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Ultra-processed foods: A new holistic paradigm?
Abstract
Background: The concept of ultra-processed foods (UPFs) is new, and it was proposed for the first time in 2009 as group 4 of the NOVA classification to address the degree of food processing. UPFs include not only “junk foods” but also foods marketed as healthy, such as light, vegan, organic, or gluten-free products. UPFs are characterized by the presence of highly-processed/purified “cosmetic” ingredients and/or additives to restore and/or exacerbate organoleptic properties, i.e., taste, aroma, color and texture. Substantial industrial processing techniques, e.g., puffing, extrusion cooking, and/or extreme fractioning/refining that greatly breakdown the food matrix, may also be markers of ultra-processing. The UPF concept has been consistently criticized for being an overly heterogeneous concept, and the NOVA classification has been criticized for being qualitative only and too imprecise.
Scope and approach: This review is intended to discuss the UPF concept from a holistic perspective and to analyze the scientific soundness of criticisms about UPFs and NOVA. The UPF concept is first defined; then, its primary nutritional characteristics are described, followed by their association with health based on human studies.
Key findings and conclusions: UPF criticisms differ between holistic and reductionist perspectives. In a holistic concept, reductionist researchers view the proposed definition of UPF as an imprecise, vague and heterogeneous technological group. However, from a holistic perspective, the UPF concept has serious advantages, such as broad and common deleterious health attributes (i.e., the loss of “matrix” effect, empty calories, poorly satiating, hyperglycemic and containing artificial compounds foreign to the human body).
... As reviewed by Reardon et al. the FP evolution over the past five decades has seen a shifting trend from processing foods at home (traditional) to buying PFs and then preparing them at home (early to mid-transitional) to now eating out frequently (modern) (7). The intention of these classification frameworks was all epidemiological, except for Siga, whose intent was based on the development of food products and portfolios and to provide proper guidance to consumers on the overview of the food to help them make better choices (13,14). The lowest level for all frameworks was unprocessed, and the highest level was UPF or highly PFs. ...
... Despite the different approaches of classification used by the frameworks, they all ultimately grouped foods as processed or unprocessed in a similar yet distinct manner. Several studies have explained and reviewed the various food classification frameworks (13)(14)(15)(16). For up-to-date, detailed information on the conceptualization and challenges with the existing classification frameworks, refer to the study by Sadler et al. (13). ...
... They defined the holistic paradigm as "an approach in food processing would lead technologists and food scientists to consider foods as systems that are not only a sum of their nutrients but rather a package of bioactive compounds included in a complex food structure." The Siga system contains four holistic groups and four reductionist subgroups based on the impact of processing on the food on the food matrix (14). ...
With increasing advocacy for plant food consumption, the sub-Saharan Africa landscape is home to diverse plant-based food commodities. The need to leverage the advantages of unprocessed/minimally processed foods (PFs) over ultra-processed foods (UPFs) is a system that requires exploitation. Most of the crops produced in the continent are either classified as traditionally or moderately PFs. However, the rise in industrialization and formalization of markets is impacting and marginalizing traditional food processing (FP). Current FP classification frameworks are briefly discussed. The level of processing of cereals, grains, fruits, vegetables, roots, and tuber crops in the continent requires intervention from nutritionists, food scientists, and scientific and governmental bodies to gain a holistic view and tackle the issue of food insecurity in Africa. This study reviews the levels of processing of African foods, challenges, and future directions.
... Notably, a lot of ultra-processed foods are characterized by deteriorated matrices due to new and highly denaturing technological treatments, e.g. extreme fractionation of foods into extracted and isolated purified compounds, puffing, extrusion-cooking, and/or chemical and enzymatic modifications [30,31]. ...
... whole versus refined cereals, red versus processed meat, whole versus fruit juice, and whole versus semi-skimmed versus skimmed milk, among others [5] or the Western diet, generally rich in ultra-processed foods or "empty calories" [141][142][143][144][145][146], notably compared, e.g. with a Mediterranean diet [147]. Ultra-processed foods have been shown to lead consumers in the short term to consume up to + 20% calories and to eat between 56 and 100% more calories per minute [42,79], probably due to their particular artificialized matrices, which demand less chewing with more friable, viscous and liquid textures [30,42,124]. Therefore, the paradigm underlying the newly developed concept of ultra-processed foods is not primarily altered nutritional composition-even if these foods overall have a lower nutritional density [148]-but the degradation of the "matrix effect" (Figs. ...
... Therefore, the paradigm underlying the newly developed concept of ultra-processed foods is not primarily altered nutritional composition-even if these foods overall have a lower nutritional density [148]-but the degradation of the "matrix effect" (Figs. 2a, b and 3) [10,30], which leads us to postulate that the increase in chronic disease prevalence worldwide is associated with the "lost" or degraded "matrix effect" through ultra-processed, artificialized and hyperpalatable food matrices. Consequently, the consumption of excess sugars, salt, fats, additives and other xenobiotics is an effect, not the root primary cause, of chronic diseases (Fig. 3) [10]. ...
Purpose
For decades, it has been customary to relate human health to the nutritional composition of foods, and from there was born food composition databases, composition labelling scores and the recommendation to eat varied foods. However, individuals can fully address their nutritional needs and become chronically ill. The nutrient balance of a food is only a small part of its overall health potential. In this paper, we discussed the proof of concept that the increased risk of chronic diseases worldwide is primarily associated with the degradation and artificialization of food matrices, rather than only their nutrient contents, based on the assumption that “food matrices govern the metabolic fate of nutrients”.
Methods
An empirico-inductive proof of concept research design has been used, based on scientific data linking the degree of food processing, food matrices and human health, notably on the glycaemic index, nutrient bioavailability, satiety potential, and synergistic effects.
Results
We postulate that if the nutrient content is insufficient to fully characterize the diet-global health relationship, one other dimensions is necessary, i.e., the food matrix through the degree of processing. Both matrix and nutrient composition dimensions have been included under the new concept of the 3V index for Real (Vrai), Vegetal (Végétal), and Varied (Varié) foods. The Real metric, reflecting the integrity of the initial food matrix, is the most important, followed by the Vegetal (nutrient origin) and the Varied (“composition” effect) metrics.
Conclusion
Concerning their effects on health, food matrix comes first, and then nutrient composition, and calorie quality matters more than calorie quantity.
... Comparatively, Fardet and Rock indicate the concern regarding industrial processing is the use of processes that greatly breakdown the food matrix, such as puffing, extrusion cooking, extreme fractioning and refining (Fardet & Rock, 2019). These "dramatic processes" are suggested to make starch and sugars more easily accessible to digestive enzymes and lead to rapid increases in blood glucose levels, potentially leading to increased risk of weight gain and type 2 diabetes (Fardet & Rock, 2019). ...
