Brazilian Children’s Dietary Intake in Relation to Brazil’s New Nutrition Guidelines: a Systematic Review

  • Ana Carolina Barco LemeEmail author
  • Regina Mara Fisberg
  • Debbe Thompson
  • Sonia Tucunduva Philippi
  • Theresa Nicklas
  • Tom Baranowski
Maternal and Childhood Nutrition (AC Wood, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Maternal and Childhood Nutrition


Purpose of Review

This systematic review reports the latest scientific evidence, from cross-sectional and cohort studies, describing the dietary intake of children and adolescents from Brazil. The goal of the review was to describe intakes according to Brazil’s new food classification system (NOVA) which classifies foods according to the degree of processing, i.e., unprocessed/minimally processed, processed culinary ingredients, processed food, and ultra-processed food. Due to a paucity of data using the NOVA classification system, studies with other intake descriptors were included.

Recent Findings

Results using the NOVA system showed a somewhat high intake of (ultra-)processed items, than of minimally processed items. Studies using other methods of dietary assessment showed not only high intake of sources rich in fat, sugar, and sodium, most of them processed items (e.g., savory snacks and sweets) but also intake of fruit, vegetables, and whole grains. Overall, the literature was marred by inconsistencies and variation in study definitions and methods making it hard to make firm conclusions regarding the dietary intake of Brazilian children.


The development of tools to evaluate the complexities of dietary intake is much needed. Such a tool needs to be accepted and adopted by numerous study groups, to describe dietary status among Brazilian children and devise the most effective, and to evaluate the success of nutrition education programs.


Diet Children Adolescents Brazil Review NOVA 


Compliance with Ethical Standards

Conflict of Interest

Ana Carolina Barco Leme declares that she has no conflict of interest.

Regina Mara Fisberg declares that she has no conflict of interest.

Debbe Thompson declares that she has no conflict of interest.

Sonia Tucunduva Philippi declares that she has no conflict of interest.

Theresa Nicklas served as chair of a workshop sponsored by the Nestlé Nutrition Institute (Switzerland) and received reimbursement for travel expenses as well as an honorarium for her participation. She has also received compensation for proposals, manuscripts, and presentations contributed to Nutrition Impact, LLC.

