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Jean-Claude Moubarac, PhD Centre for Epidemiological Studies in Health and Nutrition, University of São Paulo, Brazil McGill Institute for Global Food.

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Presentation on theme: "Jean-Claude Moubarac, PhD Centre for Epidemiological Studies in Health and Nutrition, University of São Paulo, Brazil McGill Institute for Global Food."— Presentation transcript:

1 Jean-Claude Moubarac, PhD Centre for Epidemiological Studies in Health and Nutrition, University of São Paulo, Brazil McGill Institute for Global Food Security, Canada DST-HSRC Science Seminar Programme Policy-relevant Indicators to Monitor Household Food Security Status in South Africa Cape Town, November 12th 2013 CONSIDERING ULTRA-PROCESSING IN THE DEVELOPMENT OF POLICY INDICATORS TO MONITOR FOOD SECURITY

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3 1.Public health mission 2.Interdisciplinary research 3.Transparency 4.Equity and justice Guiding principles

4 1)Why discuss food processing at a seminar on food security? 2)NOVA food classification 3)Trends in the consumption of ultra-processed products and assocations to diet quality and obesity 4)Development of policy indicators to monitor household food security status OUTLINE

5 Different views on the causes of food insecurity Lack of production: we need to double up production (FAO, agro-business). The role of industrial food processing in food systems: how, why and who transform food we produce? Lack of access, equity WHY DISCUSS FOOD PROCESSING AT A SEMINAR ON FOOD SECURITY?

6 AGRO-PROCESSING: A GROWING SECTOR OF FOOD SYSTEMS Production Processing Transport Sales Consumption 2nd industrial sector in Canada Sales of 91 billions en 2011 Use 34% of agricultural production Highly concentrated market power

7 Measurement of diet quality “Access to enough nutritious food is fundamental for human health and is therefore a primary quality-of-life indicator” “What policy interventions exist to help these households access enough nutritious food for a healthy life?” DST-HSRC Science Seminar program  But how to define healthy foods and quality of diets? WHY DISCUSS FOOD PROCESSING AT A SEMINAR ON FOOD SECURITY?

8 Nutrient-based approach is not working We need a contemporary approach, one that account for the way we produce, transform and eat food today... The world is moving towards an increasingly processed diet (Swinburn et al. 2011; Stuckler et al. 2012; Moodie et al. 2013; Monteiro and Cannon 2012; Monteiro et al. 2013; Popkin 2005; Hawkes 2007) We must consider the role of food processing in the quality of diets HOW TO DEFINE HEALTHY FOODS AND QUALITY OF DIETS?

9 2M Butchering, smoking & Drying of meats Pounding, grinding, roasting, wetting, boiling, fermenting of seeds an acorns Agriculture & Husbandry: Large granaries Mass Production of Oil, Salt & Sugar Roller- stills wheels Canning Hydrogenation, Pesticides Fertilizers OGM Cooking Evolution of food technology Core role in human evolution Gradually changed during pre-industrial era Revolutionary and rapid changes since industrialization, and globalization

10 Food processing per se has received little attention in nutritional and epidemiological analysis (nutrient-limited or product-limited). Terminology vague and multiple (highly-processed, convenience products, fast-food, etc.).  NOVA food classification system  Based on the extent and purpose of industrial food processing  First devised by Carlos Monteiro and colleagues at University of S ã o Paulo, Brazil.  Trans-disciplinary conceptual model drawing from the sciences of public health, nutrition and anthropology.  Global research network: applied to more than 40 databases, from 30 countries. DEFINITION AND METHODS OF FOOD PROCESSING

11 NATURAL RESOURCES (sun, soil, water, seeds...) UNPROCESSED FOODS (roots, stems, leaves, fruits, seeds, meat, milk, eggs...) Food production (at farms) Industrial food processing (at factories) Food processing in the food system MINIMALLY PROCESSED FOODS CULINARY INGREDIENTS MULTI-FOOD FRESHLY PREPARED DISHES DIET Culinary food processing (at kitchens) PROCESSED & ULTRA-PROCESSED FOOD PRODUCTS