... Comparatively, Fardet and Rock indicate the concern regarding industrial processing is the use of processes that greatly breakdown the food matrix, such as puffing, extrusion cooking, extreme fractioning and refining (Fardet & Rock, 2019). These "dramatic processes" are suggested to make starch and sugars more easily accessible to digestive enzymes and lead to rapid increases in blood glucose levels, potentially leading to increased risk of weight gain and type 2 diabetes (Fardet & Rock, 2019). ...
... Fardet and Rock clarify that ultra-processed foods are not only "junk foods", they include products marketed as healthy. The authors indicate a key distinction between the concepts, ultra-processed foods are madeup of fractionated ingredients "detached from their 'natural' food matrix" (Fardet & Rock, 2019). As discussed previously, this concept needs further development and consensus. ...
Background:
Processed foods are typically praised/revered for their convenience, palatability, and novelty; however, their healthfulness has increasingly come under scrutiny. Classification systems that categorise foods according to their “level of processing” have been used to predict diet quality and health outcomes and inform dietary guidelines and product development. However, the classification criteria used are ambiguous, inconsistent and often give less weight to existing scientific evidence on nutrition and food processing effects; critical analysis of these criteria creates conflict amongst researchers.
Scope and approach:
We examine the underlying basis of food classification systems and provide a critical analysis of their purpose, scientific basis, and distinguishing features by thematic analysis of the category definitions.
Key findings and conclusions:
These classification systems were mostly created to study the relationship between industrial products and health. There is no consensus on what factors determine the level of food processing. We identified four defining themes underlying the classification systems: 1. Extent of change (from natural state); 2. Nature of change (properties, adding ingredients); 3. Place of processing (where/by whom); and 4. Purpose of processing (why, essential/cosmetic). The classification systems embody socio-cultural elements and subjective terms, including home cooking and naturalness. Hence, “processing” is a chaotic conception, not only concerned with technical processes. Most classification systems do not include quantitative measures but, instead, imply correlation between “processing” and nutrition. The concept of “whole food” and the role of the food matrix in relation to healthy diets needs further clarification; the risk assessment/management of food additives also needs debate.
... Therefore, since the 1850s, nutrition research has been predominantly reductionist, considering foods as only the sum of their nutrients, which is scientifically inaccurate (Mayne, Playdon, and Rock 2016). Ultimately, if foods are only the sum of their nutrients, why not refine and decompose them, then recombine the ingredients and nutrients in artificial matrices with additives, i.e., UPFs (Fardet and Rock 2019;Monteiro, Cannon, Levy, et al. 2019)? In this case, calories and nutrients are interchangeable from one food to another. ...
... UPFs ! chronic diseases" (Fardet and Rock 2019). We proposed that if extreme reductionism has led to the development of chronic diseases, then reducing their prevalence requires a change from the "nutritional paradigm" that created them to a return to a complementary and more holistic paradigm (Fardet and Rock 2018). ...
... In this view, calories and nutrients are interchangeable. Moreover, due to all the properties lost during the process and to be close to the initial food, technologies have been scientifically designed to mimic, restore, imitate, and/or accentuate organoleptic properties through the addition of "cosmetic" additives and ingredients ( Figure 2) (Fardet and Rock 2019;Monteiro, Cannon, Levy, et al. 2019). In other words, ultraprocessing may also be viewed as "processing processed foods" to restore lost properties, leading to very long lists of ingredients as a result. ...
Exclusive reductionism in nutritional science consists of viewing foods as only the sum of nutrients. This position paper argues that the extreme application of this paradigm since 1950 has greatly contributed to confusion about a healthy diet among consumers and to the development of chronic diseases worldwide. First, history of nutritional sciences in Western countries shows that by approximately 1850, laboratory research had mainly been conducted by reducing foods to nutrients that were interchangeable from one food to another. Second, descriptive and experimental studies show that the increased prevalence of chronic diseases mainly derive from ultra-processed foods. With such foods being representative of a final output in the degree of food processing, the relevance of reformulating food versus developing less unstructured processed foods is discussed. Third, the reductionist validation of food additives, randomized controlled trials, and food scoring is also questioned. Additionally, epidemiological studies that associate dietary patterns with the risk of chronic diseases and that aggregate approaches in nutrition, technology, food science and food scoring appear to be more adapted for nutritional recommendations in society. It is concluded that a complementary holistic perspective is needed to communicate to society about diet/food health potential and to efficiently prevent populations from chronic diseases.
... Say it differently, UPFs are the symbol of the artificialization of our foods through cosmetic ingredients and/or additives, to notably exacerbate organoleptic food properties that are color, aroma, taste and texture (Fardet, 2019;Fardet & Rock, 2019). This is very profitable for three reasons: 1) one can continue to eat the food because pleasure overcome satiety; 2) one redeem the product; 3) and, if children are targeted very young, they can become customers for life, with the dramatic consequence of keeping them away of the more subtle organoleptic properties of real/homemade traditional foods. ...
... The issue of UPF consumption and human health has been recently reviewed (Elizabeth et al., 2020;FAO et al., 2019;Fardet & Rock, 2019). Today, more than 45 epidemiological studies have been carried out since the year 2010, and they showed a significant increased risk of overweight, obesity, adiposity, metabolic syndrome, type 2 diabetes, hypertension, hypercholesterolemia, total and breast cancers, cardiovascular diseases, irritable bowel syndrome and functional dyspepsia, asthma and wheezing, frailty, depression and mortality. ...
... Another explanation behind this negative health impact can consider first the artificialization of food matrices as primary cause, leading people to consume more calories, salt, sugars, saturated fats and additives than necessary, then affecting the physiology (overweight), before resulting in more severe diseases Indeed, hyper-attractive, hyper-addictive and rapidly eaten foods prompt consumers to consume beyond their real caloric and nutrional needs (Hall et al., 2019). Moreover, to approach causal links, four characteristics of these foods have been identified as being deleterious to health ( Figure 3) (Fardet & Rock, 2019): ...
