1Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil.
Introduction: In 2019, the EAT-Lancet Commission proposed a sustainable global diet aimed at reducing environmental impacts and diet-related deaths. However, criticism has been raised about the lack of attention given to the negative effects of ultra-processed foods. Despite this, there are no studies evaluating the association between the consumption of ultra-processed foods and adherence to the EAT-Lancet diet. Objective: The aim of this study was to address this gap in knowledge by investigating a nationally representative sample of the Brazilian population. Methods: Data from the Brazilian National Dietary Survey 2017-2018 on 46,164 Brazilians aged 10 years or older were used. Food consumption was evaluate through a 24-hour dietary recall. Adherence to the EATLancet diet was evaluated using the Planetary Health Diet Index (PHDI), and the Nova system was used to classify food according to its processing level: i) unprocessed or minimally processed foods; ii) processed culinary ingredientes; iii) processed foods; and iv) ultra-processed foods. Thereafter, the share (%) of contribution of each group to the total energy intake was estimated. Linear regression models were built to evaluate the association between each Nova food group and PHDI, considering the complex sample size. Results: The average PHDI total score was 45.9 points (95% CI 45.6, 46.1). Individuals in the highest quintile of share of ultra-processed foods had a 5.38-point lower PHDI total score (95% CI –6.01, –4.75). Similarly, individuals in the highest quintile of share of processed foods and culinary ingredients had 1.31-point (95% CI –1.98, –0.65) and 1.32-point (95% CI –1.88, –0.76) lower PHDI total scores, respectively. Conversely, individuals in the highest quintile of share of unprocessed or minimally processed foods had an 8.34-point higher PHDI total score (95% CI 7.76, 8.93) compared to those in the first quintile. Conclusion: This analysis of a nationally representative sample of the Brazilian population found that the consumption of ultra-processed foods, as well as processed foods and culinary ingredients, was inversely associated with adherence to a healthy and sustainable diet, as measured by the PHDI. Conversely, the consumption of unprocessed or minimally processed foods was positively associated with PHDI scores.
Keywords: EAT-Lancet diet; sustainable diet; ultra-processed foods.