Consumption of minimally processed and ultra-processed foods by individuals on hemodialysis in southeastern Brazil


  • Nina Mara Paterlini Marques a Graduate Program in Nutrition and Health, Health Sciences Center, Universidade Federal do Espírito Santo, Brazil.
  • Monica Cattafesta b Graduate Program in Collective Health, Health Sciences Center, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil.
  • Fabíola Lacerda Pires Soares a Graduate Program in Nutrition and Health, Health Sciences Center, Universidade Federal do Espírito Santo, Brazil.
  • Glenda Blaser Petarli b Graduate Program in Collective Health, Health Sciences Center, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil.
  • Mirian Patrícia Castro Pereira Paixão c Centro Universitário Salesiano, Vitória, Espírito Santo, Brazil
  • Cleodice Alves Martins a Graduate Program in Nutrition and Health, Health Sciences Center, Universidade Federal do Espírito Santo, Brazil
  • Edson Theodoro dos Santos Neto b Graduate Program in Collective Health, Health Sciences Center, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil.
  • Luciane Bresciani Salaroli a Graduate Program in Nutrition and Health, Health Sciences Center, Universidade Federal do Espírito Santo, Brazil; b Graduate Program in Collective Health, Health Sciences Center, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil.



Chronic kidney disease, Hemodialysis, Food consumption, Minimally processed foods, Food and Nutrition Education, Ultra-processed foods


Introduction: The individuals with chronic kidney disease show low adherence to a diet rich in vegetables.

Objective: To evaluate the association of minimally processed and ultra-processed food consumption with socioeconomic factors, lifestyle habits, and clinical characteristics of hemodialysis service users in southeastern Brazilian.

Methods: Cross-sectional study with 1,024 individuals on hemodialysis from southeastern Brazil. The individuals answered a questionnaire of sociodemographic data, lifestyle habits, and food consumption. After stipulating the frequency of consumption, we classified the foods as minimally processed and ultra-processed. We investigated the association between independent variables and the consumption of minimally processed and ultra-processed foods through the binary logistic regression model with Odds Ratio (OR) and their confidence intervals (95%CI).

Results: Users with less than eight years of education (OR=1.706; 95%CI1.125–2.589) and with income less than two minimum wages (OR=1.349; 95%CI1.007–1.806) had lower consumption of minimally processed foods. However, individuals aged 19 to 29 years (OR=2,857, 95%CI1.464–5.576), smokers (OR=2.349; 95%CI1.237–4.462), drinkers (OR=1.835; 95%CI1.122–3.001), and with more than 6 years on hemodialysis (OR=1.975; 95%CI1.227–3.180) were more likely to have higher consumption of ultra-processed foods. Individuals that did not practice physical activity were less likely to this consumption (OR=0.638; 95%CI0.459–0.888).

Conclusion: Being younger, smoking, consuming alcohol, and having been on hemodialysis for more than 6 years increased the chances of greater consumption of ultra-processed foods. In addition, we associated less education and lower income with a lower consumption of minimally processed foods.



Download data is not yet available.


Abreu IS, Nascimento LC, Lima RAG, Santos CB. Children and adolescents with chronic kidney disease in haemodialysis: perception of professionals. Rev Bras Enferm. 2015; 68(6):1020-1026. DOI: 10.1590/0034-7167.2015680604i

Bello AK, Levin A., Tonelli M. Assessment of global renal health status. JAMA. 2017; 317:1864-1881. DOI: 10.1001/jama.2017.4046

Neves PDMM, Sesso RCC, Thomé FS, Lugon JR, Nasicmento MM. Brazilian dialysis census: analysis of data from the decade 2009-2018. Braz J Nephrol. 2020; 42(2):191-200. DOI: 10.1590/2175-8239-JBN-2019-0234

United States Renal Data System. USRDS annual data report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD; 2016.

Chen J, Peng H, Zhang K, Xiao L, Yuan Z, Chen J, et al. The Insufficiency Intake of Dietary Micronutrients Associated with Malnutrition-Inflammation Score in Hemodialysis Population. Moysés RMA, ed. PLoS ONE. 2013; 8(6):e66841. DOI:10.1371/journal.pone.0066841

Soares LR, Pereira MLC, Mota MA, Jacob TA, Nakaoka VY, Silva E, et al (2013). The transition from malnutrition for obesity. BJSCR 5 (1): 64-68.