Global food systems are no longer sustainable for health, the environment, animal biodiversity and wellbeing, culinary traditions, socioeconomics, or small farmers. The increasing massive consumption of animal foods has been identified as a major determinant of unsustainability. However, today, the increasing consumption of ultra-processed foods (UPFs) worldwide is also questioned. Up today, more than 40 epidemiological studies have shown that excess UPF consumption significantly increase the risks of several chronic diseases and all-cause mortality. Concerning the other dimensions of sustainability, we attempted, based on the collection of scattered data from scientific literature, to build the interrelations between massive UPF consumption and impacts on food systems. For this, we first identified the main ingredients/additives present in UPFs and the agricultural practices involved in their provision to agro-industrials. Overall, UPF production is analyzed regarding its impacts on the environment, biodiversity, animal wellbeing, and cultural and socioeconomic dimensions. Our main conclusion is that UPFs are associated with intensive agriculture/livestock and threaten all dimensions of food system sustainability due to the combination of low-cost ingredients at purchase and increased consumption worldwide. However, plant-based UPFs do not produce the highest greenhouse gas emissions (GHGEs) compared to conventional meat and dairy products. In addition, only reducing energy-dense UPF consumption (associated with excess calorie intakes), without substitution, might substantially reduce GHGEs. Therefore, significant improvement in food system sustainability requires urgently encouraging limiting UPF consumption to the benefit of mildly processed foods, preferably seasonal, organic and local products, a recommendation that we formalized in the concept of the 3V-based diet for Végétal (Plant), Vrai (Real foods), Varié (Varied, preferably organic, local and seasonal-when possible).
... The concept of ultra-processed food (UPF) as a descriptor of unhealthy foods within dietary patterns is increasingly recognised in the nutrition literature [1][2][3][4][5] and authoritative reports [6,7]. Understanding of the contribution of UPFs to dietary quality and as a risk factor for diet-related diseases, disorders and conditions is rapidly emerging [8]. ...
... Several reviews have reported on UPFs and health outcomes [2][3][4][5]7,39]. However, despite the large and rapidly growing body of evidence linking UPFs with adverse health outcomes, the number of reviews and summarizing reports to date have been scarce, possibly delaying the inclusion of the 'extent and purpose of industrial processing' [21] as an independent factor for assessing the health potential of diets. ...
... Beneficial outcomes were found associated with diets higher in MPF. The findings can be summarised and classified as follows: (1) in 21 studies assessing overweight, obesity and cardio-metabolic risks in adults, 15 reported significant associations and adverse health outcomes, four reported mixed associations (that is some adverse health outcomes, and some with no associations), and two found no significant associations; (2) in eight studies assessing disease or mortality, five found significant associations and adverse health outcomes, and three found mixed associations; (3) in seven studies investigating other disorders and conditions, five found only significant associations and adverse health outcomes, and two found no associations; (4) in eight studies reporting on overweight, obesity and cardio-metabolic risks in children and adolescents, three found significant associations with adverse health outcomes, two found mixed associations and three found no associations. Seven studies in adults found associations between diets high in MPF (or MPF combined with PCI or PF) and beneficial health outcomes. ...
The nutrition literature and authoritative reports increasingly recognise the concept of ultra-processed foods (UPF), as a descriptor of unhealthy diets. UPFs are now prevalent in diets worldwide. This review aims to identify and appraise the studies on healthy participants that investigated associations between levels of UPF consumption and health outcomes. This involved a systematic search for extant literature; integration and interpretation of findings from diverse study types, populations, health outcomes and dietary assessments; and quality appraisal. Of 43 studies reviewed, 37 found dietary UPF exposure associated with at least one adverse health outcome. Among adults, these included overweight, obesity and cardio-metabolic risks; cancer, type-2 diabetes and cardiovascular diseases; irritable bowel syndrome, depression and frailty conditions; and all-cause mortality. Among children and adolescents, these included cardio-metabolic risks and asthma. No study reported an association between UPF and beneficial health outcomes. Most findings were derived from observational studies and evidence of plausible biological mechanisms to increase confidence in the veracity of these observed associations is steadily evolving. There is now a considerable body of evidence supporting the use of UPFs as a scientific concept to assess the ‘healthiness’ of foods within the context of dietary patterns and to help inform the development of dietary guidelines and nutrition policy actions.
... These outcomes can be explained not only by the unbalanced nutrient profile of UPFs and the dietary displacement of minimally processed foods, but also by the novel physical and chemical properties that result from industrial processing. Proposed mechanisms include, for example, higher glycaemic load and reduced gut-brain satiety signalling linked with food matrix degradation, inflammation resulting from food additives and gut microflora dysbiosis, and endocrine disruption from chemical plasticisers used in packaging Fardet and Rock 2019;Kliemann et al. 2022;Zinöcker and Lindseth 2018). Commercial supply chains provisioning UPFs also generate significant environmental harms (da Silva et al. 2021;Fardet and Rock 2020;Hadjikakou and Baker 2019;Seferidi et al. 2020). ...
... • Holistic, ecological approaches to nutritional science that see a food's health potential as more than the sum of nutrients and consider the whole food matrix (Fardet and Rock 2019;Lawrence 2021;Lawrence et al. 2019). ...
Many are calling for transformative food systems changes to promote population and planetary health. Yet there is a lack of research that considers whether current food policy frameworks and regulatory approaches are suited to tackle whole of food systems challenges. One such challenge is responding to the rise of ultra-processed foods (UPF) in human diets, and the related harms to population and planetary health. This paper presents a narrative review and synthesis of academic articles and international reports to critically examine whether current food policy frameworks and regulatory approaches are sufficiently equipped to drive the transformative food systems changes needed to halt the rise of UPFs, reduce consumption and minimise harm. We draw on systems science approaches to conceptualise the UPF problem as an emergent property of complex adaptive food systems shaped by capitalist values and logics. Our findings reveal that current food policy frameworks often adjust or reform isolated aspects of food systems (e.g., prices, labels, food composition), but under-emphasise the deeper paradigms, goals and structures that underlie the rise of UPFs as a systems phenomenon, and its socio-ecological implications. We propose that a ‘leverage points’ framework illuminates where to intervene in food systems to generate multi-level changes, while the theory of ecological regulation highlights how to respond to complex multi-factorial problems, like the rise of UPFs, in diverse ways that respect planetary boundaries. More research is needed to better understand the transformative potential of ecological regulation to advance food systems transformation and attenuate whole of food systems challenges.
... A second difference between the systems is that a considerable proportion of five-foodgroup foods are classified as ultra-processed. Many of these that are low in saturated fat, e.g., ready-prepared-foods, may be harmful over time due to the impact of refined ingredients or exposure to harmful chemicals such as endocrine disruptors [2,[30][31][32][33]. They may also have cumulative effects on energy storage over time if they contain highly refined, readily digestible sources of carbohydrates and fat relative to protein [34]. ...
... It is important to note, however, that the close conformity between the patterns of macronutrient intakes observed in our analysis and predictions of the protein leverage hypothesis does not in itself provide definitive evidence of protein leverage. An alternative explanation could be that aggressive marketing, hyperpalatabilty, and other extrinsic factors drive excessive consumption of discretionary food and UPF, which both dilutes dietary protein and increases energy intake independent of protein appetite [32,36]. However, this hypothesis does not explain why absolute protein remained so constant; in contrast, constant protein intake is a central prediction of the protein leverage hypothesis. ...