Tom Baranowski declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9945):766–81. Scholar
  2. 2.
    Skinner AC, Ravanbakht SN, Skelton JA, Perrin EM, Armstrong SC. Prevalence of obesity and severe obesity in US children, 1999-2016. Pediatrics. 2018;141:e20173459. Scholar
  3. 3.
    Araújo C, Toral N, Silva ACF, Velásquez-Melendez G, Dias AJR. Estado nutricional dos adolescentes e sua relação com variáveis sociodemográficas: Pesquisa Nacional de Saúde do Escolar (PeNSE), 2009. CiêncSaúde Colet. 2010;15(Supl. 2):3077–84.CrossRefGoogle Scholar
  4. 4.
    Sabin MA, Kiess W. Childhood obesity: current and novel approaches. Best Pract Res Clin Endocrinol Metab. 2015;29(3):327–38.CrossRefGoogle Scholar
  5. 5.
    Singh AS, Mulder C, Twisk JW, van Mechelen W, Chinapaw MJ. Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev. 2008;9(5):474–88. Scholar
  6. 6.
    Han JC, Lawlor DA, Kimm SY. Childhood obesity. Lancet. 2010;375(9727):1737–48. Scholar
  7. 7.
    Popkin BM, Reardon T. Obesity and the food system transformation in Latin America. Obes Rev. 2018;19:1028–64. Scholar
  8. 8.
    Yang L, Bovet P, Liu Y, Zhao M, Ma C, Liang Y, et al. Consumption of carbonated soft drinks among young adolescents aged 12 to 15 years in 53 low- and middle-income countries. Am J Public Health. 2017;107(7):1095–100. Scholar
  9. 9.
    •• Leme AC, Baranowski T, Thompson D, Philippi S, O’Neil C, Fulgoni V, Nicklas T. Top food sources of percentage of energy, nutrients to limit and total gram amount consumed among US adolescents: National Health and Nutrition Examination Survey 2011–2014. Publ Health Nutr. 2018;1–11. This article highlighted the top food sources of overconsumed nutrients of public health concern of US adolescents, which is critical for designing strategies to help them meet nutrient recommendations within energy needs.
  10. 10.
    USDA. Scientific report of the 2015 Dietary Guidelines Advisory Committee. Advisory report to the secretary of health and human services and the secretary of human services Department of Health and Human Services/Department of Agriculture USDA USA; 2015.Google Scholar
  11. 11.
    Leme AC, Baranowski T, Thompson D, Philippi S, O’Neil C, Fulgoni VL, Nicklas T. Food sources of shortfall nutrients among U.S. adolescents: analyses of National Health and Nutrition Examination Survey (NHANES) 2011–2014. In preparation. Under review.Google Scholar
  12. 12.
    Huth PJ, Fulgoni VL, Keast DR, Park K, Auestad N. Major food sources of calories, added sugars, and saturated fat and their contribution to essential nutrient intakes in the U.S. diet: data from the National Health and Nutrition Examination Survey (2003-2006). Nutr J. 2013;12:116. Scholar
  13. 13.
    Quader ZS, Gillespie C, Sliwa SA, Ahuja JK, Burdg JP, Moshfegh A, et al. Sodium intake among US school-aged children: National Health and Nutrition Examination Survey, 2011-2012. J Acad Nutr Diet. 2017;117(1):39–47.e35. Scholar
  14. 14.
    Da Silva Oliveira MS, Silva-Amparo L. Food-based dietary guidelines: a comparative analysis between the dietary guidelines for the Brazilian population 2006 and 2014. Public Health Nutr. 2018;21(1):210–7. Scholar
  15. 15.
    Ministério da Saúde. Guia Alimentar para a população brasileira: promovendo a alimentação saudável. Brasilia: Ministério da Saúde, Secretaria de Atenção à Saúde; 2008.
  16. 16.
    Philippi ST, Latterza AR, Cruz ATR, Cruz LC. Pirâmide alimentar adaptada: guia para escolha dos alimentos. Rev Nutr Campinas. 1999;12(1):65–80.CrossRefGoogle Scholar
  17. 17.
    Philippi ST. Brazilian food pyramid. Nutr Today. 2005;40(2):79–83.CrossRefGoogle Scholar
  18. 18.
    Saúde M. Guia Alimentar para a população Brasileira 2edn. Brasília: Secretaria de Atenção à Saúde/Departamento de Atenção Básica; 2014.Google Scholar
  19. 19.•
