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Ultra-processed diets cause excess calorie intake and weight gain: A one-month inpatient randomized controlled trial of ad libitum food intake
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Abstract
We investigated whether ultra-processed foods affect energy intake in 20 weight-stable adults, aged (mean±SE) 31.2±1.6 y and BMI=27±1.5 kg/m2. Subjects were admitted to the NIH Clinical Center and randomized to receive either ultra-processed or unprocessed diets for 2 weeks immediately followed by the alternate diet for 2 weeks. Meals were designed to be matched for presented calories, energy density, macronutrients, sugar, sodium, and fiber. Subjects were instructed to consume as much or as little as desired. Energy intake was greater during the ultra-processed diet (508±106 kcal/d; p=0.0001), with increased consumption of carbohydrate (280±54 kcal/d; p<0.0001) and fat (230±53 kcal/d; p=0.0004) but not protein (-2±12 kcal/d; p=0.85). Weight changes were highly correlated with energy intake (r=0.8, p<0.0001) with participants gaining 0.8±0.3 kg (p=0.01) during the ultra-processed diet and losing 1.1±0.3 kg (p=0.001) during the unprocessed diet. Limiting consumption of ultra-processed foods may be an effective strategy for obesity prevention and treatment. ClinicalTrials.gov Identifier NCT03407053
... Mexico has one of the highest prevalence of childhood obesity worldwide [1][2][3]. Consumption of discretionary foods, like breakfast cereals that contain high amounts of saturated fat and/or added sugar, is a major contributor to childhood obesity [4][5][6]. These discretionary foods represent 25% of daily caloric intake among Mexican school-aged children and adolescents [7]. ...
... The positive feelings associated with these characters will transfer to the product or brand, increasing brand preference, loyalty, and recognition [10,11]. Indeed, it has been widely documented that in children and youth, cartoon characters on product packaging attract more attention, [12,13] increase products' appeal, [5] and even change perceptions of product taste [6]. ...
Background:
Cartoon characters on processed food packaging increase the perception of product preference among children, but their effect among adults has rarely been examined. We evaluated the effect of a cartoon character on breakfast cereals on beliefs about buying them for children, as well as whether demographic characteristics modified this effect.
Methods:
An experimental study was conducted with adults from online consumer panels in Mexico (n = 3755). Participants were randomly assigned to a "cartoon" condition (n = 1789), in which they viewed a breakfast cereal box with a Minion character on the front of the package, or the "control" condition (n = 1966), in which the same cereal box was displayed with no character on the package. Participants were asked: "Is this a good cereal to buy children?" with the response options "Yes", "No", or "Don't know". Multinomial adjusted logistic models regressed responses to this question (Yes = 0, No = 1, 2 = Don't know) on experimental condition. Differences in the effect of the cartoon character across demographic characteristics were tested by introducing multiplicative interaction terms.
Results:
The adjusted model showed that participants in the "cartoon character" condition were 1.67 (1.45-1.94) times more likely to consider the cereal as being "Not good to buy for children" than those in the control condition (p < 0.001). This effect was smaller among parents (RRR = 1.39, 1.13-1.72) compared to those without children (RRR = 2.01, 1.63-2.47). No differences were observed in the proportion of participants answering "Don't know" across experimental groups.
Conclusion:
Among this sample of Mexican adults, a cereal with a cartoon character on the packaging was more often perceived as "not good to buy for children" compared to a cereal without it. This effect was smaller among parents, potentially due to children influences of parental decisions during food purchasing.
... Such diets often consist of ultra-processed foods and beverages with high caloric densities in conjunction with high levels of added sugars, saturated fats, and sodium, while providing low levels of vitamins and minerals [2]. Compelling evidence indicates that the consumption of ultra-processed foods and beverages is associated with increased risk of obesity, type 2 diabetes, hypertension, and weight gain, among other conditions [3][4][5][6][7]. ...
... 2 Product included an added sugar ingredient and had a total sugar >10 g per 100 g or >5 g per 100 mL. 3 Product included an added saturated fat ingredient and saturated fat >4 g per 100 g or >3 g per 100 mL. 4 Product included an added sodium ingredient and sodium >400 mg per 100 g or >100 mg per 100 mL 5 Product included added sugar, saturated fat, or sodium ingredient and had a total energy >275 kcal per 100 g or >70 kcal per 100 mL. Dashes indicate that no products met the nutrient threshold. ...
