Skip to main content
Advertisement
  • Loading metrics

The increasing trend in the consumption of ultra-processed food products is associated with a diet related to chronic diseases in Colombia—Evidence from national nutrition surveys 2005 and 2015

  • Gustavo Cediel ,

    Roles Conceptualization, Formal analysis, Funding acquisition, Methodology, Writing – original draft, Writing – review & editing

    gustavo.cedielg@udea.edu.co

    Affiliation Unidad de Problemáticas de Interés en Nutrición Pública, Grupo de Investigación Saberes Alimentarios, Escuela de Nutrición y Dietética, Universidad de Antioquia UdeA, Medellín, Colombia

  • Elisa María Cadena,

    Roles Methodology, Validation, Writing – review & editing

    Affiliation Faculty of Social Sciences, Department of Psychology, University of the Andes, Bogotá, Colombia

  • Pamela Vallejo,

    Roles Methodology, Resources, Supervision, Writing – original draft, Writing – review & editing

    Affiliation Ministry of Health and Social Protection, Bogotá, Colombia

  • Diego Gaitán,

    Roles Methodology, Visualization, Writing – original draft, Writing – review & editing

    Affiliation Unidad de Problemáticas de Interés en Nutrición Pública, Grupo de Investigación Saberes Alimentarios, Escuela de Nutrición y Dietética, Universidad de Antioquia UdeA, Medellín, Colombia

  • Fabio Da Silva Gomes

    Roles Methodology, Validation, Visualization, Writing – original draft, Writing – review & editing

    Affiliation Pan American Health Organization, Washington, D.C., United States of America

Abstract

Introduction

Ultra-processed food products (UPF) have been related to chronic diseases (CD). Public health politics has been establishing strategies to decrease the consumption of these products in the country.

Objectives

i) To assess the trend of the consumption of UPF between 2005 and 2015. (ii) its association with sociodemographic factors and the overall dietary content of nutrients related to CD in 2015. (iii) to estimate the Population Attributable Fraction of unhealthy nutrient intake in Colombia in 2015 due to ultra-processed food consumption.

Methods

We used data from the first (2005) and the last (2015) National Surveys of the Nutritional Status in Colombia. Food consumption was assessed using a 24-hour food recall. The NOVA classification classified the food items according to the extent and purpose of industrial processing.

Results

The consumption of processed and UPF increased in Colombia between 2005 and 2015. In 2015, no significant differences were found in the consumption of UPF between men and women but significant differences by age, wealth index, area of residence, and ethnicity (p<0.001). A significant positive association was found between the dietary share of UPF and the content of CD-related nutrients such as free sugars, total fats, saturated fats, trans-fats, and sodium. The prevalence of excessive intake of all CD-related nutrients (according to WHO recommendations) increased across quintiles of the dietary share of UPF. With the reduction of UPF consumption to the level seen among the 20% lowest consumers [1.0% (0–4.5%) of the total energy from UPF], the prevalence of excessive nutrient intake was almost three-fourths lower for trans fats; around one third lower for free sugar and saturated fats, 26% lower for sodium and 15% lower for total fat.

Conclusions

In Colombia, the increasing trend in the consumption of UPF is associated with increasing intake of CD-related nutrients. Thus, reducing the consumption of UPF is a potentially effective way to achieve the nutritional goals of the WHO for the prevention of CD.

Introduction

Ultra-processed food products (UPF) are industrial formulations made from substances derived from foods or synthesized from other organic sources. Usually, they contain little or no natural foods, high fat, sodium, or sugar content, and low content of dietary fiber, water, protein, micronutrients, and bioactive compounds [1]. These products dominate the food system in developed countries, contributing almost 60% of the total energy consumed in the United States [2] and the United Kingdom [3] and 50% in Canada [4]. The evidence in several countries shows that consumption of UPF generates a dietary pattern related to worsening diet quality and the presence of obesity and chronic diseases (CD) [5]. Given this evidence, efforts to reduce the intake of these products and nutrients related to CD through regulatory policies have been promoted in the region of the Americas [6, 7].

The Pan American Health Organization (PAHO) reported a growing trend in the sales of UPFs in Latin America, with a 26% increase between 2000 and 2013. In Colombia a similar increase of 25% over the same period was observed [8]. Additionally, analysis of food consumption at the national level in 2005 showed that 15.9% of the energy consumed by the population of Colombia came from UPF [9]. The highest consumption was observed among adolescents, with UPF contributing 20.3% to the total daily energy intake [10, 11].