    Fiolet T, Srour B, Sellem L, Kesse-Guyot E, Alles B, Mejean C, et al. Consumption of ultra-processed foods and cancer risk: results from NutriNet-Sante prospective cohort. BMJ. 2018;360:k322. This article reported that among 104,980 participants older than 18 years old from a French Cohort (2016–2017), a 10% increase in the proportion of ultra-processed foods in the diet was associated with a significant increase of greater than 10% in the risk of overall and breast cancer. CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Fardet A, Mejean C, Laboure H, Andreeva VA, Feron G. The degree of processing of foods which are most widely consumed by the French elderly population is associated with satiety and glycemic potentials and nutrient profiles. Food Funct. 2017;8(2):651–8. Scholar
  21. 21.
    Martinez Steele E, Baraldi LG, Louzada ML, Moubarac JC, Mozaffarian D, Monteiro CA. Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study. BMJ Open. 2016;6(3):e009892. Scholar
  22. 22.
    Louzada ML, Martins AP, Canella DS, Baraldi LG, Levy RB, Claro RM, et al. Impact of ultra-processed foods on micronutrient content in the Brazilian diet. Rev Saude Publica. 2015;49:45–8. Scholar
  23. 23.•
    Louzada ML, Baraldi LG, Steele EM, Martins AP, Canella DS, Moubarac JC, et al. Consumption of ultra-processed foods and obesity in Brazilian adolescents and adults. Prev Med. 2015;81:9–15. This article reported that among 30,243 individuals aged ≥ 10 years from the 2008–2009 Brazilian Dietary Survey, ultra-processed foods represented 30% of total energy intake and those in the highest quintile of consumption of ultra-processed foods had significantly higher body mass index and higher odds of being overvweight and obese. CrossRefPubMedGoogle Scholar
  24. 24.
    Monteiro CA, Cannon G, Moubarac JC, Martins APB, Martins CA, Garzillo J, et al. Dietary guidelines to nourish humanity and the planet in the twenty-first century. A blueprint from Brazil. Public Health Nutr. 2015;18(13):2311–22.CrossRefGoogle Scholar
  25. 25.
    Monteiro CA, Cannon G, Levy-Costa RB, Moubarac J-C, Jaime PC, APB M, et al. NOVA. The star shines bright [Food classification. Public health]. World Nutr. 2016;7(1–3):28–38.Google Scholar
  26. 26.
    Monteiro CA, Cannon G, Moubarac JC, Levy RB, Louzada MLC, Jaime PC. The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutr. 2018;21(1):5–17. Scholar
  27. 27.
    de Oliveira SR, Fisberg RM, Marchioni DM, Troncoso Baltar V. Dietary patterns for meals of Brazilian adults. Br J Nutr. 2015;114(5):822–8. Scholar
  28. 28.
    Fisberg RM, Slater B, Barros RR, Lima FD, Cesar CL, Barros MBA, et al. Índice de Qualidade da Dieta: avaliação da adaptação e aplicabilidade. Rev Nutr, Campinas. 2004;17(3):301–8.CrossRefGoogle Scholar
  29. 29.
    Previdelli AN, Andrade SC, Pires MM, Ferreira SR, Fisberg RM, Marchioni DM. A revised version of the Healthy Eating Index for the Brazilian population. Rev Saude Publica. 2011;45(4):794–8.CrossRefGoogle Scholar
  30. 30.
    Kapadia MZ, Askie L, Hartling L, Contopoulos-Ioannidis D, Bhutta ZA, Soll R, et al. PRISMA-Children (C) and PRISMA-Protocol for Children (P-C) Extensions: a study protocol for the development of guidelines for the conduct and reporting of systematic reviews and meta-analyses of newborn and child health research. BMJ Open. 2016;6(4):e010270. Scholar
  31. 31.
    Armijo-Olivo S, Stiles CR, Hagen NA, Biondo PD, Cummings GG. Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research. J Eval Clin Pract. 2012;18(1):12–8. Scholar
  32. 32.
    Mais LA, Warkentin S, Vega JB, De Oliveira LMDRD, Carnell S, De Aguiar Carrazedo Taddei JA. Sociodemographic, anthropometric and behavioural risk factors for ultra-processed food consumption in a sample of 2-9-year-olds in Brazil. Public Health Nutr. 2018;21(1):77–86. Scholar
  33. 33.
    Araujo MC, Cunha DB, Bezerra IN, Trindade de Castro MB, Sichieri R. Quality of food choices of Brazilian adolescents according to individual earnings. Public Health Nutr. 2017;20(17):3145–50. Scholar