Background:
Front-of-package warning labels are an increasingly common policy and have been implemented to inform consumers of the nutritional quality of ultra-processed foods. This study examined the proportion of Colombian products that could be subjected to such regulations.
Methods:
Two nutrition profile models were compared: the Pan American Health Organization (PAHO) model, and the nutrient profile established under the Chilean food labeling and advertising law (Chilean model). Products (n = 6708) exceeding nutrient criteria based on each model were identified as subject to regulation.
Results:
A total of 80.2% (PAHO model) to 66.4% (Chilean model) of foods met the criteria for regulation. The categories with the highest proportion of regulated products were meats (97.3% PAHO model; 87.5% Chilean model), sweets (95.6% PAHO) and snacks (Chilean model). The category with the lowest proportions of regulated products were cereals (47.3% PAHO model) and miscellaneous foods and fish/seafood (39.0% and 39.5%, respectively, Chilean model).
Conclusions:
Under both the PAHO and Chilean nutrient profile models, the majority of packaged foods available in Bogotá would be eligible to receive front-of-package warning labels. These results suggest a warning label law could have a major impact on the Colombian food supply, especially in the context of the growing prevalence of diet-related chronic diseases in Colombia.
... In total, 35.6 and 38.4% of Mexican children and adolescents, respectively, live with obesity [4]. Ultra-processed products, with high quantities of saturated fat and/or added sugar, have contributed to the development of this public health problem [5][6][7]. Among Mexican school-aged children and adolescents, ultraprocessed products represent 34.3% and 35.5%, respectively, of the total calories consumed [8]. ...
Background:
Warning Labels (WL) highlight excessive amounts of critical nutrients in order to discourage consumption of unhealthful packaged food products. This study aimed to evaluate among Mexican school children, the objective understanding of traditional and numeric WL (aimed at small products) considered by the Mexican regulation, and whether cartoon characters influenced the understanding of WL. We also tested some communication strategies to facilitate the correct use of the WL.
Methods:
We carried out a randomized experiment in July 2019 in public elementary schools from Morelos, Mexico. Participants aged 6-13 years, were randomly assigned to one of four groups: 1) Nutrient Facts Panel (NF) (n = 120), 2) Nutrient Facts Panel with cartoon characters (NF + C) (n = 83), considered the control groups, 3) Warning Labels (WL) (n = 109), and 4) Warning Labels with cartoon characters (WL + C) (n = 96). After allocation, children assigned to both WL groups (WL or WL + C), were randomly required to watch two posters simultaneously or a video explaining how to correctly interpret WLs. Logistic regression models adjusted by sex, age and cluster (school) were fitted.
Results:
The percentage of children correctly choosing the healthiest or the unhealthiest option was higher for WL groups (56.8, 95%CI; 40.8-72.8) compared to NF groups (24.3, 95%CI; 20.4-28.3, p < 0.05). The understanding of traditional WL was higher (28.7, 95%CI: 22.8-35.4) than the numeric WL (19, 95%CI: 14.2-25.0, p < 0.05). But, correct answers for identifying healthy and unhealthy products were higher for numeric WL than for NF groups. Cartoon characters reduced the percentage of correct answers for choosing unhealthiest products (WL + C: 48.9, 95%CI: 25.6-72.4 vs WL: 58.7, 95%CI: 36.4-81.1, p < 0.05). The video was 2.23 times more helpful than the posters to the correct interpretation of the WL (p < 0.05).
Conclusions:
In scholar Mexican children, traditional and numeric WL were useful to identify healthier and unhealthier packaged products in comparison to NF, suggesting that both WL formats may effectively communicate the excessive content of nutrients of concern among children. Cartoon characters may reduce the objective understanding of the WL, underscoring the need to regulate advertising directed to children along with the implementation of front-of-pack labeling.
... Texture and Energy Density to reduce intake to satiation; Evidence from several controlled feeding studies has demonstrated that energy density (71) and food texture (53) can independently and in combination influence the rate and extent of energy intake within meals. Findings from a recent RCT on ultra-processed foods highlights that higher energy intake rates (kcals/min) support sustained increases in ad libitum energy intake (72). These energy intake rates have been shown to vary widely within the food environment (27). ...