Data from Euromonitor International show an annual percentage growth of more than 6.0% in sales of all types of UPF in Colombia [12]. The relative increase in sales within such product categories was higher in developing countries, including Colombia, than in industrialized countries between 1998 and 2012. Other Latin American countries, such as Brazil, Chile, and Mexico, have found substantial incorporation of UPF in the diets of their populations, with 21.5% in 2008–2009, 28.6% in 2010, and 30% in 2012, respectively [1315]. These trends suggest that the population of Colombia, as in neighboring countries, is vulnerable to a dramatic increase in UPF consumption.

In concordance, evidence shows how the corporative food regime has been established in Colombia since 1990 [16, 17]. In the context of increasing foreign investment of food manufacturing companies, expanding the presence of UPF in diets and food systems, and growing trends in obesity and CD [18], it is crucial to know the pattern and direction of consumption of these UPF in Colombia. Due to this background, the objectives of this work are: i) to assess the trend consumption of ultra-processed foods between 2005 and 2015, (ii) its association with sociodemographic factors and the overall dietary content of nutrients related to CD in 2015, (iii) and to estimate the Population Attributable Fraction of unhealthy nutrient intake in Colombia in 2015 due to ultra-processed food consumption.

Methods

Data source

This cross-sectional analysis used secondary data from the first (2005) and last National Survey (2015) of the Nutritional Situation of Colombia with consumption data collected with a 24-hour recall technique (ENSIN 2005 and 2015) and the National Demographic and Health Survey of Colombia (ENDS, 2005 and 2015). ENSIN data were combined with ENDS data to link food consumption with demographic information at the individual level. The size and design of the sample were carried out to calculate the estimates of proportion and prevalence, as well as statistical models to evaluate associations [19, 20].

The dietary data within ENSIN were obtained using one 24-hour recall, administered by the interviewer, in ages between age >1y and 64 years for both sexes. The 24-hour recall captured data from random weekdays and weekends. Interviewers used standardized food models to improve the accuracy of the amount and weight of food and beverages consumed. Information on the food type, the preparation’s name, ingredients, and the amount consumed were recorded. The person responsible for preparing the food was present during the interview. In the cases in which the food consumed by a child was at school or in a daycare center, the interviewer visited the school to obtain detailed information on the preparations. The data quality was controlled throughout the process, and the interview was repeated in case of inconsistencies [19, 20].

Food classification according to processing

Food items from the two surveys were classified into one of four NOVA categories. The categories are mutually exclusive and vary depending on their extent and purpose of processing. They include 1) unprocessed or minimally processed foods, 2) processed culinary ingredients, 3) processed foods, and 4) ultra-processed products [1, 21]. Foods were categorized into one of 33 subgroups within the NOVA 4 groups (based in previous publication about diet in Colombia). In 5.6% of the cases, it was not possible to break down the typical culinary preparations into their constituent ingredients (for example, "Cooked lasagna pasta," "Arepa de chocolo," "Tamal"). They were classified as minimally processed foods in the ’freshly prepared food’ category, and those ready-to-eat fried, sweet or savory preparations were classified as processed foods (e.g., "buñuelos," "desserts," "fried empanadas").

Assessing energy and nutrient intake

The energy content and CD-related nutrients (i.e., free sugars, total fats, saturated fats, trans fats, and sodium) in consumed foods were obtained from the Colombian Food Composition Table [19, 20] or the nutrient fact panels obtained from Colombian packaged foods. The nutritional information from packaged foods was collected in diverse supermarket chains in Colombia. Free sugars were estimated using the algorithm proposed by the nutrient profile model launched by the Pan American Health Organization [6]. The World Health Organization (WHO) nutrient intake goals were used to determine the prevalence of excessive intake of CD-related nutrients: > = 10% K.J. of total energy intake for free sugars, > = 30% K.J. of total energy intake for total fats, > = 10% K.J. of total energy intake for saturated fats, > = 1% K.J. of total energy intake for trans fats, and > = 2000 mg/8372 KJ for sodium [7, 22, 23].

Sociodemographic characteristics

The sociodemographic characteristics available within ENDS included sex, age category (less than one y, 1-4y, 5-12y, 13-17y, 18-26y, 27-49y, 50-64y and pregnant woman), ethnicity (indigenous, Black/ Mulatto/Afro-Colombian and other ethnicities identified by self-reporting), area (urban/rural) and the wealth index makes it possible to compare the household economic conditions considering three aspects: Asset ownership, availability of utilities and home construction materials. The information was collected by a questionnaire sent to adult family members and households [20].

Ethics statement

The research protocols have international and national endorsement from ethics committees in investigation and contemplated the return of the sampling results to the participants in ENSIN 2005 and 2015. The name of the Ethics Committees, the numbers or a statement that approval was granted by the named board(s), and a report that formal consent was obtained from the parent/guardian (including whether it was verbal or written) OR the reason consent is presented anonymously and confidentially in these technical reports [19, 20].

