Ultra İşlenmiş Gıdaların Yaygın Etkileri

Serap Okyar; Öznur Tosun; Erhan Bezdegümeli; Bilge Nur Küçükakça; Ayşegül Erattır; Hilal Karahan; Elif Köse; Hasan Çetin Ekerbiçer

doi:10.17827/aktd.1123330

Ultra İşlenmiş Gıdaların Yaygın Etkileri

Öz

Gıdalar NOVA gıda sınıflandırmasına göre dört alt kategoride sınıflandırılmaktadır. NOVA Kategori-4: Ultra işlenmiş gıdalar gazlı içecekleri, paketlenmiş tuzlu ve tatlı atıştırmalık ürünleri, yeniden yapılandırılan hayvansal ürünleri (salam, sosis, hazır kıyma ürünleri gibi), önceden hazırlanmış gıdaları, ön-pişirilmiş ve dondurulmuş gıdaları kapsamaktadır. Ultra-işlenmiş gıdaların lezzetlerinin güzel, kolay ulaşılabilir ve ucuz olmaları sebebi ile tüketimi ve bu sebeple sağlıksız beslenme ile morbidite ve mortaliteyi de arttırdığı gözlemlenmiştir. Bu sağlık problemlerine örnekler tip-2 diyabet, obezite, kardiyovasküler hastalıklar, gastrointestinal hastalıklar ve kanserdir. Literatürde yapılan çalışmalar kapsamında, mevcut derlemede ultra-işlenmiş gıdaları ve sağlık üzerindeki yaygın etkileri ortaya konmuştur. Güncel veriler doğrultusunda ultra işlenmiş gıda tüketimini ve sağlık üzerindeki etkilerini azaltabilmek için ulusal ve uluslararası düzeyde yeni beslenme politikaları ve kılavuzlarının geliştirilmesi önem arz etmektedir.

Anahtar Kelimeler

NOVA , ULTRA İŞLENMİŞ GIDA , TİP2 DİYABET , OBEZİTE , KARDİYOVASKÜLER HASTALIKLAR

Kaynakça

Referans1 van Boekel, M., Fogliano, V., Pellegrini, N., Stanton, C., Scholz, G., Lalljie, S., Somoza, V., Knorr, D., Jasti, P. R., & Eisenbrand, G. (2010). A review on the beneficial aspects of food processing. Molecular nutrition & food research, 54(9), 1215–1247.
Referans2 Floros, J. D., Newsome, R., Fisher, W., Barbosa-Cánovas, G. V., Chen, H., Dunne, C. P., et al. (2010). Feeding the World Today and Tomorrow: The Importance of Food Science and Technology: An IFT Scientific Review. Comprehensive reviews in food science and food safety, 9(5), 572–599
Referans3 Augustin, M. A., Riley, M., Stockmann, R., Bennett, L., Kahl, A., Lockett, T., Osmond, M., Sanguansri, P., Stonehouse, W., Zajac, I., & Cobiac, L. (2016). Role of food processing in food and nutrition security. Trends in Food Science and Technology, 56, 115-125.
Referans4 Costard, S., Espejo, L., Groenendaal, H., & Zagmutt, F. J. (2017). Outbreak-Related Disease Burden Associated with Consumption of Unpasteurized Cow's Milk and Cheese, United States, 2009-2014. Emerging infectious diseases, 23(6), 957–964. https://doi.org/10.3201/eid2306.151603
Referans5 Kliemann, N., Al Nahas, A., Vamos, E. P., Touvier, M., Kesse-Guyot, E., Gunter, M. J., Millett, C., & Huybrechts, I. (2022). Ultra-processed foods and cancer risk: from global food systems to individual exposures and mechanisms. British journal of cancer, 10.1038/s41416-022-01749-y.
Referans6 Marsh, K., & Bugusu, B. (2007). Food packaging--roles, materials, and environmental issues. Journal of food science, 72(3), R39–R55.
Referans7 Monteiro, C. A., Cannon, G., Levy, R. B., Moubarac, J. C., Louzada, M. L., Rauber, F., Khandpur, N., Cediel, G., Neri, D., Martinez-Steele, E., Baraldi, L. G., & Jaime, P. C. (2019). Ultra-processed foods: what they are and how to identify them. Public health nutrition, 22(5), 936–941.