12  Grains (cereals)  Legumes (pulses)  Roots and tubers (starchy)  Vegetables (green, salad, non-starchy roots  Fruits  Nuts and seeds  Meat  Fish  Seafood  Milk  Eggs  Water  other GROUP 1 UNPROCESSED AND MINIMALLY PROCESSED FOODS

13  Oils  Animal fats  Sugars  Salt  other GROUP 2 PROCESSED SUBSTANCES

14 Food and substances are turned into freshly prepared dishes and meals by domestic/artisanal processing + =

15 Processed food products:  Bottled, canned products  Salted, salt-pickled, cured, smoked products  Cheese  other Ultra-processed products:  Industrial breads  Sweetened breakfast cereals  Sweet baked products  Sweet snacks, preserves  Salty fried or baked products  Carbonated soft drinks  Sweet juices and drinks  Reconstituted meat and fish products  Cheese products  Spreads and sauces  Baby food products  ‘Health’ and ‘slimming’ products  Pre-prepared ready-to-heat dishes, products  other GROUP 3 READY-TO-CONSUME PRODUCTS

16 ‘Ultra-processed products are assemblages of industrial ingredients obtained from the extraction, refinement, and transformation of constituents of raw foods with usually little or no whole food.’ Moodie R, Stuckler D, Monteiro C et al (2013) Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. The Lancet, Feb 12.

17 ULTRA- PROCESSED PRODUCTS UNPROCESSED FOODS Oils, fats, flours, sugar, salt starches, plant proteins, milk whey, remnants of meat Preservatives, stabilisers, emulsifiers, solvents, binders, bulkers, sweeteners, sensory enhancers, flavours, colours, other additives, synthetic micronutrients. Ultra-processing Hydrogenated oils, starch-modified sugars, hydrolyzed proteins, ex- truded meat extracts Snacks, soft drinks, sweets, sausages, frozen dishes Little or no preparation

18 ULTRA- PROCESSED PRODUCTS UNPROCESSED FOODS Oils, fats, flours, sugar, salt starches, plant proteins, milk whey, remnants of meat Preservatives, stabilisers, emulsifiers, solvents, binders, bulkers, sweeteners, sensory enhancers, flavours, colours, other additives, synthetic micronutrients. Ultra-processing Hydrogenated oils, starch-modified sugars, hydrolyzed proteins, ex- truded meat extracts Snacks, soft drinks, sweets, sausages, frozen dishes Little or no preparation

19 ULTRA- PROCESSED PRODUCTS UNPROCESSED FOODS Oils, fats, flours, sugar, salt starches, plant proteins, milk whey, remnants of meat Preservatives, stabilisers, emulsifiers, solvents, binders, bulkers, sweeteners, sensory enhancers, flavours, colours, other additives, synthetic micronutrients. Ultra-processing Hydrogenated oils, starch-modified sugars, hydrolyzed proteins, ex- truded meat extracts Snacks, soft drinks, sweets, sausages, frozen dishes Little or no preparation

20 ULTRA- PROCESSED PRODUCTS UNPROCESSED FOODS Oils, fats, flours, sugar, salt starches, plant proteins, milk whey, remnants of meat Preservatives, stabilisers, emulsifiers, solvents, binders, bulkers, sweeteners, sensory enhancers, flavours, colours, other additives, synthetic micronutrients. Ultra-processing Hydrogenated oils, starch-modified sugars, hydrolyzed proteins, ex- truded meat extracts Snacks, soft drinks, sweets, sausages, frozen dishes Little or no preparation

21 Ready-to-consume ultra-processed products: replaces home cooking

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23 Frozen productsSnacks Soft drinks Per capita retail sales of selected ultra-processed products in high- income countries ( ) Monteiro, Moubarac, Ng, Cannon & Popkin, Obesity Rev

24 Frozen products Snacks Soft drinks Per capita retail sales of selected ultra-processed products in lower- middle-income and upper-middle-income and countries ( ) ▲ Upper-middle-income countries; ■ Lower-middle-income countries.