Hruby A, Hu FB (2015). The Epidemiology of Obesity: a big picture. FarmacoEconomia 33(7):673-689.

Liu HW, Tsai WH, Liu JS, Kuo KL (2019). Association of Vegetarian Diet with Chronic Kidney Disease. Nutrients. 11(2):279. DOI: 10.3390/nu11020279

Fernandes AS, Ramos CI, Nerbass FB, Cuppari L (2018). Diet Quality of Chronic Kidney Disease Patients and the Impact of Nutritional Counseling. Journal of Renal Nutrition. 28(6):403-410. DOI: 10.1053/j.jrn.2017.10.005

Liu HW, Tsai WH, Liu JS, Kuo KL (2019). Association of Vegetarian Diet with Chronic Kidney Disease. Nutrients. 11(2):279. DOI: 10.3390/nu11020279

Santin F, Canella D, Borges C, Lindholm B, Avesani C (2019). Dietary patterns of patients with chronic kidney disease: The Influence of Treatment Modality. Nutrients. 11(8):1920. DOI: 10.3390/nu11081920

Anderson CA, Nguyen HA, Rifkin DE (2016). Nutritional interventions in chronic kidney disease. Med Clin North Am. 100:1265-1283. DOI: 10.1016/j.mcna.2016.06.008

Gazan R, Béchaux C, Crépet A, Sirot V, Drouillet-Pinard P, Dubuisson C, et al (2016). Dietary patterns in the French adult population: a study from the second French cross-sectional national dietary survey (INCA2) (2006-2007). Br J Nutr.116(2):300-315. DOI: 10.1017/S0007114516001549

Naska A, Fouskakis D, Oikonomou E, Almeida MDV, Berg MA, Gedrich K, et al (2006). Dietary patterns and their sociodemographic determinants in 10 European countries: data from the DAFNE database. Eur J Clin Nutr. 60(2):181-190. DOI: 10.1038/sj.ejcn.1602284

Sánchez-Villegas, A., Delgado-Rodríguez, M., Martínez-González, M. Irala-Estévez J, Navarra group (2003). Gender, age, socio-demographic and lifestyle factors associated with major dietary patterns in the Spanish SUN Project (Seguimiento Universidad de Navarra). Eur J Clin Nutr 57(2): 285-292. DOI: 10.1038/sj.ejcn.1601528

Machado AD, Anjos FSN, Domingos MAM, Molina MDCB, Marchioni DML, Benseñor IJM, et al (2018). Dietary intake of patients with non-dialysis chronic kidney disease: the PROGREDIR study. A cross-sectional study. São Paulo Med J. 136(3):208-215. DOI: 10.1590/1516-3180.2017.0177141217

Santin F, Canella DS, Avesani CM (2019). Dietary Intake in Chronic Kidney Disease: Association with Sociodemographic and Geographic Variables and Comparison with Healthy Individuals. Journal of Renal Nutrition. 29(4):333-342. DOI: 10.1053/j.jrn.2018.10.010

Monteiro CA, Cannon G, Levy RB, Moubarac JC, Jaime P, Martins AP, et al (2016). NOVA. The star shines. Classification of foods. Public Health. World Nutrition. 7 (1-3): 28-40.

Monteiro CA, Levy RB, Claro RM, Castro IRR, Cannon G (2010). A new classification of foods based on the extent and purpose of their processing. Cad Saúde Pública. 26(11):2039-2049. DOI: 10.1590/S0102-311X2010001100005

Brasil. Ministério da Saúde. Guia alimentar para a população brasileira [Food guide for the Brazilian population]. 2. ed. Brasília, DF. 2014. Avaliable in: ed.pdf [Accessed March 15, 2022].

World Health Organization (WHO). Diet, Nutrition and the Prevention of Chronic Disease. World Health Organization Technical Report Series, 916: 1-149, backcover, 2003.

Baker, P; Friel, S (2016). Food Systems Transformations, Ultra-Processed Food Markets and the Nutrition Transition in Asia. Globalization and Health 12 (1): 80.