NOVA classification distinguishes foods by level of processing, with evidence suggesting that a high intake of ultra-processed foods (UPFs, NOVA category 4) leads to obesity. The Australian Dietary Guidelines, in contrast, discourage excess consumption of “discretionary foods” (DFs), defined according to their composition. Here, we (i) compare the classification of Australian foods under the two systems, (ii) evaluate their performance in predicting energy intakes and body mass index (BMI) in free-living Australians, and (iii) relate these outcomes to the protein leverage hypothesis of obesity. Secondary analysis of the Australian National Nutrition and Physical Activity Survey was conducted. Non-protein energy intake increased by 2.1 MJ (p < 0.001) between lowest and highest tertiles of DF intake, which was significantly higher than UPF (0.6 MJ, p < 0.001). This demonstrates that, for Australia, the DF classification better distinguishes foods associated with high energy intakes than does the NOVA system. BMI was positively associated with both DFs (−1. 0, p = 0.0001) and UPFs (−1.1, p = 0.0001) consumption, with no difference in strength of association. For both classifications, macronutrient and energy intakes conformed closely to the predictions of protein leverage. We account for the similarities and differences in performance of the two systems in an analysis of Australian foods.
... Ultra-processed products are industrial formulations of ingredients extracted from foods that are rarely used in artisanal settings, typically have cosmetic additives, such as colours and flavours, and physical structures that differ significantly from source foods and ingredients as a consequence of processing techniques [3]. These novel chemical compositions and physical structures have been identified as providing plausible biological mechanisms to explain associations between ultra-processed foods and adverse health outcomes independently of the presence of 'risk' nutrients in the food [4,5]. For example, ultra-processed products can stimulate overconsumption of energy through disruption of the gutbrain axis regulation and/or increase the exposure to proinflammatory, toxic and endocrine disruptors compounds [6][7][8][9][10]. ...
... Total population estimate: n = 21,526,456 (n = 12,153) 95% CI 95% confidence interval, NCD non-communicable diseases, PAHO NPM Pan-American Health Organization Nutrient Profile Model † Content of NCD-related critical nutrients: Free sugars, total fats, saturated fats, and trans fats (% of the total energy intake). Sodium content: total sodium (mg) less the recommended value per age group [2000 mg (for adults and adolescents); 1640 mg (for children aged [5][6][7][8][9][10] years old); and 1122 mg (for children aged < 5 years old)]. Guideline: sodium intake for adults and children. ...
Purpose
To investigate intake levels of nutrients linked to non-communicable diseases in Australia using the novel combination of food processing and nutrient profiling metrics of the PAHO Nutrient Profile Model.
Methods
Dietary intakes of 12,153 participants from the Australian Health Survey (2011–12) aged 2 + years were evaluated. Food items reported during a 24 h recall were classified using the NOVA system. The Pan-American Health Organization Nutrient Profile Model (PAHO NPM) was applied to identify processed and ultra-processed products with excessive content of critical nutrients. Differences in mean intakes and prevalence of excessive intakes of critical nutrients for groups of the population whose diets were made up of products with and without excessive content in critical nutrients were examined.
Results
The majority of Australians consumed daily at least three processed and ultra-processed products identified as excessive in critical nutrients according to the PAHO NPM. Individuals consuming these products had higher intakes of free sugars (β = 8.9), total fats (β = 11.0), saturated fats (β = 4.6), trans fats (β = 0.2), and sodium (β = 1788 for adolescents and adults; β = 1769 for children 5–10 years; β = 1319 for children aged < 5 years) (p ≤ 0.001 for all nutrients) than individuals not consuming these foods. The prevalence of excessive intake of all critical nutrients also followed the same trend.
Conclusion
The PAHO NPM has shown to be a relevant tool to predict intake levels of nutrients linked to non-communicable diseases in Australia and, therefore, could be used to inform policy actions aimed at increasing the healthiness of food environments.
... However, an often overlooked virtue of UPF is that it forms a highly heterogeneous food category. Food products considered as UPF are heterogeneous with respect to their nutritional composition, as well as their contribution to a habitual diet, and the context in which they are consumed [24]. For example, according to the frequently used NOVA classification [8], UPF includes pre-packaged bread, a staple food item which in many cultures is consumed with main meals; as well as cakes or fast food, which are consumed more occasionally. ...
... Participants were included in the study between 2006 and 2013. So far, four follow-up assessment rounds took place, i.e., T1=baseline, median (interquartile) months to follow-up rounds: T2=13 (13-15), T3=25 (23)(24)(25)(26)(27)(28), and T4=44 (35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51). Comprehensive physical examinations, biobanking, and questionnaires were conducted at T1 and T4, and follow-up questionnaires (including questions for diabetes status) were issued to participants at T2 and T3. ...
Background
The overall consumption of ultra-processed food (UPF) has previously been associated with type 2 diabetes. However, due to the substantial heterogeneity of this food category, in terms of their nutritional composition and product type, it remains unclear whether previous results apply to all underlying consumption patterns of UPF.
Methods
Of 70,421 participants (35–70 years, 58.6% women) from the Lifelines cohort study, dietary intake was assessed with a food frequency questionnaire. UPF was identified according to the NOVA classification. Principal component analysis (PCA) was performed to derive UPF consumption patterns. The associations of UPF and adherence to UPF consumption patterns with incidence of type 2 diabetes were studied with logistic regression analyses adjusted for age, sex, diet quality, energy intake, alcohol intake, physical activity, TV watching time, smoking status, and educational level.
Results
During a median follow-up of 41 months, a 10% increment in UPF consumption was associated with a 25% higher risk of developing type 2 diabetes (1128 cases; OR 1.25 [95% CI 1.16, 1.34]). PCA revealed four habitual UPF consumption patterns. A pattern high in cold savory snacks (OR 1.16 [95% CI 1.09, 1.22]) and a pattern high in warm savory snacks (OR 1.15 [95% CI 1.08, 1.21]) were associated with an increased risk of incident type 2 diabetes; a pattern high in traditional Dutch cuisine was not associated with type 2 diabetes incidence (OR 1.05 [95% CI 0.97, 1.14]), while a pattern high in sweet snacks and pastries was inversely associated with type 2 diabetes incidence (OR 0.82 [95% CI 0.76, 0.89]).
Conclusions
The heterogeneity of UPF as a general food category is reflected by the discrepancy in associations between four distinct UPF consumption patterns and incident type 2 diabetes. For better public health prevention, research is encouraged to further clarify how different UPF consumption patterns are related to type 2 diabetes.
... UPF differ from other types of processed foods that have undergone processing steps such as refining, canning, or fermentation, but that have not been exposed to chemical alteration or the addition of many artificial ingredients [99]. While UPF are sometimes marketed as healthy, low-fat, low-sugar, organic, and/or vegan [101], most are high-energy, low nutrient-dense foods that are frequently over-consumed, likely due to their high palatability and the low level of satiety they typically provide due to their low protein and fiber content [101]. ...