  34. 34.••
    Azeredo CM, De Rezende LFM, Canella DS, Moreira Claro R, IRR DC, Luiz ODC, et al. Dietary intake of Brazilian adolescents. Publ Health Nutr. 2015;18(7):1215–24. This article verified that the nutritional scale average was higher in adolescents attending public school and exhibiting positive correlation with protective behaviors, such as being physically active, having meals with parents, and eating breakfast, and a negative correlation with risk behaviors, such as eating while studying or watching television, having smoked, drunk alcohol, or used other drugs in the previous 30 days. CrossRefGoogle Scholar
  35. 35.
    Barreto Neto AC, Andrade MIS, Lima VLM, Diniz AS. Peso corporal e escores de consumo alimentar em adolescentes no nordeste brasileiro (Body weight and food consumption scores in adolescents from northeast Brazil). Rev Paul Pediatr. 2015;33(3):318–25. Scholar
  36. 36.••
    Borges CA, DML M, Levy RB, Slater B. Dietary patterns associated with overweight among Brazilian adolescents. Appetite. 2018;123:402–9. This article identified the dietary patterns of adolescents and associate these patterns with overweight using a Brazilian representative sample ( n= 6784). Four dietary patterns were recorded: traditional Brazilian pattern, snacks pattern, fast-food pattern, and the milk, fruit and cereal breakfast patterm. Higher adherence to snacks and fast-food patterns, the higher the chances of becoming overweight. CrossRefPubMedGoogle Scholar
  37. 37.
    Corrêa RS, Vencato PH, Rockett FC, Bosa VL. Padrões alimentares de escolares: existem diferenças entre crianças e adolescentes? (Dietary patterns: are there differences between children and adolescents?). Ciênc Saúde Colet. 2017;22(2):553–62. Scholar
  38. 38.
    Costa CS, Flores TR, Wendt A, Neves RG, Assunção MCF, Santos IS. Sedentary behavior and consumption of ultraprocessed foods by Brazilian adolescents: Brazilian national school health survey (PeNSE), 2015. Cad Saude Publica. 2018;34(3).
  39. 39.
    Cunha DB, Da Costa THM, Da Veiga GV, Pereira RA, Sichieri R. Ultra-processed food consumption and adiposity trajectories in a Brazilian cohort of adolescents: ELANA study. Nutr Diabetes. 2018;8(1):28. Scholar
  40. 40.
    D’Avila HF, Kirsten VR. Energy intake from ultra-processed foods among adolescents. Rev Paul Pediatr. 2017;35(1):54–60.;2017;35;1;00001.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.••
    De Assumpção D, SMA D, Fisberg RM, MBA B. Social and demographic inequalities in diet quality in a population-based study. Rev Nutr. 2016;29(2):151–62. This article evaluated sociodemographic inequalities in the diet quality of the urban population ( n= 3382 ≥ 10 years old) of the city of Campinas, São Paulo, Brazil. The Revised Brazilian Healthy Eating Index scores increased with age and education level. Females consumed more vegetables, fruits, and milk, and less sodium, meat and eggs, oils, saturated and solid fats, alcohol, and added sugars than males. Scores for whole grains, vegetables, and fruits also increased with age and education level. CrossRefGoogle Scholar
  42. 42.
    de Matos SMA, Barreto ML, Rodrigues LC, Oliveira VA, Oliveira LPM, D’Innocenzo S, et al. Dietary patterns of children under five years of age living in the state capital and other counties of Bahia State, Brazil, 1996 and 1999-2000. Cad Saude Publica. 2014;30(1):44–54. Scholar
  43. 43.
    De Melo ISV, Costa CACB, Dos Santos JVL, Dos Santos AF, Florêncio TMDMT, Bueno NB. Consumption of minimally processed food is inversely associated with excess weight in adolescents living in an underdeveloped city. PLoS One. 2017;12(11):e0188401. Scholar
  44. 44.•