Monteiro CA, Cannon G, Levy RB, Moubarac JC, Louzada ML, Rauber F, et al (2019). Ultra-processed foods: what they are and how to identify them. Saúde Pública Nutr. 22(5):936-941. DOI: 10.1017/S1368980018003762

Martins AM, Moreira ASB, Canella DS, Rodrigues J, Santin F, Wanderley B, et al (2017). Elderly Patients on Hemodialysis Have Worse Dietary Quality and Higher Consumption of ultra-processed Food than Elderly without Chronic Kidney Disease. Nutrition. 41:73-79. DOI: 10.1016/j.nut.2017.03.013

Wendling AL, Balbino KP, Ribeiro PVM, Epifânio APS, Marota LD, Hermsdorff HHM (2020). Processed and ultra-processed food consumption is related to metabolic markers in hemodialysis subjects. Rev Nutr. 33. DOI: 10.1590/1678-9865202033e190138

Rey-García J, Donat-Vargas C, Sandoval-Insausti H, Bayan-Bravo A, Moreno-Franco B, Banegas JR, et al (2021). Ultra-Processed Food Consumption Is Associated with Renal Function Decline in Older Adults: A Prospective Cohort Study. Nutrients. 13(2):428. DOI: 10.3390/nu13020428

World Health Organization (WHO). Global strategy on diet, physical activity and health. [S.l.]: World Health Organization. 2005. Avaliable in: [Accessed April 14, 2022].

Brasil. Ministério da Saúde. Vigitel Brasil 2019: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico – estimativas sobre frequência e distribuição sociodemográfica de fatores de risco e proteção para doenças crônicas nas capitais dos 26 estados brasileiros e no Distrito Federal em 2019 [Vigitel Brazil 2019: surveillance of risk and protection factors for chronic diseases by telephone survey: estimates on frequency and sociodemographic distribution of risk and protection factors for chronic diseases in the capitals of the 26 Brazilian states and the Federal District in 2019]. Brasília: Ministério da Saúde, 2020. Avaliable in: [Accessed May 02, 2022].

Monteiro CA, Moura EC, Jaime PC, Claro RM (2008). Validity of food and beverage intake data obtained by telephone survey. Rev Saúde Pública. 42(4):582-9. DOI: 10.1590/s0034-89102008000400002

Cade J, Thompson R, Burley V, Warm D (2002). Development, validation and use of food frequency questionnaires - a review. Public Health Nutr. 5(4):567-587. DOI: 10.1079/PHN2001318

González-Ortiz A, Xu H, Avesani CM, Lindholm B, Cederholm T, Riserus U, et al (2020). Plant-based diets, insulin sensitivity, and inflammation in elderly men with chronic kidney disease. J Nephrol. 33(5):1091-1101. DOI: 10.1007/s40620-020-00765-6

Bortolotto LA (2008). Hypertension and chronic renal failure. Rev bras hipertens. 15(3): 152-155.

Martins APB, Levy RB, Claro RM, Moubarac JC, Monteiro CA (2013). Growing participation of ultra-processed products in the Brazilian diet (1987-2009). Rev Saude Publ. 47(4):656-665. DOI: 10.1590/S0034-8910.2013047004968

Wijtzes AI, Jansen W, Jansen PW, Jaddoe VWV, Hofman A, Raat H (2013). Maternal educational level and preschool children’s consumption of high-calorie snacks and sugar-containing beverages: Mediation by the family food environment. Preventive Medicine. 57(5):607-612. DOI: 10.1016/j.ypmed.2013.08.014

Momm N, Höfelmann DA (2014). Diet quality and associated factors in children enrolled in a municipal school in Itajaí, Santa Catarina. Cad saúde colet. 22(1):32-39. DOI: 10.1590/1414-462X201400010006

Darmon N, Drewnowski A (2008). Does social class predict diet quality? The American Journal of Clinical Nutrition. 87(5):1107-1117. DOI: 10.1093/ajcn/87.5.1107

Gutiérrez OM, Anderson C, Isakova T, Scialla J, Negrea L, Anderson AH, et al (2010). Low socioeconomic status is associated with elevated serum phosphate levels regardless of race. J Am Soc Nephrol. 21(11): 1953-1960. DOI: 10.1681/ASN.2010020221

Baraldi LG, Martinez Steele E, Canella DS, Monteiro CA (2018). Consumption of ultra-processed foods and associated sociodemographic factors in the USA between 2007 and 2012: evidence from a nationally representative cross-sectional study. BMJ Open. 8(3):e020574. DOI: 10.1136/bmjopen-2017-020574

Lenardson JD, Hansen AY, Hartley D (2015). Rural and Remote Food Environments and Obesity. Curr Obes Rep. 4(1):46-53. DOI: 10.1007/s13679-014-0136-5.

