Ultra-processed foods in a rural Ecuadorian community: associations with child anthropometry and bone maturation.

Frequent ultra-processed food (UPF) consumption is consistently associated with poor health outcomes. Little is known about UPF intake during early childhood and its effects on growth. We assessed UPFs in relation to child anthropometry, bone maturation, and their nutrition profiles in a rural Ecuadorian community. Covariate-adjusted regression models estimated relationships between UPF intake from a 24-hour food frequency questionnaire and three outcomes: linear growth, weight status, and bone maturation. Nutrition Profiling Models (NPM) evaluated a convenience sample of UPFs (n=28) consumed by children in the community. In this cohort (n=125; mean age=33.92±1.75 months), 92.8% consumed some form of UPF the previous day. On average, children consuming UPFs four to 12 times per day (highest tertile) had lower height-for-age z-scores than those with none or a single instance of UPF intake (lowest tertile) [β =-0.43±0.18; p=0.02]. Adjusted stunting odds were significantly higher in the highest tertile relative to the lowest tertile [OR: 3.07, 95%CI: 1.11-9.09]. Children in the highest tertile had significantly higher bone age z-scores (BAZ) on average compared to the lowest tertile [β=0.58±0.25, p =0.03]. Intake of savory UPF was negatively associated with weight-for-height z-scores [β=-0.30±0.14; p=0.04], but positively associated with BAZ [β=0.77±0.23, p< 0.001]. NPMs indicated the availability of unhealthy UPFs to children, with excessive amounts of saturated fats, free sugars, and sodium. Findings suggest that frequent UPF intake during early childhood may be linked to stunted growth (after controlling for bone age and additional covariates), despite paradoxical associations with bone maturation.