Sensory properties inform likes and dislikes, but also play an important functional role in guiding food choice and intake behavior. Odors direct food choice and stimulate sensory-specific appetites and taste helps to anticipate calorie and nutrient content of food. Food textures moderate eating rate and the energy consumed to satiation and post-ingestive metabolism. We summarize how sensory cues moderate intake, and highlight opportunities to apply sensory approaches to improve dietary behavior. Salt, sweet and savory taste influence liking, but also influence energy intake to fullness, with higher taste intensity and duration linked to lower intake. Psycho-physical studies show it is relatively easy to rank taste intensities at different concentrations but more challenging to discriminate fat contents, and fat discrimination declines further when combined with high-taste intensity. Fat has low impact on sensory intensity, but makes significant contributions to energy content. Combinations of high taste and fat-content can promote passive energy over-consumption, and adding fat also increases energy intake rate (kcals/min), reducing opportunities to orally meter consumption. Consumers adapt their oral processing behaviors to a foods texture, which can influence the rate and extent of energy intake. Understanding how texture influences eating behaviors and bolus formation, affords new opportunities to impact eating rate, energy intake and metabolic response to food. Food formulation has traditionally focused on composition and sensory appeal. Future research needs to consider the role of sensory properties in moderating consumer interaction with their food environment, and how they influence calorie selection, and shape our eating behaviors and intake.
... However, various studies that have assessed the impact of RTE cereals on dietary intakes and human health show that despite the supposed health benefits (4)(5)(6)(7)(8), the majority of these products are highly processed and high-in some nutrients like (4) sugar, sodium and unhealthy saturated fats (9). Nutrients frequently associated with consumption on increased dietary intake and weight gain (10), which in turn relate to an increased risk of overweight and obesity, abdominal obesity, all-cause mortality, metabolic syndrome, and depression in adults (9,11). This is a matter of concern if we consider the UPF has been particularly pronounced in Latin America and the Caribbean (12)(13)(14). ...
Background: The use of advertising content strategies that suggest consuming a product will confer nutrient- and health-related benefits influences household food purchasing decisions, which increases consumption of energy-dense, nutrient-poor products. We examined the presence of marketing claims regarding nutrient content, health and nature in ready-to-eat (RTE) cereal packages in relation to the products' nutritional quality.
Methods: A cross-sectional content analysis was conducted on 178 RTE cereal packages available in the six largest supermarket chains in four Colombian cities from August to November 2018. The nutritional quality of products was assessed through the nutrient profile model established by the Chilean Law of Food Labeling and Advertising law.
Results: All products sampled exceeded the regulation threshold for at least one nutrient of concern (e.g., high-in calories and/or sugar). The majority (66.3%) of packages had claims related to nature, 57.3% had nutrient-content claims, and 15.7% had health benefit or risk avoidance claims. Most products with nature, nutrient-content, and health claims were high in energy (99.2, 98.0, and 92.9%, respectively) and sugar (88.1, 87.3, and 92.9%, respectively).
Conclusion: RTE cereal products offered in major Colombian supermarket chains are heavily marketed using nutrition- and nature-related claims. Nearly all products with claims are high in energy and sugar, despite the messages conveyed by the claims to consumers. Results support the implementation of mandatory regulations restricting claims on food and beverage products high in nutrients of concern.
... Several studies have shown that low carbohydrate intake (which results in a ketogenic or "insulin sparing" diet) can reverse these changes and indeed, T2DM itself [40]. It is probable that fatty foods have been wrongly blamed for the obesity epidemic, and the sugar [41] and fast-food industry marketing ultraprocessed food [42] have actively contributed to this myth [43]. ...
Non-alcoholic fatty liver disease (NAFLD) is a fast-spreading epidemic across the globe and has serious implications far beyond that of a "benign" liver condition. It is usually an outcome of ectopic fat storage due to chronic positive energy balance leading to obesity and is associated with multiple health problems. While association with cardiovascular disease and hepatocellular cancer is well recognized, it is becoming clear the NAFLD carries with it an increased risk of cancers of extrahepatic tissues. Studies have reported a higher risk for cancers of the colon, breast, prostate, lung, and pancreas. Fatty liver is associated with increased mortality; there is an urgent need to understand that fatty liver is not always benign, and not always associated with obesity. It is, however, a reversible condition and early recognition and intervention can alter its natural history and associated complications.