Bielemann RM, Motta JVS, Minten GC, Horta BL, Gigante DP (2015). Consumption of ultra-processed foods and their impact on the diet of young adults. Rev Saude Publ. 49(28):1-10. DOI: 10.1590/S0034-8910.2015049005572

Bojorquez I, Unikel C, Cortez I, Cerecero D (2015). The social distribution of dietary patterns. Traditional, modern and healthy eating among women in a Latin American city. Appetite. 92:43-50. DOI: 10.1016/j.appet.2015.05.003

Ricardo CZ, Claro RM (2012). Cost of food and energy density of the diet in Brazil, 2008-2009. Cad Saúde Pública. 28(12):2349-2361. DOI: 10.1590/s0102-311x2012001400013

Drewnowski A, Darmon N (2005). The economics of obesity: dietary energy density and energy cost. The American Journal of Clinical Nutrition. 82(1):265S-273S. DOI: 10.1093/ajcn/82.1.265S

Medina LPB, Barros MBA, Sousa NFS, Bastos TF, Lima MG, Szwarcwald CL (2019). Social inequalities in the food consumption profile of the Brazilian population: National Health Survey, 2013. Rev bras epidemiol. 22(suppl 2):E190011. DOI: 10.1590/1980-549720190011

Santana RS, Carvalho ADT, Silva MAFS, Castro SR, Alcântara FR, Conceição MS et al (2020). Sociodemographic and behavioral profile of patients on hemodialysis treatment in Teresina, State of Piaui. RSD. 9(12):e42391211305. DOI: 10.33448/rsd-v9i12.11305

Berti TL, Rocha TF, Curioni CC, Junior EV, Bezerra FF, Canella DS, et al (2019). Food consumption according to the degree of processing and sociodemographic characteristics: Pro-Health Study. Rev bras epidemiol. 22:e190046. DOI: 10.1590/1980-549720190046

Jaime PC, Monteiro CA (2005). Fruit and vegetable intake by Brazilian adults, 2003. Cad Saúde Pública. 2005;21(suppl 1):S19-S24. DOI: 10.1590/S0102-311X2005000700003

IBGE. Pesquisa de Orçamentos Familiares: 2017-2018: Nutritional Assessment Of Household Food Availability In Brazil / IBGE, Coordenação de Trabalho e Rendimento; 2020.

Andrade CG, Julia C, Deschamps V, Srour B, Hercberg S, Kesse-Guyot E, et al (2021). ultra-processed food consumption and its association with sociodemographic characteristics and diet quality in a representative sample of French adults. Nutrients 13 (2): 682. DOI: 10.3390/nu13020682

Chung S, Popkin BM, Domino ME, Stearns SC (2007). Effect of retirement on eating out and weight change: an analysis of gender differences. Obesity (Silver Spring). 15(4):1053-60. DOI: 10.1038/oby.2007.538

Plessz M, Guéguen A, Goldberg M, Czernichow S, Zins M (2015). Aging, retirement and changes in vegetable consumption in France: results from the prospective GAZEL cohort. British Journal of Nutrition 114 (6): 979-987. DOI: 10.1017/S0007114515002615

Kosmadakis GC, Bevington A, Smith AC, Clapp EL, Viana JL, Bishop NC, et al (2010). Physical Exercise in Patients with Severe Kidney Disease. Nephron Clin Pract. 115(1):c7-c16. DOI: 10.1159/000286344

Mafra D, Deleaval P, Teta D, Cleaud C, Arkouche W, Jolivot A, et al (2011). Influence of inflammation on total energy expenditure in hemodialysis patients. J Ren Nutr. 21(5):387-393. DOI: 10.1053/j.jrn.2010.09.006

Johansen KL (2005). Exercício e Doença Crónica dos Rins: Recomendações actuais. Medicina desportiva. 35(6):485-499.

Pintor P, Marcus RL (2013). Avaliação da Função Física e Actividade Física em Pacientes com CKD. CJASN 8(5):861-872.