    Enes CC, Slater B. Dietary intake of adolescents compared with the Brazilian food guide and their differences according to anthropometric data and physical activity. Rev Bras Epidemiol. 2015;18(4):798–808. This article assessed dietary intake of 476 adolescents from a countryside city of São Paulo, Brazil and compared with the Brazilian Food Guide Pyramid. Most of adolescents did not follow the good group recommendations (i.e., below the recommendations for fruit and vegetables, and above the recommendations for oils/fats and sugars/sweets) and those who where physically active (≥ 300 min/week) have healthier food habits. CrossRefPubMedGoogle Scholar
  45. 45.
    Ferreira NL, Claro RM, Lopes ACS. Consumption of sugar-rich food products among Brazilian students: National School Health Survey (PeNSE 2012). Cad Saude Publica. 2015;31(12):2493–504. Scholar
  46. 46.
    Karnopp EVN, Vaz JDS, Schafer AA, Muniz LC, Souza RDLVD, Santos ID, et al. Food consumption of children younger than 6 years according to the degree of food processing. J Pediatr. 2017;93(1):70–8. Scholar
  47. 47.
    Leal KK, Schneider BC, França GVA, Gigante DP, Id S, Assunção MCF. Qualidade da dieta de pré-escolares de 2 a 5 anos residentes na área urbana da cidade de Pelotas, RS (Diet quality of preschool children aged 2 to 5 years living in the urban area of Pelotas, Brazil). Rev Paul Pediatr. 2015;33(3):310–7. Scholar
  48. 48.
    Longo-Silva G, Menezes RCE, Souza CAN, Marinho PM, Toloni MHA, Oliveira MAA. Factors associated with regular consumption of obesogenic foods: National School-Based Student Health Hurvey, 2012 (Fatores associados ao consumo regular de alimentos obesogênicos: Pesquisa Nacional de Saúde do Escolar, 2012). Rev Nutr. 2016;29(5):609–33. Scholar
  49. 49.
    Mascarenhas JMO, Silva RCR, Assis AMO, Santana MLP, Moraes LTLP, Barreto ML. Identification of food intake patterns and associated factors in teenagers (Identificação dos padrões de consumo alimentar e fatores associados em adolescentes). Rev Nutr. 2014;27(1):45–54. Scholar
  50. 50.
    Momm N, Höfelmann DA. Qualidade da dieta e fatores associados em crianças matriculadas em uma escola municipal de Itajaí, Santa Catarina (Diet quality and associated factors in children enrolled in a municipal school of Itajaí, Santa Catarina). Cad Saúde Coletiva. 2014;22(1):32–9. Scholar
  51. 51.
    Monteiro LS, Rodrigues PRM, Veiga GV, Marchioni DML, Pereira RA. Diet quality among adolescents has deteriorated: a panel study in Niterói, Rio de Janeiro State, Brazil, 2003–2008 (A queda na qualidade da alimentação dos adolescentes brasileiros: um estudo de painel em Niterói, Estado do Rio de Janeiro, Brasil, 2003–2008 La caída en la calidad de la alimentación de los adolescentes brasileños: un estudio de panel en Niterói, Estado de Río de Janeiro, Brasil, 2003–2008). Cad Saúde Públ. 2016;32(12):e00124715. Scholar
  52. 52.
    Pinho MGM, Adami F, Benedet J, Vasconcelos FAG. Association between screen time and dietary patterns and overweight/obesity among adolescents (Associação entre tempo de tela e padrões alimentares com sobrepeso/obesidade em adolescentes). Rev Nutr. 2017;30(3):377–89. Scholar
  53. 53.
    Sparrenberger K, Friedrich RR, Schiffner MD, Schuch I, Wagner MB. Consumo de alimentos ultraprocessados entre crianças de uma Unidade Básica de Saúde (Ultra-processed food consumption in children from a Basic Health Unit). J Pediatr. 2015;91(6):535–42. Scholar
  54. 54.
    Tavares LF, de Castro IRR, Levy RB, Cardoso LO, Claro RM. Dietary patterns of Brazilian adolescents: results of the Brazilian National School-Based Health Survey (PeNSE). Cad Saude Publica. 2014;30(12):2679–90. Scholar
  55. 55.••