... Cross-sectional and longitudinal studies show dose-response association between the dietary contribution of ultra-processed foods and obesity (27)(28)(29)(30), and also hypertension (31), cardiovascular diseases (32), dyslipidaemia (33), metabolic syndrome (34), gastrointestinal disorders (35), total and breast cancer (36), depression (37), and all-cause mortality (38,39). An in-patient, two-week, crossover randomized controlled trial conducted by the US National Institutes of Health compared diets with an average of 83% of energy from ultra-processed foods with diets containing no ultra-processed foods (40). The main findings of the trial showed that "when consuming ultra-processed food diets people ate on average 508 more calories per day … and that, not surprisingly given this finding, people gained weight on the ultraprocessed diet (1.7lbs in just 2 weeks) and lost weight on the flip side (2.4lbs in just 2 weeks)" (41). ...
Policies to control and prevent the pandemic of obesity and related conditions and diseases have failed. This is because the efficient causes of the pandemic have not yet been agreed. We state here that its outstanding immediate cause is the increased and rapidly increasing consumption of ultra-processed foods, which displace unprocessed or minimally processed foods and freshly prepared dishes and meals, most conspicuously now in middle- and lower-income countries.
The underlying cause of this is the phenomenal rise since the 1980s of the transnational corporations whose huge profits depend on the use of cheap ingredients and arrays of additives made into ultra-processed food. The scale and power of the transnationals, which tend towards oligopoly, and their penetration of middle and lower-income countries, have been accelerated by global political and economic agreements that have deregulated trade and allowed capital flow that opens countries to penetration by foreign businesses.
Food is essential for life and health, but there is no need to consume ultra-processed foods. In this sense, they are similar to tobacco products. The same statutory policies and programmes that are applied to smoking should be adapted to limit and reduce consumption of ultra-processed foods. Revenue from taxation should be used to protect local food producers and retailers, to promote healthy and sustainable diets, and to ensure food security for vulnerable populations. Overall, a Framework Convention on Food Systems, promulgated by the relevant United Nations agencies as agreed by UN member states, supported by professional and civil society organisations and social movements, is needed. This will be designed to create healthy food systems and supplies and thus healthy diets that also are beneficial socially, culturally, economically and environmentally.
... Cross-sectional and longitudinal studies show dose-response association between the dietary contribution of ultra-processed foods and obesity (27)(28)(29)(30), and also hypertension (31), cardiovascular diseases (32), dyslipidaemia (33), metabolic syndrome (34), gastrointestinal disorders (35), total and breast cancer (36), depression (37), and all-cause mortality (38,39). An in-patient, two-week, crossover randomized controlled trial conducted by the US National Institutes of Health compared diets with an average of 83% of energy from ultra-processed foods with diets containing no ultra-processed foods (40). The main findings of the trial showed that "when consuming ultra-processed food diets people ate on average 508 more calories per day … and that, not surprisingly given this finding, people gained weight on the ultraprocessed diet (1.7lbs in just 2 weeks) and lost weight on the flip side (2.4lbs in just 2 weeks)" (41). ...
Commentary in World Nutrition. Policies to control and prevent the pandemic of obesity and related conditions and diseases have failed. This is because the efficient causes of the pandemic have not yet been agreed. We state here that its outstanding immediate cause is the increased and rapidly increasing consumption of ultra-processed foods, which displace unprocessed or minimally processed foods and freshly prepared dishes and meals, most conspicuously now in middle-and lower-income countries. The underlying cause of this is the phenomenal rise since the 1980s of the transnational corporations whose huge profits depend on the use of cheap ingredients and arrays of additives made into ultra-processed food. The scale and power of the transnationals, which tend towards oligopoly, and their penetration of middle and lower-income countries, have been accelerated by global political and economic agreements that have deregulated trade and allowed capital flow that opens countries to penetration by foreign businesses. Food is essential for life and health, but there is no need to consume ultra-processed foods. In this sense, they are similar to tobacco products. The same statutory policies and programmes that are applied to smoking should be adapted to limit and reduce consumption of ultra-processed foods. Revenue from taxation should be used to protect local food producers and retailers, to promote healthy and sustainable diets, and to ensure food security for vulnerable populations. Overall, a Framework Convention on Food Systems, promulgated by the relevant United Nations agencies as agreed by UN member states, supported by professional and civil society organisations and social movements, is needed. This will be designed to create healthy food systems and supplies and thus healthy diets that also are beneficial socially, culturally, economically and environmentally.