Data analysis

First, we estimated the mean contribution to the total energy intake of each of the NOVA groups and subgroups, and a combination of groups in the consumption of culinary preparations combining energy intake from unprocessed or minimally processed foods and processed culinary ingredients, and of ready-to-eat food products (processed and UPF), to evaluate a proxy of consumption behavior by dietary patterns, in 2005 and 2015. Second, we estimated the mean content of CD-related nutrients (i.e., nutrients of which excessive intake according to the WHO thresholds has been linked to CD: energy density (KJ/g), free sugars (% of total energy intake), total fats (% of total energy intake), saturated fats (% of total energy intake), trans fats (% of total energy intake) and sodium (mg/8372 KJ)). It was done in the overall Colombian diet and two population diet fractions, one restricted to UPF items and the other limited to non-UPF items (unprocessed or minimally processed foods, processed culinary ingredients, and processed foods).

Third, we estimated the mean content of nutrients related to CD in the overall diet across quintiles of the dietary share of UPF. Linear regression models were used to test linear trends across quintiles. Crude- and sociodemographic-adjusted beta regression coefficients (β) were estimated to allow comparisons across variables with different measuring units. Fourth, we analyzed the association between the dietary share of ultra-processed foods (quintiles) and the frequency of dietary nutrient inadequacies using Poisson regression models, where the status of each individual regarding dietary inadequacy on each nutrient is the outcome variable (No: 0; Yes: 1) and quintiles of the dietary share of UPF (1–5) are the explanatory variable. Fifth, adjusted linear regression analyses were performed with sociodemographic indicators and all NOVA categories.

Finally, population attributable fractions (PAFs) were calculated to estimate the reduction in the prevalence of excessive intake of nutrients that, according to the WHO thresholds, has been linked to CD if the consumption of ultra-processed foods in Colombia was the one seen in the 20% lowest consumers of ultra-processed foods (the first quintile). The dietary share of ultra-processed foods among these consumers (n = 6820) represented 1.0% of total energy intake ranging from 0% to 4.5%. PAFs were calculated using the following equation: P is the prevalence of nutrient inadequacy in the population, and Pq1 is in the first quintile of ultra-processed food consumption. The analysis of the "Taylor series linearization variance approximation procedure" was used for variance estimation in all analyses to account for the complex sample design and the sample weights. Data were analyzed using the Stata 15. Excel was used for Figures.

Results

In 2015, all foods and beverages’ average daily energy intake was 8150 KJ. Natural or minimally processed foods accounted for 59.2% of total energy intake, processed culinary ingredients contributed 7.2%, and processed foods and UPF 14.4% and 19.2%, respectively (Table 1).

thumbnail
Table 1. Mean and standard error consumption (Energy intake (%)) of food according to NOVA classification in Colombia between 2005 and 2015.

https://doi.org/10.1371/journal.pgph.0001993.t001

Table 1 also shows the contribution of different subcategories of products within the NOVA categories to energy intake. Within the natural or minimally processed foods category, those that contributed the most to energy intake were cereal grains, bananas, roots, and tubers (26%), followed by red meat with 9.2%. Freshly prepared foods (mainly prepared from unprocessed foods) accounted for 4.5% of total energy, fruits (not sources of vitamin A) contributed 3.3%, and dairy (milk/yogurt) and vegetables contributed 3.2% and 3.1%, respectively.

Among processed culinary ingredients, sugars were the most significant contributors to total energy (3.8%), followed by vegetable oils (3.1%). In the category of processed foods, the most significant contribution came from fried, salty, or sweet preparations (4.9%), followed by fresh bread and bakery products (3.1%) and cheeses (2.2%). Within the UPF, those that contributed the most to total energy intake were industrial bread (4.8%), sweet and salty packaged snacks (4.0%), sugar-sweetened beverages (3.7%), ice creams and commercial dairy drinks (2.3%), sausages and reconstituted meats (1.6%), were some of the other essential subcategories.

When evaluating the change in the consumption of foods and products by NOVA subgroups between 2005 and 2015, a decrease in the consumption of almost all food subgroups is observed in the group of natural or minimally processed foods, being more remarkable in the group of cereals, bananas, roots and tubers (-4.2%), followed by the group of homemade culinary preparations (-2.6%), the group of natural milk and yogurt (-2.3%) and legumes and legumes (-1.2%). On the contrary, there is an increase in the consumption of red meat (4.1%) and slightly of vegetables (1.5%). In the group of processed culinary ingredients, a decrease was observed in all the subgroups, being higher in sugars (-5.1%), followed by vegetable oils (-3.0%) and animal fat (-0.6%).

In the group of processed foods, an increase in consumption is observed in all subgroups, being higher in fried preparations (3.7%), followed by fresh bakery (1.4%) and slightly cheeses (0.3%). In the UPF group, an increase is observed in most of the subgroups, being higher in the subgroup of ice cream, industrial, commercial milk drinks (2.1%), followed by sweet and salty snacks (1.5%), sugar-sweetened beverages (1.2%), there was a slight decrease in confectionery (-0.8%).

