fiber, and antioxidants that are beneficial for maintaining a healthy diet. This group will be mentioned hereafter as “in-natura foods”.

The second group encompasses " **processed culinary ingredients** " that are derived from unprocessed foods, such as oils, butter, salt, and sugar. Although these ingredients are extracted or refined from whole foods, they are typically used in small quantities to enhance the flavor or cooking process and are not consumed as standalone items.

Moving further along the processing spectrum, the third group comprises " **processed foods** ." These products often contain a combination of processed culinary ingredients along with added substances such as preservatives, sweeteners, and flavor enhancers. Examples of processed foods include canned vegetables, cured meats, and bread. While these foods may still retain some nutritional value, they tend to have reduced amounts of essential nutrients and may also contain higher levels of salt, sugar, and unhealthy fats.

The final category within the NOVA classification is " **ultra-processed foods** ." These foods are heavily modified and typically contain a multitude of ingredients, including additives, preservatives, artificial flavors, and other chemical substances. Examples of ultra-processed foods are soft drinks, packaged snacks, ready-to-eat meals, and sugary cereals.

Recent systematic reviews and meta analyses have summarized a wealth of accumulating evidence linking ultra-processed food consumption with negative health outcomes, which, in addition to weight gain, include increased risk of all-cause mortality, cardiovascular, cardiometabolic, and cerebrovascular diseases, low HLD-cholesterol levels, dyslipidaemia in children, hypertension, metabolic syndrome, irritable bowel syndrome, functional dyspepsia, cancer (breast and overall), gestational obesity, adolescent wheezing, frailty, and depression (Costa et al., 2018, Askari et al., 2020, Chen et al., 2020; Santos et al., 2020, Silva et al., 2020, Delpino et al., 2021; de Miranda et al., 2021, Lane et al., 2021, Pagliai et al., 2021; Suksatan et al., 2021; Louzada et al., 2022; Moradi et al., 2022), with more recent evidence also establishing an association with chronic kidney disease (Avesani et al., 2023). The evidence is particularly robust on the causal linkage with obesity (including a randomized control trial which controlled for the level of processing while matching intake of calories, energy density, macronutrients, sugar, sodium, and fiber) (Hall, 2019). While many existing studies on linkages with other chronic conditions are observational and cross-sectional, increasing possible confounding (particularly with obesity, which has multiple causal factors), large cohort studies have also maintained the link with NCDs like cardiovascular disease, diabetes, and cancer after controlling for obesity (Louzada et al., 2022).

This evidence also indicates that the pernicious health effects of ultra-processed foods go beyond their tendency to be more energy-dense, higher in added sugar, fat, and salt, and lower in fiber and nutritional value (Monteiro, et al., 2019). While the precise biological mechanisms still require further clinical studies, plausible causal links with obesity and NCDs are based on the use of additives and food matrix alterations that accompany industrial processing, which can induce increased caloric intake and negatively interfere with satiety signaling, while generating unfavorable gut microbiomes and hormonal imbalances (Crimarco, et al., 2021).

2.2. Consumption and production of ultra-processed foods and health outcomes in Brazil According to estimations from Nilson et al. (2023), ultra-processed foods represent between 13% and 21% of total estimated energy intake of Brazilian adults across age and sex stratum, and their consumption was associated with 57,000 premature deaths in 2019 (10.5% of all premature deaths of adults from 3069 years of age). Dos Passos et al. (2020) also found that the price of ultra-processed foods is inversely associated with the prevalence of overweight and obesity in Brazil, highlighting the role of these products 4