Because AFSs are diverse, dynamic, and evolve continuously, they require massive continuous investment to enable ongoing discovery and adaptation merely to prevent backsliding.
Introduction: Ultra-processed foods (UPF), or packaged foods defined by industrial processing and food additives, are associated with poor nutrient quality of the diet, weight gain, and may impact physical activity levels. Young active populations are understudied with respect to UPF. The purpose of this study is to explore relationships between UPF and BMI, dietary habits, and physical activity in young active adults. Methods: Healthy college students (n=42) completed two 24-hr dietary recalls and physical activity surveys. Data were median split into the top 50th percentile (HIGHUPF) and low 50th percentile (LOWUPF) groups based on UPF intake (%). Independent samples t-tests were used to analyze differences between groups. Results: No significant differences in BMI (kg/m2) were seen between HIGHUPF (25.5) and LOWUPF (23.7) (p=0.055). A significantly higher BMI was seen in HIGHUPF after controlling for physical activity (p=0.04). Compared to LOWUPF, HIGHUPF exhibited lower protein (%) intake (p=0.04), lower fiber intake (p=0.05), higher added sugar (tsp/1000kcal) intake (p=0.05), higher refined grains (oz/1,000kcal) intake (p=0.001), and higher sedentary time (mins/day) (p=0.001). Conclusions: Our results suggest that ≥476 mins/week of recreational physical activity diminishes the relationship between UPF and BMI. Greater UPF intake is associated with greater sedentary time, and adverse dietary makeup.
Background. Warning Labels (WL) are a new approach which highlight excessive amounts of critical nutrients in processed foods or beverages in order to discourage consumption of unhealthful products. This study aimed to evaluate among Mexican school children, the objective understanding of traditional and numeric WL considered by the Mexican regulation. To identify the impact of cartoon characters in the objective understanding of the WL and, to test some communication strategies to facilitate the correct use of the WL.
Methods. We carried out a randomized experiment in July of 2019 in public elementary schools Morelos, Mexico. Participants were randomly assigned to one of four groups: 1) Nutrient Facts Panel (NF), 2) Nutrient Facts Panel with cartoon characters (NF+C), 3) Warning Labels (WL), and 4) Warning Labels with cartoon characters (WL+C). After allocation, children assigned to both WL groups (WL or WL+C), were randomly required to watch simultaneously two posters or a video explaining how to correctly interpret WLs. Logistic regression models adjusted by sex, age and cluster (school) were fitted.
Results. The proportion of children correctly choosing the healthiest or the least healthy option was higher for WL groups (56.8%, 95%CI; 40.8-72.8) compared to all NF groups (24.3%, 95%CI; 20.4-28.3, p<0.05). The objective understanding of traditional WL was higher (28.7%, 95%CI: 22.8-35.4) than the numeric WL (19%, 95%CI: 14.2-25.0, p<0.05). For choosing the unhealthiest products, WL group responded correctly in a higher proportion when using traditional WL (58.7%, 95%CI: 36.4-81.1) in comparison to WL+C group (48.8%, 95%CI: 25.4-64.2, p<0.05). By tool of communication, the video was 2.23 times more helpful than the posters to the correct interpretation of the WL (p<0.05), being 2.41 times more helpful for choosing the healthiest item (p<0.05) and 1.57 for choosing the unhealthiest choice (p<0.05).
Conclusions. In scholar Mexican children, WL were useful to identify easily and quickly healthier and unhealthier packaged products in comparison to NF. Importantly, numeric WL seemed to be as effective as WL to help children identify healthy and unhealthy products. Cartoons displayed on the packages reduced the objective understanding of the WL, especially for breakfast cereals and milks for which cartoons where perceived as the unhealthiest ones.