Table 1 also shows the distribution of energy consumption in 2005 and 2015 in Colombia, according to the degree of food processing. In the groups of natural and minimally processed foods and processed culinary ingredients, a reduction in consumption is observed when comparing the years 2005 and 2015, of -4.1% and -8.6%, respectively. On the contrary, an increase in processed foods and UPF consumption has been observed, of 9.5% and 3.3%, respectively.

Making a combination of groups to evaluate a proxy of consumption behavior by dietary patterns, a decrease in the consumption of culinary preparations (-12.7%, combining energy intake from unprocessed or minimally processed foods and processed culinary ingredients) is observed between 2005 and 2015. On the contrary, when evaluating the trend in the consumption of ready-to-eat food products (processed and UPF), an increase (12.8%) in consumption is observed between the same years.

Fig 1 shows Colombia’s share of UPF consumption by sociodemographic determinants in 2015. Those individuals that live in urban areas, with higher wealth index, children and adolescents, and without ethnicity or black/mulato/afro-descendant, according to the self-report, present the higher consumption of UPF in Colombia.

thumbnail
Fig 1. Distribution of total energy intake according to NOVA classification and sociodemographic determinants in Colombia in 2015 y.

https://doi.org/10.1371/journal.pgph.0001993.g001

No significant differences were found between men and women in the consumption of ultra-processed foods. We observed significant differences by age, wealth index, area of residence, and ethnicity. The oldest participants had the highest consumption of natural or minimally processed foods. In contrast, the youngest participants (1–4 years old) had the highest intake of ultra-processed foods: more than double that of the participants aged over 50 years. The highest consumers of natural or minimally processed foods and the lowest consumers of ultra-processed foods were from the most lower wealth status and resided in rural areas.

The mean nutrient intake of the overall diet across quintiles of the dietary share of ultra-processed foods in ENSIN 2015 is presented in Table 2. From the lower to the upper quintile, there were increases in free sugars (from 8.1 to 15.4% of total energy intake), total fats (from 22.4 to 27.4% of total energy intake), saturated fats (from 8.1 to 11.1% of total energy intake), trans fats (from 0.21 to 0.60% of total energy intake), and sodium (from 1332 to 2169 mg/day). Trends of the increase of CD-promoting nutrients across quintiles of ultra-processed food consumption were statistically significant even after adjusting for potential sociodemographic confounders (P≤0.001).

thumbnail
Table 2. The mean content of CD-related nutrients in the overall diet across quintiles of the dietary share of ultra-processed foods.

Colombian population aged one year or over (2015).

https://doi.org/10.1371/journal.pgph.0001993.t002

Table 3 presents the prevalence of nutrient intake inadequacies for the overall population and across quintiles of the dietary share of ultra-processed foods. The higher prevalence of CD-related nutrients excess consumption was found for sodium (67.6%), followed by free sugars (48.6%), saturated fats (40.8%), total fats (26.7%), and trans fats (9.7%). The prevalence of CD-related nutrients excess consumption significantly increased with ultra-processed foods, even after adjusting for potential sociodemographic confounders (P≤0.001). Thus, compared with individuals in the lowest quintile, individuals in the highest quintile of ultra-processed food consumption were significantly more likely to have diets exceeding the dietary goals for trans fats (5.7 times), free sugars (2.7 times), sodium (2.3 times), saturated fats (2.1 times) and total fats (1.9 times).

thumbnail
Table 3. Prevalence of diets with excessive content of CD-related nutrients δ in the whole population and across quintiles of the dietary share of ultra-processed foods.

Colombian population aged one year or over (2015).

https://doi.org/10.1371/journal.pgph.0001993.t003

Fig 2 presents estimates of the fractions of the populations that have an inadequate intake of CD-related nutrients attributable to high consumption of ultra-processed foods in Colombia (higher than the one found among the 20% lowest consumers of UPF, who consume 1.0% of the total energy intake on average, ranging from 0 to 4.5%). Three-fourths of the population’s excessive intake of trans fats; around one-third of the population’s excessive intake of free sugars and saturated fats; nearly 26% population’s excessive intake of sodium; and 15% population’s excessive intake of total fats; are due to the referred excessive intake of UPF.

thumbnail
Fig 2. Population attributable fraction due to the high consumption of ultra-processed foods (higher than the observed in the first quintile) of inadequate NCD-related nutrients dietary content.