... UPF differ from other types of processed foods that have undergone processing steps such as refining, canning, or fermentation, but that have not been exposed to chemical alteration or the addition of many artificial ingredients [99]. While UPF are sometimes marketed as healthy, low-fat, low-sugar, organic, and/or vegan [101], most are high-energy, low nutrient-dense foods that are frequently over-consumed, likely due to their high palatability and the low level of satiety they typically provide due to their low protein and fiber content [101]. ...
The adoption of more sustainable diets (SD) has the capacity to meet the needs of individuals without compromising future generations' abilities to do the same. Nutrition educators are ideal candidates for delivering SD education to consumers, yet evidence-based recommendations for the profession have not been crafted. The results of a thorough, narrative review of the literature performed in 2021 suggest there are five well-supported recommendations nutrition educators should consider incorporating in their work. They are (1) shift towards a plant-based diet, (2) mitigate food waste, (3) limit consumption of ultra-processed foods (UPF), (4) engage in local food systems, and (5) choose sustainable seafood. Each recommendation is discussed below in detail, to provide nutrition educators with a nuanced scope of the issue, after which suggestions for the inclusion of these recommendations, using an example of the authors' experiences from the US Expanded Food and Nutrition Education Program (EFNEP), are provided.
... The definition of UPFs by NOVA has changed drastically over the 10+ years since its introduction, initially from referring only to the types of ingredients, to subsequently including their origin, their number, and more recently, the purpose and nature of food processing [16]. UPF-associated technologies are said to characteristically formulate cheap food imitations, which often contain little or no "whole food" [14] and have a disrupted food matrix leading to the loss of the natural "matrix effect" [17]. However, both of these terms are not precisely defined [7], making identification of UPFs not a straightforward exercise. ...
... Some common UPFs are: carbonated soft drinks; sweet, fatty or salty packaged snacks; candies (confectionery); mass produced packaged breads and buns, cookies (biscuits), pastries, cakes and cake mixes; margarine and other spreads; sweetened breakfast cereals and fruit yoghurt and energy drinks; pre-prepared meat, cheese, pasta and pizza dishes; poultry and fish nuggets and sticks; sausages, burgers, hot dogs and other reconstituted meat products; powdered and packaged instant soups, noodles and desserts; and baby formula [14]. UPFs include not only "junk foods" but also foods marketed as healthy, such as light, vegan, organic, or gluten-free products [17]. For example, most plant-based dairy and meat substitutes are UPFs [20]; as a result, UPFs contribute about 40% of total energy intake in vegetarian and vegan diets [21]. ...
Ultra-processed foods (UPFs) are negatively perceived by part of the scientific community, the public, and policymakers alike, to the extent they are sometimes referred to as not “real food”. Many observational surveys have linked consumption of UPFs to adverse health outcomes. This narrative synthesis and scientific reappraisal of available evidence aims to: (i) critically evaluate UPF-related scientific literature on diet and disease and identify possible research gaps or biases in the interpretation of data; (ii) emphasize the innovative potential of various processing technologies that can lead to modifications of the food matrix with beneficial health effects; (iii) highlight the possible links between processing, sustainability and circular economy through the valorisation of by-products; and (iv) delineate the conceptual parameters of new paradigms in food evaluation and classification systems. Although greater consumption of UPFs has been associated with obesity, unfavorable cardiometabolic risk factor profiles, and increased risk for non-communicable diseases, whether specific food processing techniques leading to ultra-processed formulations are responsible for the observed links between UPFs and various health outcomes remains elusive and far from being understood. Evolving technologies can be used in the context of sustainable valorisation of food processing by-products to create novel, low-cost UPFs with improved nutritional value and health potential. New paradigms of food evaluation and assessment should be funded and developed on several novel pillars—enginomics, signalling, and precision nutrition—taking advantage of available digital technologies and artificial intelligence. Research is needed to generate required scientific knowledge to either expand the current or create new food evaluation and classification systems, incorporating processing aspects that may have a significant impact on health and wellness, together with factors related to the personalization of foods and diets, while not neglecting recycling and sustainability aspects. The complexity and the predicted immense size of these tasks calls for open innovation mentality and a new mindset promoting multidisciplinary collaborations and partnerships between academia and industry.
... However, the hypotheses should be well defined before laboratory tests are undertaken. These hypotheses can be based on specific compounds that are exclusively found in certain products, and on a reductionist view of those foods, for example, additives conferring potential adverse metabolism-induced biological effects, or based on the food structure or matrix containing these compounds, which represents a more holistic view (Fardet and Rock 2019) that acknowledges more direct physiological satiety effects through physical impacts, such as chewing. ...
... Beyond this risk, it is however possible to deconstruct the UPFs and to study separately the effects of additives, other xenobiotics, technological processes, added salt/sugar/fats, and so on. Although the HDM is undoubtedly useful in this context, in particular for strengthening scientific evidence, the aggregation of reductionist data thus obtained may never fully account for the holistic concept of UPF (Fardet and Rock 2019), which indeed often combines several additives, technological processes and xenobiotic, leading to millions of combinations. Therefore, in the end, reducing UPF consumption, based on the evidence of epidemiological studies, might have better health outcome together with a strong societal and environmental impact. ...
Scientific research generally follows two main methods: empirico-inductive (EI), gathering scattered, real-world qualitative/quantitative data to elaborate holistic theories, and the hypothetico-deductive (HD) approach, testing the validity of hypothesized theory in specific conditions, generally according to reductionist methodologies or designs, with the risk of over simplifying the initial complexity empirically perceived in its holistic view. However, in current food and nutrition research, new hypotheses are often elaborated from reductionist data obtained with the HD approach, and aggregated to form (ultra)reductionist theories, with no application of EI observations, limiting the applicability of these hypotheses in real life. This trend and the application of the EI method are illustrated as regards with the global health issue through the examples of food classifications/scoring, clinical studies, the definition of a sustainable diet, the “matrix effect”-related hypothesis, the concept of healthy core metabolism, and obesity prevention within the perspective of social sciences. To be efficient for producing food and nutritional data appropriable by the society, it finally appears that not only both approaches are necessary, starting with the EI method then the HD one, but also a back and forth between the two, this being not always realized, potentially leading to confusion and misunderstanding in society.
... Some features of industrial processing, such as lose of food matrix (soft texture demanding less chewing), as well as increase of energy density and use of additives amplifying sensory properties, might led to increased eating rate and delayed satiety signaling, thereby resulting in overconsumption [4,8,45]. However, the breakdown of food matrix could lead to adiposity not only by Fig. 1. ...