    Vieira DAS, Castro MA, Fisberg M, Fisberg RM. Nutritional quality of dietary patterns of children: are there differences inside and outside school? (Qualidade nutricional dos padrões alimentares de crianças: existem diferenças dentro e fora da escola?). J Pediatr. 2017;93(1):47–57. This article described the dietary patterns of 2979 Brazilian children inside and outside school and investigate their associations with sociodemographic factors and nutritional status. There are differences in nutritional quality of dietary patterns inside and outside school, and heterogeneity in adherence to these patterns was observed across regions and socioeconomic status. CrossRefGoogle Scholar
  56. 56.
    Wendpap LL, Ferreira MG, Rodrigues PRM, Pereira RA, Loureiro AS, Goncalves-Silva RMV. Qualidade da dieta de adolescentes e fatores associados (Adolescents’ diet quality and associated factors) (Calidad de la dieta de adolescentes y factores asociados). Cad Saúde Pública. 2014;30(1):97–106. Scholar
  57. 57.
    Xavier ICVM, Hardman CM, Andrade MLSS, Barros MVG. Frequency of consumption of fruits, vegetables and soft drinks: a comparative study among adolescents in urban and rural areas (Frequência de consumo de frutas, hortaliças e refrigerantes: estudo comparativo entre adolescentes residentes em área urbana e rural). Rev Bras Epidemiol. 2014;17(2):371–80. Scholar
  58. 58.
    Ogata BN, Hayes D. Position of the academy of nutrition and dietetics: nutrition guidance for healthy children ages 2 to 11 years. J Acad Nutr Diet. 2014;114(8):1257–76. Scholar
  59. 59.
    Monteiro CA, Cannon G, Moubarac JC, Levy RB, Louzada MLC, Jaime PC. Ultra-processing. An odd ‘appraisal’. Public Health Nutr. 2018;21(3):497–501. Scholar
  60. 60.
    Nahar-van Venrooij LMW, Marhe E, Antonius-Smits C, Krishnadath IS. Adequate and excessive food consumption in Suriname: a multiethnic middle-income country. Int J Public Health. 2018;63(9):1059–69. Scholar
  61. 61.
    Pyramid power is here to stay: behind the new food guide. J Am Diet Assoc. 1992;92(8):925.Google Scholar
  62. 62.
    Collins CE, Watson J, Burrows T. Measuring dietary intake in children and adolescents in the context of overweight and obesity. Int J Obes. 2010;34(7):1103–15. Scholar
  63. 63.
    Subar AF, Kirkpatrick SI, Mittl B, Zimmerman TP, Thompson FE, Bingley C, et al. The Automated Self-Administered 24-hour dietary recall (ASA24): a resource for researchers, clinicians, and educators from the National Cancer Institute. J Acad Nutr Diet. 2012;112(8):1134–7. Scholar
  64. 64.
    Arouca A, Moreno LA, Gonzalez-Gil EM, Marcos A, Widhalm K, Molnar D, et al. Diet as moderator in the association of adiposity with inflammatory biomarkers among adolescents in the HELENA study. Eur J Nutr. 2018.
  65. 65.
    Arouca AB, Santaliestra-Pasias AM, Moreno LA, Marcos A, Widhalm K, Molnar D, et al. Diet as a moderator in the association of sedentary behaviors with inflammatory biomarkers among adolescents in the HELENA study. Eur J Nutr. 2018.
  66. 66.
    Della Corte KW, Perrar I, Penczynski KJ, Schwingshackl L, Herder C, Buyken AE. Effect of dietary sugar intake on biomarkers of subclinical inflammation: a systematic review and meta-analysis of intervention studies. Nutrients. 2018;10(5).
  67. 67.
    Moraeus L, Lemming EW, Hursti UK, Arnemo M, Sipinen JP, Lindroos AK. Riksmaten adolescents 2016-17: a national dietary survey in Sweden—design, methods, and participation. Food Nutr Res. 62;2018.
  68. 68.
    Wark PA, Hardie LJ, Frost GS, Alwan NA, Carter M, Elliott P, et al. Validity of an online 24-h recall tool (myfood24) for dietary assessment in population studies: comparison with biomarkers and standard interviews. BMC Med. 2018;16(1):136. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Ana Carolina Barco Leme
    • 1
    Email author
  • Regina Mara Fisberg
    • 1
  • Debbe Thompson
    • 2
  • Sonia Tucunduva Philippi
    • 1
  • Theresa Nicklas
    • 2
  • Tom Baranowski
    • 2
  1. 1.Department of Nutrition, School of Public HealthUniversity of São PauloSao PauloBrazil
  2. 2.USDA/ARS Children’s Nutrition Research Center, Department of PediatricBaylor College of MedicineHoustonUSA

Personalised recommendations