Colombian population aged one years or over (2015).

https://doi.org/10.1371/journal.pgph.0001993.g002

Discussion

In Colombia, there is an increase in the consumption of UPF. In 2015, no significant differences were found in the consumption of UPF between men and women. But, significant differences by age, wealth index, area of residence, and ethnicity. A significant positive association was found between the dietary share of UPF and the intake of CD-related nutrients such as content of free sugars, total fats, saturated fats, trans-fats, and sodium. The prevalence of excessive intake of all these nutrients (WHO recommendations) increased across quintiles of the dietary share of UPF. In concordance, with the reduction of UPF consumption to the level seen among the 20% lowest consumers, the prevalence of excessive nutrient intake would be reduced in 72% for trans fats; in 39% for free sugar, 27.5% in saturated fats, in 26% for sodium and 15% for total fat.

These observed trends of increased consumption of UPF in Colombia are consistent with the data described by PAHO on the increase in the sale of UPF in recent decades in the country and the region [24]. It is essential to highlight that parallel to the risk associated with the increase in the presence and consumption of these unhealthy UPF in the country, a decrease in the consumption of natural or minimally processed foods and culinary preparations is observed. Both phenomena (increase in the consumption of UPF and decrease in the consumption of culinary preparations based on natural foods) generate a deterioration in the quality of the diet due to an increase in the content of critical nutrients related to the presence of obesity and chronic diseases (i.e., free sugars, total, saturated and trans fats, and sodium) and the reduction of dietary diversity of natural foods [25], and essential nutrients for health like micronutrients, fiber and protein [11].

In Colombia, in 2015, rural residents and older adults are likely to have more traditional cooking and eating practices and more stable dietary patterns. These groups may also be more protected from marketing practices that appeal to the younger generation and more advantaged people with less stable dietary habits and, therefore, more likely to try these products. These findings are in line with the ENSIN 2005 results [10].

In light of the substantial amount of recent research accentuating the risks of UPFs [5], the results presented above reflect an alarming situation which has been associated with the corporate food regime [26]. According to Ordoñez, this regime emerged in the 1990s in Colombia [17, 27], presenting the following characteristics: (i) institutional frameworks and functional regulatory frameworks for the industrial agri-food system; (ii) privatization of seeds and the restriction of their conservation and free circulation; (iii) intensive use of chemical poisons and fertilizers in agriculture; (iv) corporate concentration of its production, import and sale; (v) land grabbing by national and foreign businessmen in large regions of the country such as the “Altillanura”; (vi) deepening of agro-industrial bets and the extension of monocultures; (vii) expansion and increase of food distribution chains in large supermarkets and express formats; (viii) proliferation of UPF sales (of national and international origin), and fast-food chains in the different food environments [24]; (viii) increase obesity, chronic diseases and standardization of people in a situation of malnutrition; and (ix) he precise definition of a vital business bloc in the agricultural and food sectors. Additionally, this trend in the increase of UPF may be due to the different marketing and advertising techniques used by the food industry, which is based on the management of emotions, for the sale of their products, such as selling: fun/ happiness, fantasy and imagination, palatability, drawings or animated characters, music/jingles and messages aimed at children [28].

According to Mialon et al. [16, 29], proximity between the industry, government, and the media is particularly evident and remains unquestioned in Colombia. The influence of vulnerable populations in communities and the feeling of insecurity by public health advocates is also problematic. The Corporative Political Activity of the food industry has the potential to weaken and delay efforts to develop and implement public health policies that could improve the healthiness of food environments. Mechanisms to prevent and manage the influence of the food industry must be developed in the country [16, 2933].

The results of this study from 2015 support the hypothesis that strategies to reduce the consumption of UPF are a potentially effective way to achieve the nutritional goals of the WHO for the prevention of diet-related CD. We observed that a reduction of UPF consumption to the level seen among the 20% lowest consumers significantly reduced the prevalence of excessive CD-related nutrients intake. In concordance, Martinez and Cols also found that inadequate intakes of these nutrients would be reduced considerably in all eight countries studied (Brazil, Chile, Canada, Mexico, Australia, UK, US, and Colombia with data from 2005) if ultra-processed food consumption were decreased to levels observed among the lowest quintile of UPF consumption in each country [9].

The results of this study highlight the need for regulations of UPFs, including:

(i) implementation of law 2120 approved by the Colombian parliament to improve the food environments to prevent CD [34].

(ii) disseminate health promotion tools, such as plant-based dietary guidelines that consider the extent and purpose of processing, such as those adopted in Brazil [35] and Uruguay [36], where have these recommendations: Make natural or minimally processed foods the basis of your diet, use oils, fats, salt, and sugar in small amounts when seasoning and cooking natural or minimally processed foods and to create culinary preparations, limit consumption of processed foods, and avoid consumption of ultra-processed foods.