Referans8 Paglia L. (2019). The sweet danger of added sugars. European journal of paediatric dentistry, 20(2), 89.
Referans9 Bray, G. A., Nielsen, S. J., & Popkin, B. M. (2004). Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. The American journal of clinical nutrition, 79(4), 537–543.
Referans10 Monteiro, C. A., Moubarac, J. C., Cannon, G., Ng, S. W., & Popkin, B. (2013). Ultra-processed products are becoming dominant in the global food system. Obesity reviews : an official journal of the International Association for the Study of Obesity, 14 Suppl 2, 21–28.

Referans11 Monteiro, C. A., Levy, R. B., Claro, R. M., Castro, I. R., & Cannon, G. (2010). A new classification of foods based on the extent and purpose of their processing. Cadernos de saude publica, 26(11), 2039–2049.
Referans12 Monteiro, C. A., Cannon, G., Moubarac, J. C., Levy, R. B., Louzada, M., & Jaime, P. C. (2018). The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public health nutrition, 21(1), 5–17.
Referans13 Moubarac, J. C., Parra, D. C., Cannon, G., & Monteiro, C. A. (2014). Food Classification Systems Based on Food Processing: Significance and Implications for Policies and Actions: A Systematic Literature Review and Assessment. Current obesity reports, 3(2), 256–272.
Referans14 Monteiro, C.A., Cannon, G., Lawrence, M., Costa Louzada, M.L. and Pereira Machado, P. 2019. Ultra- processed foods,diet quality, and health using the NOVA classification system. Rome, FAO.
Referans15 Monteiro, C.A., Cannon, G., Lawrence, M., Costa Louzada, M.L. and Pereira Machado, P. 2019. Ultra-processed foods,diet quality, and health using the NOVA classification system. Rome, FAO.
Referans16 Hellenäs, K. E., Abramsson-Zetterberg, L., & Skog, K. (2005). The HEATOX Project. Journal of AOAC International, 88(1), 242–245.
Referans17 Poti, J. M., Mendez, M. A., Ng, S. W., & Popkin, B. M. (2016). Highly Processed and Ready-to-Eat Packaged Food and Beverage Purchases Differ by Race/Ethnicity among US Households. The Journal of nutrition, 146(9), 1722–1730. https://doi.org/10.3945/jn.116.230441
Referans18 Solberg, S. L., Terragni, L., & Granheim, S. I. (2016). Ultra-processed food purchases in Norway: a quantitative study on a representative sample of food retailers. Public health nutrition, 19(11), 1990–2001.
Referans19 Monteiro, C. A., Moubarac, J. C., Levy, R. B., Canella, D. S., Louzada, M., & Cannon, G. (2018). Household availability of ultra-processed foods and obesity in nineteen European countries. Public health nutrition, 21(1), 18–26.
Referans20 Julia, C., Martinez, L., Allès, B., Touvier, M., Hercberg, S., Méjean, C., & Kesse-Guyot, E. (2018). Contribution of ultra-processed foods in the diet of adults from the French NutriNet-Santé study. Public health nutrition, 21(1), 27–37.
Referans21 Slimani, N., Deharveng, G., Southgate, D. A., Biessy, C., Chajès, V., van Bakel et al (2009). 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. European journal of clinical nutrition, 63 Suppl 4, S206–S225.
Referans22 Venn, D., Banwell, C., & Dixon, J. (2017). Australia's evolving food practices: a risky mix of continuity and change. Public health nutrition, 20(14), 2549–2558.
Referans23 Luiten, C. M., Steenhuis, I. H., Eyles, H., Ni Mhurchu, C., & Waterlander, W. E. (2016). Ultra-processed foods have the worst nutrient profile, yet they are the most available packaged products in a sample of New Zealand supermarkets. Public health nutrition, 19(3), 530–538.
Referans24 Martins, A. P., Levy, R. B., Claro, R. M., Moubarac, J. C., & Monteiro, C. A. (2013). Increased contribution of ultra-processed food products in the Brazilian diet (1987-2009). Revista de saude publica, 47(4), 656–665.