25 Frozen products Snacks Soft drinks Per capita retail sales of selected ultra-processed products in South Africa and upper-middle-income and countries ( ) ▲ Upper-middle-income countries; ■ South Africa

26 Time trend changes in household purchases of food groups in canada, % available kcal at household level Ultra-processed products Unprocessed/minimally processed foods Processed ingredients Processed products

27 Dietary shifts in the global food systems Diets based on freshly prepared meals and dishes made from foods Diets based on ready-to-consume products that require little or no preparation What kind of power and control people loose when they stop to cook?

28 Food processing and quality of diets Compared to foods and culinary ingredients, ready-to- consume products (most are ultra-processed) have: less protein less dietary fiber more free sugar more total, saturated and trans fats more sodium less potassium, less vitamins higher energy density Sources: Monteiro et al Public Health Nutrition 2011 Moubarac et al. Public Health Nutrition 2012

29 Source: Moubarac J-C et al PHN * p <.001 for linear trend Indicator< >73Goal Protein (% of calories) * Fiber (g/1,000 kcal) *> 12.5 Free sugars (% of calories) 9.2* * < 10 Sodium (mg/1,000 kcal) *< 1 Energy density (kcal/g) * Higher proportion of ultra-processed products is associated to lower diet quality

30 FOODS AND INGREDIENTS VS READY-TO-CONSUME PRODUCTS CountryFood + Ingredients Ready-to-consume products CANADA BELGIUM AUSTRIA FINLAND SPAIN GERMANY ,9 UK BRAZIL COLOMBIA ALL ENERGY DENSITY (KCAL/G)

31 UNIQUE CHARACTERISTICS OF ULTRA-PROCESSED PRODUCTS Affordable, accessible and highly marketed products Liquid calories (all sugared drinks) Vartanian et al (2007) Am J Public Health 97: Hyper-palatability (all products) Kessler (2009) The End of Overeating. New York, Rodale. Habituation/addiction Brownell and Gold (2012) Food and addiction. New York, Oxford University Press; Garber and Lustig (2012). Current Drug Abuse Reviews 4(3): Super size servings (many products) Report of the DGAC on the Dietary Guidelines for Americans 2010 Mindless eating (all products) Cohen & Farley (2008) Prev Chronic Dis 2008;5:1-7

32 % of total energy Estimates for the dietary share of ultra-processed products in 27 countries ( ) Estimated from national household food expenditure surveys for Brazil (HBS), Canada (FOODEX), Chile (EPF), Colombia (ENIG), Peru (ENAPREF) Mexico (ENIGH), Uruguay (EGIH), and the Data Food Networking (DAFNE) for all European countries, except UK (LCF), and from 24 h recall survey for USA ((HANES)

33 Obesity in adults (%) Ultra-processed products (% of total energy) Source: National household food expenditure surveys and national health surveys in the same year or period and NHANES for USA Peru Colombia Brazil Uruguay Mexico Canada Chile USA SHARE OF ULTRA-PROCESSED PRODUCTS IN NATIONAL FOOD BASKETS AND OBESITY IN 19 EUROPEAN COUNTRIES ( )

34 France Italy Portugal Greece Cyprus Spain Lithuania Latvia Austria Slovakia Norway Hungary Croatia Malta Finland Belgium Ireland Germany UK Ultra-processed products (% of total energy ) Obesity in adults (%) Source: National household food expenditure surveys and national health surveys in the same year or period

35 Availability of ultra- processed products (mean values according to quartiles) Obesity indicator Mean BMI (Z score) Prevalence of excess weight (%) Prevalence of obesity (%) 1 st (220.0 kcal) nd (345.6 kcal) rd (422.0 kcal) th (564.3 kcal) PREDICTIVE VALUES FOR OBESITY INDICATORS ACCORDING TO THE HOUSEHOLD AVAILABILITY OF ULTRA-PROCESSED FOOD PRODUCTS (KCAL/PERSON/DAY). BRAZIL, Values are adjusted by log of income, proportion of women in stratum, proportion of elderly in stratum, proportion of children in stratum, setting, region, percentage of expenditure on eating out of home, and for complementary calories, including calories of processed food products), set for the mean value of the confounding variables. Source: Canela et al (in review)