(iii) implementing the warning labeling to encourage healthier options at points of purchase, such as the octagonal warning labels adopted in several Latin American countries, as recommended by PAHO [3739]

(iv) counteracting the different strategies of political activity by the corporate food regime that has been established in Colombia [16, 29]

(v) Adopt healthy taxes on UPF products high in CD-promoting nutrients and the presence of sweeteners

(vi) apply the PAHO nutrient profile model in food policies to regulated de UPF, which has demonstrated in nine countries (including Colombia) that those individuals that consume UPF or processed products with excess content of nutrients related to a CD according to PAHO presented two to four times more probability to have a diet associated with a risk of CD [6, 40]

(vii) regulate UPF advertising for children and adolescents complying with the WHO set of Recommendations on the Marketing of Food and Non-Alcoholic Beverages to Children.

(viii) improve food systems so that they are healthy and sustainable, based on clean production, avoiding the UPF in social programs, support and subsidies for local producers of natural foods, short marketing circuits, and supported by food and nutrition education strategies.

This study has its limitations. All dietary information available within ENSIN was of 24-hour dietary recall. Beyond recall bias, participants may choose to retain information about certain food products considered socially undesirable in terms of product categories and quantities consumed. This single point of dietary information may not capture the participants’ usual diet and therefore be less representative of their intake. Nonetheless, the probabilistic nature of the sample studied, the national representativeness of the Colombian population using national surveys with available 24-hour dietary recall, and the standardization of dietary data collection are some of the strengths of this study.

In addition, it also represents a strength, the fact that the study provides intake reference levels using the ENSIN 2005 as a baseline and compares with the most recent dietary evaluations in the country (ENSIN 2015), capturing trends in the consumption of UPF in Colombia. Additionally, this work considers the nutrients related to chronic diseases that are the focus of the recent food policy on Front of package labeling and healthy taxes on UPF in the country. Finally, the analysis of PAFs of unhealthy nutrient intake in Colombia in 2015 due to ultra-processed food consumption could be a reference as a baseline for follow-up in the political to reduce ultra-processed foods in Colombia. These results suggest an installation of the corporate food regime in Colombia, displacing the ancestral traditional food system related to a diet based on natural foods and typical culinary preparations associated with a healthy and sustainable diet. These data highlight the need to improve the current health promotion and prevention policies reducing the sale of UPF to achieve the nutritional goals of the WHO for the prevention of diet-related CD.

Conclusions

This study shows an increasing trend in the consumption of UPF by the population of Colombia from 2005 to 2015 and a decrease in the consumption of natural and minimally processed foods and culinary preparations (except red meat). Children and adolescents were found to have a higher consumption of UPF, which is probably due to the fact that they are more easily hooked up by marketing practices of UPF and, therefore, are more vulnerable to their deleterious effects on diet, increasing the consumption of CD-related nutrients. Adopting low-UPF diets, following the 20% lowest consumers of UPF (≤1.0% (0–4.5%) of the total energy from UPF), would allow the prevalence of unhealthy diets among the Colombian population to reduce significantly. Strategies to reduce the consumption of UPF are a potentially effective way to achieve the nutritional goals of the WHO for the prevention of diet-related CD.

Supporting information

S1 Fig. Food consumption, according to NOVA classification and sociodemographics factors in Colombia.

https://doi.org/10.1371/journal.pgph.0001993.s002

(XLSX)

Acknowledgments

Thanks to Colombia’s Ministry of Health and social protection for providing the database.