... affecting the oral processing and satiation/satiety, but also by increasing the absorption and bioavailability of undesirable nutrients (i.e. sugars), and decreasing the amount of fiber entering the colon [4,46,47]. In this regard, we found that fiber deprivation partly mediated the association between UPF and visceral and total fat. ...
Background & Aims
Ultra-processed food and drink products (UPF) consumption has been associated with obesity and its-related comorbidities. Excess of visceral fat, which appears with increasing age, has been considered as the culprit contributing to adiposity-associated adverse health outcomes. However, none of previous studies elucidated the link between UPF and directly quantified adiposity and its distribution. We aimed to prospectively investigate the association between concurrent changes in UPF consumption and objectively assessed adiposity distribution.
Methods
A subsample of 1485 PREDIMED-Plus participants (Spanish men and women aged 55-75 years with overweight/obesity and metabolic syndrome) underwent body composition measurements. Consumption of UPF at baseline, 6 and 12 months was evaluated using a validated 143-item semi-quantitative Food Frequency Questionnaire. Food items (g/day) were categorized according to their degree of processing using NOVA system. Regional adiposity (visceral fat (in g) and android-to-gynoid fat ratio) and total fat mass (in g) at three time points was measured with dual-energy X-ray absorptiometry (DXA) and were normalized using sex-specific z-scores. The association of changes in UPF consumption, expressed as the percentage of total daily intake (daily g of UPF/total daily g of food and beverage intake*100), with adiposity changes was evaluated using mixed-effects linear models.
Results
On average, the consumption of UPF accounted for 8.11% (SD 7.41%) of total daily intake (in grams) at baseline. In multivariable-adjusted model, 10% daily increment in consumption of UPF was associated with significantly (all p-values <0.05) greater accumulation of visceral fat (β 0.09 z-scores, 95% CI 0.05;0.13), android-to-gynoid fat ratio (0.05, 0.00;0.09) and total fat (0.09, 0.06;0.13).
Conclusion
A higher consumption of UPF was associated with greater age-related visceral and overall adiposity accumulation. Further studies are warranted to confirm these results in other populations and settings.
Trial registration
The trial was registered at the International Standard Randomized Controlled Trial (ISRCTN: http://www.isrctn.com/ISRCTN89898870) with number 89898870 and registration date of 24 July 2014, retrospectively registered.
... Recent evidence suggests that the majority of children and adolescents do not meet the Dietary Guidelines [1], as they prefer to consume ultra-processed foods (UPFs), such as sweet/salty snacks and soft drinks, which are high in added sugar and sodium, low in protein, fiber, and micronutrients [2], instead of adhering to a high-quality diet rich in nutrient-dense foods (e.g., Mediterranean diet) [3]. According to several studies, both the consumption and the availability of UPFs, have reached alarming rates, with their estimated contribution to the total energy intake ranging between 10% and 60% [4,5].Through the displacement of healthy foods in the diet [6], UPFs, tend to cause the deterioration of nutrient profile, which in combination with the satiating properties or the presence of artificial compounds [7], have serious consequences on the prevalence of chronic diseases, such as childhood obesity [8]. ...
Citation: Gketsios, I.; Tsiampalis, T.; Kanellopoulou, A.; Vassilakou, T.; Notara, V.; Antonogeorgos, G.; Rojas-Gil, A.P.; Kornilaki, E.N.; Lagiou, A.; Panagiotakos, D.B.; et al. The Synergetic Effect of Soft Drinks and Sweet/Salty Snacks Consumption and the Moderating Role of Obesity on Preadolescents' Emotions and Behavior: A School-Based Epidemiological Study. Life 2023, 13, 633. https:// Abstract: The consumption of ultra-processed foods (UPFs) is high along with the prevalence of emotional and behavioral problems among children and adolescents. The present study sought to investigate the synergetic effect of soft drinks and sweet/salty snacks consumption, and the moderating role of obesity on preadolescents' emotions and behavior. A cross-sectional study was conducted among 1728 Greek preadolescents aged 10-12 and their parents, during the school years 2014-2016. Parental and child characteristics were collected anonymously, through self-administered and validated questionnaires. Among others, soft drinks and sweet/salty snacks consumption was recorded, classifying preadolescents as low or at least moderate consumers, while anthropometric characteristics (height, weight, Body Mass Index (BMI)) were also recorded. Approximately 6 out of 10 preadolescents were characterized by at least moderate consumption of either sweet/salty snacks, or soft drinks, while 22.7% of the participants had at least moderate consumption of both soft drinks and sweet/salty snacks. Boys and preadolescents with a lower level of adherence to the Mediterranean diet, as well as those living in a more obesogenic family environment were more likely to be in the higher consumption groups. When compared to just either the moderate consumption of sweet/salty snacks, or the moderate consumption of soft drinks, the combination of both unhealthy eating habits was associated with significantly higher odds of both aggressiveness and loneliness, while the examined relationships were significantly stronger in overweight/obese children. The positive synergistic effect of soft drinks and sweet/salty snacks consumption on preadolescents' emotions of loneliness and aggressive behavior is even burdened by obesity status highlighting the urgent need for policymakers to take preventive measures to halt the detrimental consequences of UPFs consumption on health outcomes, particularly in overweight/obese children. The importance of the improvement of children's unhealthy eating habits by emphasizing the association between food intake and emotional and behavioral status is highlighted.
... However, it has been noted that highly processed, sugar-laden foods can no longer be viewed as "natural". Many modern foods are highly altered by using additives such as hydrogenated or interesterified oils, maltodextrin, high-fructose corn syrup, preservatives, antioxidants and stabilizers, and concentrated in order to make them convenient, palatable and highly profitable (Fardet & Rock, 2019). Thus, it is argued that highly palatable foods resemble drugs of addiction, which are also processed and concentrated forms of naturally occurring substances. ...
Background:
Food addiction may play a role in rising obesity rates in connection with obesogenic environments and processed food availability, however the concept of food addiction remains controversial. While animal studies show evidence for addictive processes in relation to processed foods, most human studies are psychologically focussed and there is a need to better understand evidence for biological mechanisms of food addiction in humans. Several key hormones are implicated in models of food addiction, due to their key roles in feeding, energy metabolism, stress and addictive behaviours. This systematic literature review examines evidence for relationships between food addiction, hormones and other blood biomarkers.
Methods:
A series of literature searches was performed in Scopus, PsychInfo, MedLine, ProQuest, CINAHL and Web of Science. A total of 3111 articles were found, of which 1045 were duplicates. Articles were included if they contained a psychometric measurement of food addiction, such as the Yale Food Addiction Scale, as well as addressed the association between FA and hormones or blood biomarkers in humans. Articles were assessed for eligibility by two independent reviewers.
