LAUSR

Poor diet quality is a major risk factor for the development of anemia. An increased consumption of fortified ultra-processed food (UPF) among children presents a new contributor to micronutrient intake, one that could potentially improve anemia biomarkers despite having a concomitantly low diet quality. Our objective was to investigate the impact of fortified UPF consumption on the prevalence of anemia and diet quality among children from low-income families in Brazil. A cross-sectional analyses from a randomized field trial of children at 3 years of age (n = 432) from Porto Alegre, Brazil. Capillary blood samples were taken to measure hemoglobin concentration (Hb) and used to determine anemia status. Dietary data was assessed using two multiple-pass 24-h recalls and the consumption of UPF was classified according to the NOVA system. UPF account for 42.6% of total energy intake. Children in the highest tertile of UPF consumption had significantly lower risk of anemia (Hb < 110 g/L) compared to those in the lowest tertile (tertile 3 vs. tertile 1; OR 0.56 95% CI 0.39 to 0.82). Similarly, a 10% increase in the consumption of UPF was associated with a 22% lower risk of anemia (95% CI 0.64 to 0.94). Conversely, consumption of UPF was negatively associated with consumption of unprocessed/minimally processed foods. Finally, as the contribution of UPF to total energy intake increased, the intake of added sugars, total fats, and sodium increased, whereas the intake of proteins, fiber, and calcium decreased. The consumption of fortified UPF was associated with a lower risk of anemia and a poor diet quality in children from a low-income community in Brazil. The co-existence of normal Hb with poor diet quality suggests the need for a more nuanced assessment of dietary patterns in low-income settings to best address this paradoxical situation as the prevalence of the double burden of disease continues to increase throughout the world. Coordination for the Improvement of Higher Education Personnel (CAPES).