References

  1. 1. Monteiro CA, Cannon G, Levy RB, Moubarac J-C, Louzada ML, Rauber F, et al. Ultra-processed foods: what they are and how to identify them. Public Health Nutr. 2019;22: 936–941. pmid:30744710
  2. 2. Martínez Steele E, Popkin BM, Swinburn B, Monteiro CA. The share of ultra-processed foods and the overall nutritional quality of diets in the US: evidence from a nationally representative cross-sectional study. Popul Health Metr. 2017;15: 1–6. pmid:28193285
  3. 3. Rauber F, da Costa Louzada ML, Steele E, Millett C, Monteiro CA, Levy RB. Ultra-Processed Food Consumption and Chronic Non-Communicable Diseases-Related Dietary Nutrient Profile in the UK (2008–2014). Nutrients. 2018;10: 587. pmid:29747447
  4. 4. Moubarac J-C, Batal M, Louzada ML, Martinez Steele E, Monteiro CA. Consumption of ultra-processed foods predicts diet quality in Canada. Appetite. 2017;108: 512–520. pmid:27825941
  5. 5. Food and Agriculture Organization of the United Nations. Ultra-processed foods, diet quality, and health using the NOVA classification system. 2019. Available: http://www.fao.org/3/ca5644en/ca5644en.pdf
  6. 6. Pan American Health Organization. Nutrient Profile Model. Washington, D.C.: PAHO; 2016 [cited 1 Mar 2017] pp. 1–31. Available: http://iris.paho.org/xmlui/handle/123456789/18621
  7. 7. World Health Organization. Diet, nutrition and the prevention of chronic diseases. Report of a joint FAO/WHO Expert Consultation. World Heal Organ Tech Rep Ser. 2003;916: 61–71. Available: http://www.who.int/dietphysicalactivity/publications/trs916/en/
  8. 8. Moubarac J-C, Pan American Health Organization, World Health Organization. Ultra-processed food and drink products in Latin America: Trends, impact on obesity, policy implications. In: US1.1 [Internet]. PAHO; 2015 [cited 17 Jul 2016] pp. 1–58. Available: http://iris.paho.org/xmlui/bitstream/handle/123456789/7699/9789275118641_eng.pdf
  9. 9. Martinez Steele E, Marrón Ponce JA, Cediel G, Louzada MLC, Khandpur N, Machado P, et al. Potential reductions in ultra-processed food consumption substantially improve population cardiometabolic-related dietary nutrient profiles in eight countries. Nutr Metab Cardiovasc Dis. 2022. pmid:36163210
  10. 10. Khandpur N, Cediel G, Obando DA, Jaime PC, Parra DC. Sociodemographic factors associated with the consumption of ultra-processed foods in Colombia. Rev Saude Publica. 2020;54: 19. pmid:32049210
  11. 11. Parra DC, Costa-louzada ML, Moubarac J, Bertazzi-levy R, Khandpur N, Cediel G, et al. The association between ultra-processed food consumption and the nutrient profile of the Colombian diet in 2005. Salud Publica Mex. 2019;61.
  12. 12. Organización Panamericana de la Salud. Washington DC. O 2019. Alimentos y bebidas ultraprocesados en América Latina: ventas, fuentes, perfiles de nutrientes e implicaciones. Washington (DC); 2019. Available: http://iris.paho.org/xmlui/bitstream/handle/123456789/51523/9789275320327_spa.pdf?sequence=1&isAllowed=y
  13. 13. Costa-Louzada M, Martins A, Canella D, Baraldi L, Levy R, Claro R, et al. Ultra-processed foods and the nutritional dietary profile in Brazil. Rev Saude Publica. 2015;49.
  14. 14. Cediel G, Reyes M, Corvalán C, Levy RB, Uauy R, Monteiro CA. Ultra-processed foods drive to unhealthy diets: evidence from Chile. Public Health Nutr. 2020; 1–10. pmid:32338229
  15. 15. Marrón J, Flores M, Cediel G, Monteiro C, Batis C. Associations between Consumption of Ultra-Processed Foods and Intake of Nutrients Related to Chronic Non-Communicable Diseases in Mexico. J Acad Nutr Diet. 2019.
  16. 16. Mialon M, Gaitan Charry DA, Cediel G, Crosbie E, Baeza Scagliusi F, Pérez Tamayo EM. “the architecture of the state was transformed in favour of the interests of companies”: Corporate political activity of the food industry in Colombia. Global Health. 2020;16: 1–16. pmid:33046110
  17. 17. Asociación Nacional de Zonas de Reserva Campesina. Colombia y el régimen alimentario corporativo. In: Agencia prensa rural [Internet]. [cited 3 Jul 2020]. Available: https://prensarural.org/spip/spip.php?article13059
  18. 18. DANE. Principales resultados de Estadísticas Vitales nacimientos y defunciones para el cuarto trimestre de 2022pr, acumulado del año 2022 y el año corrido de 2023. Bogotá, D,C, Colombia; 2023.
  19. 19. ICBF. Instituto Colombiano de Bienestar Familiar. ENSIN—Encuesta Nacional de Situación Nutricional en Colombia. Primera Ed. Bogotá; 2005.
  20. 20. Gobierno Nacional. ENSIN: Encuesta Nacional de Situación Nutricional 2015. Instituto Colombiano. Bogotá; 2019. Available: https://www.icbf.gov.co/bienestar/nutricion/encuesta-nacional-situacion-nutricional