The environmental impacts of food are currently at unsustainable levels. Consumers undoubtedly play a central role in reducing the impacts of the food system to more sustainable levels via dietary changes and food waste reduction. Mathematical optimisation is one approach to identifying less environmentally impactful dietary patterns. A limited number of studies, however, have assessed whether impact reductions offered by optimised diets are enough to remain within planetary boundaries (i.e. attain ‘absolute’ environmental sustainability). Using UK food consumption as a case study, here we employ linear programming to identify nutritionally adequate diets that meet sociocultural acceptability criteria whilst minimising (a) environmental impact transgressions of their allocated share of the safe operating space (SoSOS) for nine planetary boundaries (PBs), (b) cost, or (c) deviation from the current diet. We show that the current diet is unsustainable as it transgresses six or seven PBs, depending on the SoSOS allocation principle. Optimising for minimum SoSOS transgressions yields diets offering significant impact reductions (66 - 95% reduction across all PBs) compared to the current average dietary pattern, but whether they completely mitigate SoSOS transgressions depends on the sharing principle adopted to assign the SoSOS to national food consumption. Additionally, by comparing least-cost and least-transgression solutions, we find a trade-off between cost and environmental sustainability indicating that more sustainable dietary patterns are not currently incentivised by the relative prices of food items in the UK. Our work demonstrates the value in embedding ‘absolute’ sustainability in diet optimisation so that solutions inherently provide a more clear-cut understanding of their broad implications on the environment.
The implementation of front‐of‐pack labelling to assist consumers in making healthier food choices requires an appropriate Nutritional Profile Model (NPM) to be defined. However, four different models have been proposed in Brazil: the Pan American Health Organization (PAHO), the Brazilian Association of Food Industries (ABIA) and National Health Surveillance Agency (ANVISA) less (1) and more restrictive (2) models. The present study aimed to use the information provided on the labels of eight ultra‐processed food categories selected from the most popular group of foods targeted at Brazilian children, to score critical nutrient levels according to the four different NPMs and compare the proportion of products categorised as ‘high’, ‘medium’ or ‘low’ according to each one. Labels (n = 409) were collected in supermarkets in Belo Horizonte‐MG, Brazil. Data were tabulated, and a comparison of the ‘high’ content of the four nutrients, total sugars, total and saturated fats and sodium, according to the four NPMs, was performed. Agreement between ‘high’, ‘medium’ and ‘low’ scores according to the different NPMs, in comparison with the PAHO model, was performed using the Kappa test. Of all ‘fruit’ drinks, 95% were considered as ‘high’ in total sugars by the PAHO model, while only 5% were categorised as ‘high’ by the ABIA and ANVISA 1 models. For total sugars, no product in the cakes, breakfast cereals and yogurts categories and only 5.7% of the sandwich cookies were categorised as ‘high’ by the ABIA model, while 100% of sandwich cookies were categorised as having a ‘high’ total sugars content by the PAHO and ANVISA models. Similar findings were observed for breakfast cereals, yogurts and corn snacks for the proportion of products scoring ‘high’ for saturated fats and sodium. Kappa's concordance analysis showed moderate to excellent agreement between the PAHO and ANVISA 2 models. It was observed that the PAHO model indicated more foods with a ‘high’ content of critical nutrients. We conclude that the ABIA model is more permissive when compared to the other models and the PAHO model more restrictive.
Link to public copy
https://www.nature.com/documents/Bundles_agrifood_transformation.pdf
The aim: to investigate the metabolic effects of different treatment options in patients with obesity and concomitant non-alcoholic fatty liver disease (NAFLD) based on the presence of CG and GG genotypes PPARG rs1801282 (Pro12Ala) polymorphism in Ukrainians. Materials and methods: 123 patients with NAFLD in combination with obesity 1, 2, 3 classes were included in the motivational weight loss program (5 visits, 3 months). The case group was treated with pioglitazone 15 mg / day, while the control group received only a program. Ultrasound steatometry, anthropometric and laboratory tests before and after treatment, genetic testing rs1801282 polymorphism in PPARG gene were performed. Results: the carriers of CG and GG genotypes PPARG rs1801282 polymorphism had less high stimulated insulin levels compared with groups of different genotypes (p<0.001). It was found pioglitazone effectiveness with significant difference in dynamics of CAP reduction (p<0.001) regardless of polymorphism. Dynamics of BMI decrease was the lowest in control group CC carries – –2.81 (–3.23; –2.39) kg (p<0.001) compared among other groups. Subjects from pioglitazone group with rs1801282 polymorphism carrying of CG and GG genotypes had significant differences in dynamics of fasting С-peptide decrease, serum uric acid reduction – –1.31 (–1.50; –1.13) µg/L and -165.3 (–182.80; –147.80) µmol/L (p<0.001) respectively compared among other groups. Conclusions: Better reduction of metabolic parameters during pioglitazone treatment of patients with obesity and concomitant NAFLD appears to be associated with carrying of CG and GG genotypes PPARG rs1801282 polymorphism.