Bogatajär, Pajek M, Pajek J, Buturović Ponikvar J, Paravlic A (2019). Exercise-Based Interventions in Hemodialysis Patients: A Systematic Review with a Meta-Analysis of Randomized Controlled Trials. J Clin Med. 9(1):43. DOI: 10.3390/jcm9010043

Johansen KL, Painter P, Kent-Braun JA, Ng AV, Carey S, Silva M, et al (2001). Validation of physical and disease phase to estimate end-stage renal activity. Kidney International. 59(3):1121-1127. DOI: 10.1046/j.1523-1755.2001.0590031121.x

Katayama A, Miyatake N, Nishi H, Uzike K, Sakano N, Hashimoto H, et al (2014). Evaluation of physical activity and its relationship to health related quality of life in patients on chronic hemodialysis. Med. Saúde Ambiental Prev. 19(3):220-225. DOI: 10.1007/s12199-014-0380-z

Kim JC, Shapiro BB, Zhang M, Li Y, Porszasz J, Bross R, Feroze U, et al. Daily physical activity and physical function in adult maintenance hemodialysis patients. J Cachexia Sarcopenia Muscle. 5(3):209-220. DOI: 10.1007/s13539-014-0131-4

Lear SA, Hu W, Rangarajan S, Gasevic D, Leong D, Lqbal R, et al (2017). The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries: the PURE study. Lancet. 390(10113):2643-2654. DOI: 10.1016/S0140-6736(17)31634-3

Zhang L, Luo H, Kang G, Wang W, Hu Y (2017). The association between physical activity and mortality among patients undergoing maintenance hemodialysis. International Journal of Nursing Practice. 23(1):e12505. DOI: 10.1111/ijn.12505

Machado PP, Steele EM, Levy RB, Louzada MLC, Rangan A, Woods J, et al (2020). Ultra-processed food consumption and obesity in the Australian adult population. Nutr Diabetes. 10(1):39. DOI: 10.1038/s41387-020-00141-0

Camelo L do V, Rodrigues JF de C, Giatti L, Barreto SM (2012). Sedentary leisure time and food consumption among Brazilian adolescents: the Brazilian National School-Based Adolescent Health Survey (PeNSE), 2009. Cad Saúde Pública. 28(11):2155-2162. DOI: 10.1590/S0102-311X2012001100015

Costa CS, Flores TR, Wendt A, Neves RG, Assunção MCF, Santos IS (2018). Sedentary behavior and consumption of ultra-processed foods by Brazilian adolescents: Brazilian National School Health Survey (PeNSE), 2015. Cad Saúde Pública. 34(3):e00021017. DOI: 10.1590/0102-311X00021017

Grant D, Tomlinson D, Tsintzas K, Kolic P, Onambele-Pearson G (2020). Shifting sedentary behavior with light-intensity physical activity spontaneously alters habitual macronutrient intake and improves dietary dietary qualities in older women. Nutrientes. 12 (8): 2431. DOI: 10.3390/nu12082431

Berto SJP, Carvalhaes MABL, Moura EC (2010). Smoking associated with other behavioral risk factors for chronic non-communicable diseases. Cad Saúde Pública. 26(8):1573-1582. DOI: 10.1590/s0102-311x2010000800011

Zhong G-C, Gu H-T, Peng Y, Wang K, Wu YQL, Hu TY, et al (2021). Association of ultra-processed food consumption with cardiovascular mortality in the American population: long-term results of a large prospective multicenter study. Int J Behav Nutr Phys Act. 18(1):21. DOI: 10.1186/s12966-021-01081-3

Moreira PFP, Martiniano Filho F (2008). Aspectos nutricionais e o abuso do álcool em idosos. Envelhecimento e Saúde 14(1): 23-6.

Alvarenga LA, Andrade BD, Moreira MA, Nascimento RP, Macedo ID, Aguiar AS (2017). Nutritional profile of hemodialysis patients concerning treatment time. J Bras Nefrol 39(3). DOI: 10.5935/0101-2800.20170052

Louzada MLC, Martins APB, Canella DS, Baraldi LG, Levy RB, Claro RM, et al (2015). Impact of ultra-processed foods on micronutrient content in the Brazilian diet. Rev Saúde Pública. 2015;49(0):1-8. DOI: 10.1590/S0034-8910.2015049006211

Monteiro CA, Cannon G, Moubarac J-C, Levy RB, Louzada MLC, Jaime PC (2018). The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutr. 21(1):5-17. DOI: 10.1017/S1368980017000234