fonseca SC, Rosa MLG, Yokoo EM. Relationship between ultra-processed foods and metabolic syndrome in adolescents from a Brazilian family doctor program. Public Health Nutr. 2012;15(11):82–7.PubMedCrossRefGoogle Scholar
  97. 97.
    Costa JC, Claro RM, Martins AP, Levy RB. Food purchasing sites. Repercussions for healthy eating. Appetite. 2013;70:99–103.PubMedCrossRefGoogle Scholar
  98. 98.
    Leite FH, Oliveira MA, Cremm EC, Abreu DS, Maron LR, Martins PA. Availability of processed foods in the perimeter of public schools in urban areas. J Pediatr (Rio J). 2012;88(4):328–34.CrossRefGoogle Scholar
  99. 99.
    Vandevijvere S, Monteiro C, Krebs-Smith SM, Lee A, Swinburn B, Kelly B, et al. Monitoring and benchmarking population diet quality globally: a step-wise approach. Obes Rev. 2013;14 Suppl 1:135–49.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Jean-Claude Moubarac
    • 1
  • Diana C. Parra
    • 1
    • 2
  • Geoffrey Cannon
    • 1
  • Carlos A. Monteiro
    • 1
    • 3
  1. 1.Centre for Epidemiological Studies in Health and NutritionUniversity of São PauloSão PauloBrazil
  2. 2.Program in Physical Therapy, School of MedicineWashington University in St. LouisSt. LouisUSA
  3. 3.Department of Nutrition, Faculty of Public HealthUniversity of São PauloSão PauloBrazil

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