Ultra-processed foods, incident overweight and obesity, and longitudinal changes in weight and waist circumference: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

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 center dot 8-year follow-up. We assessed associations, through Poisson regression with robust variance, of UPF consumption with large weight gain (1 center dot 68 kg/year) and large waist gain (2 center dot 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 (n 11 827), aged 35-74 years at baseline (2008-2010). Results: UPF provided a mean 24 center dot 6 (sd 9 center dot 6) % of ingested energy. After adjustment for smoking, physical activity, adiposity and other factors, fourth (>30 center dot 8 %) v. first (<17 center dot 8 %) quartile of UPF consumption was associated (relative risk (95 % CI)) with 27 and 33 % greater risk of large weight and waist gains (1 center dot 27 (1 center dot 07, 1 center dot 50) and 1 center dot 33 (1 center dot 12, 1 center dot 58)), respectively. Similarly, those in the fourth consumption quartile presented 20 % greater risk (1 center dot 20 (1 center dot 03, 1 center dot 40)) of incident overweight/obesity and 2 % greater risk (1 center dot 02; (0 center dot 85, 1 center dot 21)) of incident obesity. Approximately 15 % of cases of large weight and waist gains and of incident overweight/obesity could be attributed to consumption of >17 center dot 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.