36  Food insecurity is associated to higher prevalence of obesity; this relation is thought to be mediated by diet quality, but diet quality is related to the types of processing. Initial studies  In Canada, since people living in food insecure households tend to be of lower income and buy ready-to-consume products that are cheap, but energy dense and nutritionally imbalanced (McLaughlin 2003; Engler-Stringer et al. 2011)  In the US, higher frequency and complexity of home food preparation and cooking, more structure meal patterns and eating with others, are associated with higher dietary quality (Laska et al. 2012; Larson et al. 2006, 2007, 2009) RESEARCH PROGRAM MCGILL INSTITUTE FOR GLOBAL FOOD SECURITY UNIVERSITY OF SÃO PAULO

37 The research program is centered on three related hypotheses: 1) Industrial food processing and cooking activity are among the main determinants of diet quality; 2) Obesity is related to the consumption level of ultra-processed products and the frequency, complexity and diversity of cooking 3) The relationship between food security and obesity is mediated by the role of industrial food processing in the diet. Food security Food processing Quality of diet Obesity RESEARCH PROGRAM MCGILL INSTITUTE FOR GLOBAL FOOD SECURITY UNIVERSITY OF SÃO PAULO

38  Trends in sales and availability of ultra-processed products in the food system  Household availability and consumption of ultra-processed products (linked to quality of diets)  Measures that grasp household’s cooking capacities and abilities  Access, price, and marketing of ultra-processed products in local food systems. Quality of diets: Start with food categories; and then use nutrient profiling models to assess quality diversity within ultra- processed products DEVELOPMENT OF NEW POLICY INDICATORS TO MONITOR HOUSEHOLD FOOD SECURITY STATUS

39 Human security interventions in the region should focus on improving livelihoods in countries that are dependent on agriculture and agro- processing by supporting efforts to improve productivity and include an increasing proportion of Africa producers in global value chains. Centralized power  “In South Africa, however, a highly centralised, vertically integrated agro-processing sector already exists for staple foods. The scope for small-scale manufacturing and agro-processing targeting local consumers in poor communities is limited”. Invasion of supermarkets (Hawkes 2007) South African agro-food fystem and the dualistic nature of the agriculture and deep penetration of supermarkets (taken from the seminar program) NATIONAL DEVELOPMENT PLAN 2030-CHALLENGES

40 Recommendations:  Expand and diversify trade in agriculture and agro-processing - which should include a purposeful strategy on food security. (p.246)  International bargaining must include securing investment, diversification and continued progressive development in agriculture and agro-processing (p.243)  Provide innovative market linkages, by: linking farmers to markets will also require infrastructure for processing and value addition and new forms of intermediaries, such as cooperatives, to help small producers achieve economies of scale in processing (p.229).  Links between agriculture and nutrition can be strengthened, particularly regarding producing and processing nutrient-rich foods such as legumes and other vegetables (p.235)  MINIMAL PROCESSING NATIONAL DEVELOPMENT PLAN 2030

41 PUBLIC ACTIONS TO INCENTIVE, SUPPORT, AND PROTECT TRADITIONAL FOOD SYSTEMS AND DIETS: LEARNING FROM BREAST-FEEDING! ACTIONHUMAN MILKMINIMALLY PROCESSED FOODS Incentive Information/educationInformation/education (health, environment, and culture arguments) Support Maternal leave, baby- friendly hospitals, human milk banks Subsidies and taxes, family agriculture support, government food procurement Protection Code to regulate the marketing of infant formulas Code to regulate the marketing of ultra- processed products

42 Industrial food processing is a important determinant of quality of diets and of the risk of obesity. This role need to be considered in the development of indicators to monitor food security at the household, local and national level. Food processing is (one of) the missing links between Agriculture and Nutrition CONCLUSION

43 Carlos Augusto Monteiro, Geoffrey Cannon Centre for Epidemiological Studies in Health and Nutrition (NUPENS) School of Public Heath,University of Säo Paulo. Brazil Hugo Melgar Quinonez McGill Institute for Global Food Security Fundação de Amparo à Pesquisa do Estado de São Paulo


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