Objective
To assess the association between consumption of ultra-processed foods and obesity, diabetes, hypertension and heart disease in a nationally representative sample of Canadian adults.Methods
This study used cross-sectional data from 13,608 adults (aged 19+ years) from the 2015 Canadian Community Health Survey–Nutrition. The survey provided data on food consumption (from 24-h recall) and prevalent obesity (BMI ≥ 30 kg/m2) and self-reported diabetes, hypertension and heart disease. All foods and drinks consumed were classified according to the extent and purpose of industrial processing using the NOVA classification. Ultra-processed food consumption was estimated as proportion of total daily energy intake. Multivariable logistic regression models assessed the association between ultra-processed food consumption and obesity, diabetes, hypertension and heart disease, adjusting for a range of socio-demographic and lifestyle factors.ResultsIn 2015, ultra-processed food contributed, on average, to 24% of total daily energy intake in the lowest tertile of ultra-processed food consumption and 73% in the highest tertile. Compared with those in the lowest tertile, adults in the highest tertile of ultra-processed food consumption had 31% higher odds of obesity (OR = 1.31, 95% CI: 1.06–1.60), 37% higher odds of diabetes (OR = 1.37, 95% CI: 1.01–1.85) and 60% higher odds of hypertension (OR = 1.60, 95% CI: 1.26–2.03), adjusting for a range of covariates.Conclusion
Higher consumption of ultra-processed foods is associated with higher prevalence of obesity, diabetes and hypertension among Canadian adults. A comprehensive set of strategies and policies is needed to discourage consumption of ultra-processed foods in Canada and to make unprocessed or minimally processed foods more affordable, available and appealing.
Background:
The Food Guide for the Brazilian Population relies on natural or minimally processed foods mainly of plant origin such as beans and rice with low oil, salt, and sugar content and limited consumption of ultraprocessed foods. Reduction of ultraprocessed foods improves diet quality and energy consumption.
Objective:
The goal of this study is to evaluate the effectiveness of an intervention for the treatment of obesity in children, with counseling based on the Brazilian Food Guide plus control of total energy intake.
Methods:
A parallel, randomized clinical trial will include children aged 7 to 12 years. Randomization will be performed in blocks of 10 individuals using computer-generated random sequence numbers. Both the control and intervention groups will participate in 6 standardized educational activities based on the 10 steps of the Brazilian Food Guide. These activities will be conducted at the University Hospital Toy Library, located in the pediatric outpatient clinic. For the intervention group, in addition to the educational activities, an individualized food plan based on the nutritional recommendations of the Brazilian Society of Pediatrics will be prescribed and discussed with the mothers and fathers. The primary outcome of the study will be variations in body mass index, and secondary outcomes will include analysis of insulin resistance, blood pressure, body fat percentage, and waist and neck circumference.
Results:
This project was funded by the National Council for Scientific and Technological Development in December 2017 (grant no 408333/2017-0). Recruitment began in August 2018 and by September 2019, we had enrolled the 101 participants. In addition to the patients referred by the national system of regulation, recruitment was made by medical outpatient referral and external indication. This is an ongoing study. We expect the results to be published in April 2020.
Conclusions:
At the end of the project, in case of a positive result, a protocol for the treatment of obesity based on the Brazilian Food Guide will be proposed to the Unified Health System. A successful method to reduce childhood obesity is expected.
Clinicaltrial:
Brazilian Registry of Clinical Trials RBR-3st5sn; http://www.ensaiosclinicos.gov.br/rg/RBR-3st5sn.
International registered report:
DERR1-10.2196/16170.
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