Referans25 Cornwell, B., Villamor, E., Mora-Plazas, M., Marin, C., Monteiro, C. A., & Baylin, A. (2018). Processed and ultra-processed foods are associated with lower-quality nutrient profiles in children from Colombia. Public health nutrition, 21(1), 142–147.
Referans26 Cediel, G., Reyes, M., da Costa Louzada, M. L., Martinez Steele, E., Monteiro, C. A., Corvalán, C., & Uauy, R. (2018). Ultra-processed foods and added sugars in the Chilean diet (2010). Public health nutrition, 21(1), 125–133.
Referans27 Setyowati, D., Andarwulan, N., & Giriwono, P. E. (2018). Processed and ultraprocessed food consumption pattern in the Jakarta Individual Food Consumption Survey 2014. Asia Pacific journal of clinical nutrition, 27(4), 840–847.
Referans28 Rischke R, Kimenju SC, Klasen S, Qaim M. (2015).Supermarkets and food consumption patterns: The case of small towns in Kenya. Food Policy, 52:9–21.
Referans29 Matos, R. A., Adams, M., & Sabaté, J. (2021). Review: The Consumption of Ultra-Processed Foods and Non-communicable Diseases in Latin America. Frontiers in nutrition, 8, 622714.
Referans30 Pérez-Escamilla, R., Obbagy, J. E., Altman, J. M., Essery, E. V., McGrane, M. M., Wong, Y. P., Spahn, J. M., & Williams, C. L. (2012). Dietary energy density and body weight in adults and children: a systematic review. Journal of the Academy of Nutrition and Dietetics, 112(5), 671–684.
Referans31 Asfaw A. (2011). Does consumption of processed foods explain disparities in the body weight of individuals? The case of Guatemala. Health economics, 20(2), 184–195.
Referans32 Schulte, E. M., Avena, N. M., & Gearhardt, A. N. (2015). Which foods may be addictive? The roles of processing, fat content, and glycemic load. PloS one, 10(2), e0117959.
Referans33 Poti, J. M., Mendez, M. A., Ng, S. W., & Popkin, B. M. (2015). Is the degree of food processing and convenience linked with the nutritional quality of foods purchased by US households?. The American journal of clinical nutrition, 101(6), 1251–1262.
Referans34 Costa Louzada, M. L., Martins, A. P., Canella, D. S., Baraldi, L. G., Levy, R. B., Claro, R. M., Moubarac, J. C., Cannon, G., & Monteiro, C. A. (2015). Ultra-processed foods and the nutritional dietary profile in Brazil. Revista de saude publica, 49, 38.
Referans35 Moubarac, J. C., Batal, M., Louzada, M. L., Martinez Steele, E., & Monteiro, C. A. (2017). Consumption of ultra-processed foods predicts diet quality in Canada. Appetite, 108, 512–520.
Referans36 Steenhuis, I., & Poelman, M. (2017). Portion Size: Latest Developments and Interventions. Current obesity reports, 6(1), 10–17.
Referans37 Louzada, M. L., Baraldi, L. G., Steele, E. M., Martins, A. P., Canella, D. S., Moubarac, J. C., Levy, R. B., Cannon, G., Afshin, A., Imamura, F., Mozaffarian, D., & Monteiro, C. A. (2015). Consumption of ultra-processed foods and obesity in Brazilian adolescents and adults. Preventive medicine, 81, 9–15.
Referans38 Mendonça, R. D., Lopes, A. C., Pimenta, A. M., Gea, A., Martinez-Gonzalez, M. A., & Bes-Rastrollo, M. (2017). Ultra-Processed Food Consumption and the Incidence of Hypertension in a Mediterranean Cohort: The Seguimiento Universidad de Navarra Project. American journal of hypertension, 30(4), 358–366.
Referans39 Lin, X., Xu, Y., Pan, X., Xu, J., Ding, Y., Sun, X., Song, X., Ren, Y., & Shan, P. F. (2020). Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025. Scientific reports, 10(1), 14790.
Referans40 Wang, Z., Siega-Riz, A. M., Gordon-Larsen, P., Cai, J., Adair, L. S., Zhang, B., & Popkin, B. M. (2018). Diet quality and its association with type 2 diabetes and major cardiometabolic risk factors among adults in China. Nutrition, metabolism, and cardiovascular diseases : NMCD, 28(10), 987–1001.