Results:
Sixteen studies were identified that examined relationships between food addiction and blood biomarkers, published between 2015 and 2021. Significant findings were reported for leptin, ghrelin, cortisol, insulin and glucose, oxytocin, cholesterol, plasma dopamine, thyroid stimulating hormone (TSH), haemoglobin A1c (HbA1c), triglyceride (TG), amylin, tumour necrosis factor alpha (TNF- α) and cholecystokinin (CCK). Methodological issues included small sample sizes and variation in obesity status, sex and mental health-related comorbidities. Due to methodological limitations, definite connections between FA, hormones and other blood biomarkers cannot yet be determined.
Conclusion:
This systematic review identified preliminary evidence linking FA symptoms to hormones and other blood biomarkers related to feeding, addiction, and stress. However, due to the small number of studies and methodological limitations, further research is needed to evaluate biopsychosocial models of FA and to resolve controversies.
... UPFs are intrinsically fatty, sugary or salty, high calorie and poor in protein, dietary ber, micronutrients and other bioactive compounds, and usually contain no or small amount of whole food 6,7 . During the past decade UPFs displaced unprocessed or minimally processed meals and fresh foods 8- 10 . As they are usually accessible, convenient, durable, ready to consume, low-cost, ultra-palatable and often habit- ...
The purpose of this cross-sectional study is to examine the association between UPFs intake level and lipid profile in Iranian people. This is a cross-sectional study which was performed on 236 individuals with the age range of 20 to 50 years in Shiraz, Iran. Food intakes of participants were evaluated by food frequency questionnaire (FFQ) which was previously validated in Iranian populations. For estimating the ultra-processed food, the classification of NOVA food group was used. Serum lipids including TC, TG, HDL-C and LDL-C were measured in blood samples. Logistic regression was used to evaluation the relation between UPF score and lipid profile. Higher UPFs intake was associated with increased OR of TG, LDL and HDL in both crude (OR: 2.60; 95% CI: 1.24–5.46 and OR: 2.05; 95% CI: 1.01–4.17 and OR: 4.34; 95% CI: 1.89–9.91 and adjusted model (OR: 2.76; 95% CI: 1.29–5.89 and OR: 2.08; 95% CI: 1.01–4.26 and OR: 4.91; 95% CI: 2.05–11.74). Thus, our results show significant associations between ultra-processed foods intake and dietary nutrient profiles that result in dyslipidemia as a risk factor of chronic diseases. In conclusion, UPF consumption worsen the nutritional profile of the diet and lead to negative changes in the lipid profile parameters.
... Processed and Ultra-Processed Foods (UPF) are concepts that are used to refer to unhealthy diets and that are increasingly gaining space within the characterization of the type of diet of the general population [1][2][3][4][5]. ...
Objective
To evaluate the consumption of processed and ultra-processed foods in Paraguayan adults and its relationship with quality of life and sleep quality.
Methods: A cross-sectional descriptive observational study was carried out on Paraguayan adults in May 2022. An online survey was applied in which sociodemographic data, frequency of food consumption using the NOVA classification and Pan American Health Organization criteria, quality of life evaluated by the European Quality of Life-5 Dimensions and report of hours of sleep were collected.
Results
A total of 273 Paraguayan adults were included in the study, of which 71.1% were female, 51.6% lived in the capital, 53.1% were single, 66% had a university educational level and the average age was 36.48±13.2. Regarding the consumption of processed and ultra-processed foods, the critical nutrients most consumed daily were free sugars by 34.0%, and fats by 23.4% of the population. The global quality of life index was low (0,58±0,05) and 69.0% reported insufficient hours of sleep. Statistically significant relationships were found between the consumption of processed and ultra-processed foods with quality of life and quality of sleep (p<0.05 for both).
Conclusion
The most consumed critical nutrients in the Paraguayan adult population are free sugars and fats, finding a significant relationship between the consumption of processed and ultra-processed foods with quality of life and quality of sleep.
Keywords:
Hours of sleep; Processed foods; Quality of life; Ultra-processed foods
... BACKGROUND Ultra-processed foods and beverages (from hereon ultra-processed foods (UPFs)) are becoming increasingly prominent in human diets worldwide, with major implications for human and planetary health. 1 2 Diets high in UPFs, which are typically high in fat, salt and sugar, are associated with multiple adverse health outcomes, including overweight and obesity, cardiovascular disease; cancer, type 2 diabetes, depression and all-cause mortality. [3][4][5] Of the UPFs, sugar-sweetened beverages in particular are linked with rising WHAT IS ALREADY KNOWN ON THIS TOPIC ⇒ A key driver of the growing burden of unhealthy diets and related non-communicable diseases in lowincome and middle-income countries is the growing reach, power and influence of the transnational ultra-processed food and beverage industry. ...
Background
The market and non-market activities of the food and beverage industry contribute to unhealthy and unsustainable dietary patterns, increasingly in low-income and middle-income countries (LMICs). We aimed to describe how The Coca-Cola Company (TCCC), as the world market leader in the sugar-sweetened beverage sector, operationalises their activities in LMICs in East Asia, among the world’s most highly populated yet under-researched countries, to illustrate the ways in which these activities may negatively influence health outcomes.
Methods
We adopted a theoretically-guided qualitative research design and documentary analysis method. Data sources included: industry documents and web pages, marketing case studies obtained from the World Advertising Research Centre, media reports, global trade summaries and websites of industry associations. To guide data analysis, we synthesised a conceptual framework from existing commercial determinants of health literature, to describe ways in which the market and non-market activities of TCCC influence health.
Results
TCCC leverages subsidiary companies and investments in international networks to expand its supply chains. The company engages in frequent political activities to minimise the implementation of nutrition policies that may impact profits. The company markets products, particularly on digital and mobile devices, often targeting children, adolescents and mothers, and undertakes public relations activities related to human rights, environmental sustainability and community and economic supports, and these public relations activities are often integrated into marketing campaigns. The identified activities of TCCC are frequently in direct contrast to efforts to improve the healthfulness of population diets in East Asia LMICs.
Conclusions
A public health analysis of the market and non-market activities of corporations active in unhealthy commodity industries needs to be broad in scope to cover the diverse set of strategies used to increase their market power and influence. Governments should consider a suite of policy options to attenuate these commercial determinants of unhealthy diets.
... In 2009 the NOVA classification system was developed to classify foods into four groups according to processing level: unprocessed or minimally processed food, processed culinary ingredients, processed food, and ultra-processed foods [9]. Ultra-processed foods are so designated because they contain substances not generally used in the kitchen for food preparation (extracted or derived from oils, proteins, starches, fats, and sugars) or are manufactured in laboratories to enhance food preservation, flavor, color, and/or (hyper-) palatability [10]. ...