  21. 21. Monteiro CA, Cannon G, Moubarac J-C, Levy RB, Louzada MLC, Jaime PC. The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutr. 2017; 1–13. pmid:28322183
  22. 22. World Health Organization. Guideline Sugars intake for adults and children. WHO Library Cataloguing-in-Publication Data, editor. Geneva, Switzerland: WHO; 2015 [cited 17 Oct 2016] pp. 1–49. Available: http://apps.who.int/iris/bitstream/10665/149782/1/9789241549028_eng.pdf
  23. 23. WHO | Potassium intake for adults and children. WHO. World Health Organization; 2015. Available: http://www.who.int/nutrition/publications/guidelines/potassium_intake/en/
  24. 24. Organización Panamericana de la Salud, Organización Mundial de la Salud. Alimentos y bebidas ultraprocesados en América Latina: ventas, fuentes, perfiles de nutrientes e implicaciones normativas. Washington, DC: OPS; 2019.
  25. 25. Marrón-Ponce JA, Sánchez-Pimienta TG, Rodríguez-Ramírez S, Batis C, Cediel G. Ultra-processed foods consumption reduces dietary diversity and micronutrient intake in the Mexican population. J Hum Nutr Diet. 2022; 1–11. pmid:35279889
  26. 26. McMichael P. Global development and the corporate food regime. Res Rural Sociol Dev. 2005;11: 269–303. Available: https://devsoc.cals.cornell.edu/sites/devsoc.cals.cornell.edu/files/shared/documents/McM-global-dev-corp-regimeFR-pdf.pdf
  27. 27. León Rodríguez N, Meza Carvajalino CA, Isaza Castro JG. Las transformaciones del sector rural en Colombia desde las reformas neoliberales: un análisis entre 1980 y 2004. Available: https://www.casadellibro.com/ebook-las-transformaciones-del-sector-rural-en-colombia-desde-las-reformas-neoliberales-ebook/9789588572512/2574188?utm_source=webgains&utm_campaign=21394&utm_content=ND&utm_medium=RedAfiliacion&wgtarget=https%3A%2Fwww.casadellibro.com%2Febook-las-transformaciones-del-sector-rural-en-colombia-desde-las-reformas-neoliberales-ebook%2F9789588572512%2F2574188&wgu=8941_16644_1593898400075_f350885044&wgexpiry=1601674400
  28. 28. Gómez P, Zapata ME, Rovirosa A, Gotthelf S, Ferrante D. Técnicas de marketing en publicidades de alimentos y bebidas en canales infantiles de Argentina: diferencias según calidad nutricional nutricional. Rev argent salud pública. 2017;8.
  29. 29. Mialon M, Gaitan Charry DA, Cediel G, Crosbie E, Scagliusi FB, Perez Tamayo EM. ‘I had never seen so many lobbyists’: food industry political practices during the development of a new nutrition front-of-pack labelling system in Colombia. Public Health Nutr. 2020; 1–9. pmid:32819452
  30. 30. Fian Colombia–Por el Derecho a la alimentación. [cited 3 Jul 2020]. Available: http://www.fiancolombia.org/
  31. 31. Equipo–Educar Consumidores. [cited 15 Apr 2020]. Available: https://educarconsumidores.org/somos/equipo/
  32. 32. Red Papaz–Red Papaz. [cited 3 Jul 2020]. Available: https://www.redpapaz.org/
  33. 33. Pan Rebelde—YouTube. [cited 3 Jul 2020]. Available: https://www.youtube.com/watch?time_continue=1&v=WyQvKDmsKV4&feature=emb_title
  34. 34. Congreso de Colombia. Ley 2120, 30 de Julio de 2021, “POR MEDIO DE LA CUAL SE ADOPTAN MEDIDAS PARA FOMENTAR ENTORNOS ALIMENTARIOS SALUDABLES Y PREVENIR ENFERMEDADES NO TRANSMISIBLES Y SE ADOPTAN OTRAS DISPOSICIONES.” El congreso de Colombia. 2021: 1–9.
  35. 35. Ministério de Saúde. Guia Alimentar para a população Brasileira. Brasília—DF; 2014 [cited 22 Mar 2017] pp. 1–158. Available: http://portalarquivos.saude.gov.br/images/pdf/2014/novembro/05/Guia-Alimentar-para-a-pop-brasiliera-Miolo-PDF-Internet.pdf
  36. 36. Ministerio de Salud (URY). Guía alimentaria para la población uruguaya. Montevideo; 2016.
  37. 37. Corvalán C, Marcela R, Maria Luisa G, Uauy R. Structural responses to the obesity and non-communicable diseases epidemic: update on the Chilean Law of Food Labeling and Advertising. Obes Rev. 2018;20. Available: pmid:30549191
  38. 38. Pan American Health Organization. Front-of-Package Labeling as a policy tool for the prevention of noncommunicable diseases in the Americas. 2020; 1–36.
  39. 39. Crosbie E, Gomes FS, Olvera J, Patiño SR, Hoeper S, Carriedo A. Health Policy A policy study on front–of–pack nutrition labeling in the Americas: Emerging developments and outcomes. Lancet Reg Heal—Am. 2022; 100400. pmid:36844016
  40. 40. Pan American Health Organization. Consumo de productos ultraprocesados y procesados con exceso de nutrientes asociados con enfermedades crónicas no transmisibles y la alimentación insalubre en las Américas. 2022. Available: https://iris.paho.org/handle/10665.2/55547