Referans41 Moradi, S., Hojjati Kermani, M. A., Bagheri, R., Mohammadi, H., Jayedi, A., Lane, M. M., Asbaghi, O., Mehrabani, S., & Suzuki, K. (2021). Ultra-Processed Food Consumption and Adult Diabetes Risk: A Systematic Review and Dose-Response Meta-Analysis. Nutrients, 13(12), 4410.
Referans42 Levy, R. B., Rauber, F., Chang, K., Louzada, M., Monteiro, C. A., Millett, C., & Vamos, E. P. (2021). Ultra-processed food consumption and type 2 diabetes incidence: A prospective cohort study. Clinical nutrition (Edinburgh, Scotland), 40(5), 3608–3614.
Referans43 Nardocci, M., Polsky, J. Y., & Moubarac, J. C. (2021). Consumption of ultra-processed foods is associated with obesity, diabetes and hypertension in Canadian adults. Canadian journal of public health = Revue canadienne de sante publique, 112(3), 421–429.
Referans44 Lanaspa, M. A., Kuwabara, M., Andres-Hernando, A., Li, N., Cicerchi, C., Jensen, T., et al (2018). High salt intake causes leptin resistance and obesity in mice by stimulating endogenous fructose production and metabolism. Proceedings of the National Academy of Sciences of the United States of America, 115(12), 3138–3143.
Referans45 Martínez Steele, E., Baraldi, L. G., Louzada, M. L., Moubarac, J. C., Mozaffarian, D., & Monteiro, C. A. (2016). Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study. BMJ open, 6(3), e009892.
Referans46 Stanhope K. L. (2016). Sugar consumption, metabolic disease and obesity: The state of the controversy. Critical reviews in clinical laboratory sciences, 53(1), 52–67.
Referans47 World Health Organization. Cardiovascular diseases (CVDs) fact sheet. WHO.
Referans48 Timmis, A., Townsend, N., Gale, C., Grobbee, R., Maniadakis, N., Flather, M., et al & ESC Scientific Document Group (2018). European Society of Cardiology: Cardiovascular Disease Statistics 2017. European heart journal, 39(7), 508–579.
Referans49 Zhang, Y., Huang, M., Zhuang, P., Jiao, J., Chen, X., Wang, J., & Wu, Y. (2018). Exposure to acrylamide and the risk of cardiovascular diseases in the National Health and Nutrition Examination Survey 2003-2006. Environment international, 117, 154–163.
Referans50 eJarnett, N., Conklin, D. J., Riggs, D. W., Myers, J. A., O'Toole, T. E., Hamzeh, I., et al (2014). Acrolein exposure is associated with increased cardiovascular disease risk. Journal of the American Heart Association, 3(4), e000934.
Referans51 Srour, B., Fezeu, L. K., Kesse-Guyot, E., Allès, B., Méjean, C., Andrianasolo, R. M., et al (2019). Ultra-processed food intake and risk of cardiovascular disease: prospective cohort study (NutriNet-Santé). BMJ (Clinical research ed.), 365, l1451.
Referans52 Juul, F., Vaidean, G., Lin, Y., Deierlein, A. L., & Parekh, N. (2021). Ultra-Processed Foods and Incident Cardiovascular Disease in the Framingham Offspring Study. Journal of the American College of Cardiology, 77(12), 1520–1531.
Referans53 Shim, S. Y., Kim, H. C., & Shim, J. S. (2022). Consumption of Ultra-Processed Food and Blood Pressure in Korean Adults. Korean circulation journal, 52(1), 60–70.
Referans54 Bonaccio, M., Di Castelnuovo, A., Costanzo, S., De Curtis, A., Persichillo, M., Sofi, F., et al (2021). Ultra-processed food consumption is associated with increased risk of all-cause and cardiovascular mortality in the Moli-sani Study. The American journal of clinical nutrition, 113(2), 446–455.
Referans55 Cuevas-Sierra, A., Milagro, F. I., Aranaz, P., Martínez, J. A., & Riezu-Boj, J. I. (2021). Gut Microbiota Differences According to Ultra-Processed Food Consumption in a Spanish Population. Nutrients, 13(8), 2710.
Referans56 Elizabeth, L., Machado, P., Zinöcker, M., Baker, P., & Lawrence, M. (2020). Ultra-Processed Foods and Health Outcomes: A Narrative Review. Nutrients, 12(7), 1955.
Referans57 Tubbs, A. L., Liu, B., Rogers, T. D., Sartor, R. B., & Miao, E. A. (2017). Dietary Salt Exacerbates Experimental Colitis. Journal of immunology (Baltimore, Md. : 1950), 199(3), 1051–1059.
Referans58 Poti, J. M., Braga, B., & Qin, B. (2017). Ultra-processed Food Intake and Obesity: What Really Matters for Health-Processing or Nutrient Content?. Current obesity reports, 6(4), 420–431. https://doi.org/10.1007/s13679-017-0285-4
Referans59 Narula, N., Wong, E., Dehghan, M., Mente, A., Rangarajan, S., Lanas, F., et al. (2021). Association of ultra-processed food intake with risk of inflammatory bowel disease: prospective cohort study. BMJ (Clinical research ed.), 374, n1554.
Referans60 Chen, X., Zhang, Z., Yang, H., Qiu, P., Wang, H., Wang, F., Zhao, Q., Fang, J., & Nie, J. (2020). Consumption of ultra-processed foods and health outcomes: a systematic review of epidemiological studies. Nutrition journal, 19(1), 86.
Referans61 Defrees, D. N., & Bailey, J. (2017). Irritable Bowel Syndrome: Epidemiology, Pathophysiology, Diagnosis, and Treatment. Primary care, 44(4), 655–671.
Referans62 Schnabel, L., Buscail, C., Sabate, J. M., Bouchoucha, M., Kesse-Guyot, E., Allès, B., et al. (2018). Association Between Ultra-Processed Food Consumption and Functional Gastrointestinal Disorders: Results From the French NutriNet-Santé Cohort. The American journal of gastroenterology, 113(8), 1217–1228.
Referans63 TÜİK. Ölüm Nedeni İstatistikleri, 2017. tuikweb.tuik.gov.tr.
Referans64 World Cancer Research Fund International/American Institute for Cancer Research. Cancer preventability estimates for diet, nutrition, body fatness, and physical activity. 2017.
Referans65 Latino-Martel, P., Cottet, V., Druesne-Pecollo, N., Pierre, F. H., Touillaud, M., Touvier, et al. (2016). Alcoholic beverages, obesity, physical activity and other nutritional factors, and cancer risk: A review of the evidence. Critical reviews in oncology/hematology, 99, 308–323.
Referans66 Fiolet, T., Srour, B., Sellem, L., Kesse-Guyot, E., Allès, B., Méjean, C., et al. (2018). Consumption of ultra-processed foods and cancer risk: results from NutriNet-Santé prospective cohort. BMJ (Clinical research ed.), 360, k322.
Referans67 Queiroz S.A., de Sousa I.M., Silva F.R.M., Lyra C.O., Fayh A.P.T. Nutritional and environmental risk factors for breast cancer: A case-control study. Sci. Med. 2018;28:1–8. doi: 10.15448/1980-6108.2018.2.28723
Referans68 Bouvard, V., Loomis, D., Guyton, K. Z., Grosse, Y., Ghissassi, F. E., Benbrahim-Tallaa, et al., & International Agency for Research on Cancer Monograph Working Group (2015). Carcinogenicity of consumption of red and processed meat. The Lancet. Oncology, 16(16), 1599–1600.
Referans69 IARC Working Group on the Evaluation of Carcinogenic Risks to Humans (2010). Carbon black, titanium dioxide, and talc. IARC monographs on the evaluation of carcinogenic risks to humans, 93, 1–413.
Referans70 Santarelli, R. L., Vendeuvre, J. L., Naud, N., Taché, S., Guéraud, F., Viau, M., et al. (2010). Meat processing and colon carcinogenesis: cooked, nitrite-treated, and oxidized high-heme cured meat promotes mucin-depleted foci in rats. Cancer prevention research (Philadelphia, Pa.), 3(7), 852–864.
Referans71 Chang, X., Zhang, Y., Tang, M., & Wang, B. (2013). Health effects of exposure to nano-TiO2: a meta-analysis of experimental studies. Nanoscale research letters, 8(1), 51.
Referans72 Panel on Food Additives and Nutrient Sources Added to Food Opinion on the re-evaluation of aspartame (E 951) as a food additive. EFSA Journal 2013;11:3496
Referans73 Panel on Contaminants in the Food Chain Acrylamide in food. EFSA Journal 2015;13:4104 10.2903/j.efsa.2015.4104.
Referans74 Kim, H., Hu, E. A., & Rebholz, C. M. (2019). Ultra-processed food intake and mortality in the USA: results from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994). Public health nutrition, 22(10), 1777–1785.
Referans75 Schnabel, L., Kesse-Guyot, E., Allès, B., Touvier, M., Srour, B., Hercberg, S., Buscail, C., & Julia, C. (2019). Association Between Ultraprocessed Food Consumption and Risk of Mortality Among Middle-aged Adults in France. JAMA internal medicine, 179(4), 490–498.
Referans76 Rico-Campà, A., Martínez-González, M. A., Alvarez-Alvarez, I., Mendonça, R. D., de la Fuente-Arrillaga, C., Gómez-Donoso, C., & Bes-Rastrollo, M. (2019). Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study. BMJ (Clinical research ed.), 365, l1949.
Referans77 Blanco-Rojo, R., Sandoval-Insausti, H., López-Garcia, E., Graciani, A., Ordovás, J. M., Banegas, J. R., Rodríguez-Artalejo, F., & Guallar-Castillón, P. (2019). Consumption of Ultra-Processed Foods and Mortality: A National Prospective Cohort in Spain. Mayo Clinic proceedings, 94(11), 2178–2188.
Referans78 Juhola, J., Magnussen, C. G., Viikari, J. S., Kähönen, M., Hutri-Kähönen, N., Jula, A., et al. (2011). Tracking of serum lipid levels, blood pressure, and body mass index from childhood to adulthood: the Cardiovascular Risk in Young Finns Study. The Journal of pediatrics, 159(4), 584–590.
Referans79 Steinberger, J., Daniels, S. R., Hagberg, N., Isasi, C. R., Kelly, A. S., Lloyd-Jones, D., et al., & American Heart Association Atherosclerosis, Hypertension, and Obesity in the Young Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Epidemiology and Prevention; Council on Functional Genomics and Translational Biology; and Stroke Council (2016).
Referans80 Brasil. Ministério da Saúde. Secretária de Ciência, Tecnologia e Insumos Estratégicos. Departamento de Ciência e Tecnologia. Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS-2006) Ministério da Saúde, Brasília (2009)
Referans81 Brasil. Ministério do Planejamento, Orçamento e Gestão. Pesquisa de Orçamentos Familiares 2008–2009: Antropometria e estado nutricional de crianças, adolescentes e adultos no Brasil Instituto Brasileiro de Geográfia e Estatística, Rio de Janeiro (2010)
Referans82 Costa, C. S., Rauber, F., Leffa, P. S., Sangalli, C. N., Campagnolo, P., & Vitolo, M. R. (2019). Ultra-processed food consumption and its effects on anthropometric and glucose profile: A longitudinal study during childhood. Nutrition, metabolism, and cardiovascular diseases : NMCD, 29(2), 177–184.
Referans83 Sparrenberger, K., Friedrich, R. R., Schiffner, M. D., Schuch, I., & Wagner, M. B. (2015). Ultra-processed food consumption in children from a Basic Health Unit. Jornal de pediatria, 91(6), 535–542.
Referans84 Leffa, P. S., Hoffman, D. J., Rauber, F., Sangalli, C. N., Valmórbida, J. L., & Vitolo, M. R. (2020). Longitudinal associations between ultra-processed foods and blood lipids in childhood. The British journal of nutrition, 124(3), 341–348.
Referans85 Machado Azeredo, C., Cortese, M., Costa, C., Bjornevik, K., Barros, A., Barros, F. C., et al, A. (2020). Ultra-processed food consumption during childhood and asthma in adolescence: Data from the 2004 Pelotas birth cohort study. Pediatric allergy and immunology: official publication of the European Society of Pediatric Allergy and Immunology, 31(1), 27–37.