Objective
We aimed to conduct a systematic review and meta-analysis of observational studies examining the relationship between ultra-processed food (UPF) consumption and the risk of mental health disorders.
Methods
The ISI Web of Science, PubMed/MEDLINE, and Scopus databases were searched without date restriction until 28 December 2021. Data were extracted from 26 studies, including 260,385 participants from twelve countries. Risk ratios for mental health disorders were pooled by a random-effects model.
Results
Meta-analyses suggested that UPF consumption was associated with an increased risk of depression (RR = 1.28; 95% CI: 1.19, 1.38; I2 = 61.8%; p = 0.022) but not anxiety (RR = 1.35; 95% CI: 0.86, 2.11; I2 = 77.8%; p = 0.198). However, when analyzed for the dietary assessment method, UPF consumption was significantly associated with an enhanced risk of depression among studies utilizing food frequency questionnaires (RR = 1.31; 95% CI: 1.21, 1.41; I2 = 60.0%; p < 0.001) as opposed to other forms of dietary recall approaches. Additionally, for every 10% increase in UPF consumption per daily calorie intake, 11% higher risk of depression (RR = 1.11; 95% CI: 1.01, 1.17; I2 = 88.9%; p < 0.001) was observed among adults. Dose-response analysis further emphasized a positive linear association between UPF consumption with depression risk (p-nonlinearity = 0.819, p-dose-response = p < 0.001).
Conclusion
Our findings indicate that UPF consumption is related to an enhanced depressive mental health status risk. There may be different causes for this increased risk, and further studies are needed to investigate if there is a causal relationship between consumption of UPF and mental health.
... Parallel with the major increase in obesity prevalence over the last few decades, there has been extensive globalization of the food system and increased availability of processed foods high in added sugar and other refined carbohydrates [16,17]. Traditional markers of carbohydrate quality include the glycemic index (GI), dietary fiber, and sugar content [18], but do not adequately account for the possible metabolic impact of the food matrix [19], and there could be adverse metabolic effects of carbohydrate refining aside from added sugar (e.g., flour-based products, even whole-grain versions). ...
Background and aims
Visceral adipose tissue (VAT) volume is associated with common lifestyle diseases. Dietary quality, including food matrix and degree of carbohydrate cellularity, as well as the carbohydrate/fat ratio, may influence VAT volume. We aimed to determine the effects of isocaloric diets differing in either “cellularity”, a novel marker of dietary carbohydrate quality, or carbohydrate amount on visceral fat volume and anthropometric measures in adults with obesity.
Methods
In a randomized controlled trial of 193 people with obesity/central adiposity, we compared changes in VAT volume after 6 and 12 months, measured by abdominal computed tomography, on three isocaloric eating patterns based on “acellular” carbohydrate sources (e.g., flour-based whole-grain products; comparator arm), “cellular” carbohydrate sources (minimally processed foods with intact cellular structures such as fruits, potatoes/tubers, and rice), or low-carbohydrate high-fat (LCHF) principles. Outcomes were compared by an intention-to-treat (ITT) analysis using constrained linear mixed-effects modelling (cLMM) providing baseline-adjusted change scores and proper missing data handling without imputation.
Results
78 and 57 participants completed 6 and 12 months, respectively, with similar intakes of energy (females: 1,820−2,060 kcal, males: 2,480−2,550 kcal) and protein (16−17 energy percent, E%) throughout the intervention, and only modest reductions in energy from baseline. Reported dietary intakes were 42−44, 41−42, and 11−15 E% carbohydrate and 36−38, 37−38, and 66−70 E% fat in the acellular, cellular and LCHF groups, respectively. There were no significant between-group differences in VAT volume after 6 months (cellular vs. acellular [95% CI]: −55 cm³ [−545, 436]; LCHF vs. acellular [95% CI]: −225 cm³ [−703, 253]) or after 12 months (cellular vs. acellular [95% CI]: −122 cm³ [−757, 514]; LCHF vs. acellular [95% CI]: −317 cm³ [−943, 309]). VAT volume decreased significantly within all groups by 14−18% and 12−17% after 6 and 12 months, respectively. Waist circumference was reduced to a significantly greater degree in the LCHF vs. acellular group at 6 months (LCHF vs. acellular [95% CI]: −2.78 cm [−5.54, −0.017]).
Conclusions
Despite modest energy restriction, the three isocaloric eating patterns, differing in carbohydrate cellularity and amount, decreased visceral fat volume significantly and to a similar clinically relevant degree.
Clinical trials Identifier
NCT03401970. https://clinicaltrials.gov/ct2/show/NCT03401970.
... One of the most recent consumer concerns regarding the food environment has been the sale of ultra-processed foods, which is being discussed more since the development of the NOVA classification based on the extent and purpose of industrial processing (Fardet and Rock 2019). However, this new concept has not yet been introduced to most consumers, and there is still professional disagreement about its benefits and accuracy. ...
The food industry has recently been under unprecedented pressure due to major global challenges, such as climate change, exponential increase in world population and urbanization, and the worldwide spread of new diseases and pandemics, such as the COVID-19. The fourth industrial revolution (Industry 4.0) has been gaining momentum since 2015 and has revolutionized the way in which food is produced, transported, stored, perceived, and consumed worldwide, leading to the emergence of new food trends.
After reviewing Industry 4.0 technologies (e.g., artificial intelligence, smart sensors, robotics, blockchain, and the Internet of Things) in Part I of this work (Hassoun, Aït-kaddour, et al., 2022), this complimentary review will focus on emerging food trends (such as fortified and functional foods, additive manufacturing technologies, cultured meat, precision fermentation, and personalized food) and their connection with Industry 4.0 innovations. Implementation of new food trends has been associated with recent advances in Industry 4.0 technologies, enabling a range of new possibilities. The results show several positive food trends that reflect increased awareness of food chain actors of the food-related health and environmental impacts of food systems. Emergence of other food trends and higher consumer interest and engagement in the transition towards sustainable food development and innovative green strategies are expected in the future.
... The nutrient profiles of UPFs are thought to have detrimental effects on health (Adams et al., 2020). In parallel, the term "empty calories" is used for UPFs because of their high energy and low nutrient density (Fardet & Rock, 2019). These products are energy-dense and have higher free sugar, saturated fats, and sodium as compared to less processed alternatives (Adams et al., 2020). ...
Increasing the quality characteristics, i.e., nutritional value, color,
consistency, smell, and crispness, during the processing, storage, and
transportation processes and making use of the food processing methods and additives in that direction ensure food safety and preservation of the nutritional value and quality of the foods and significantly reduce food waste by preventing deterioration. Food processing has positive effects on the shelf life, transportation, and variety of foods but also has adverse effects on consumer health. In recent years, there has been an increasing interest in studying the relationship between the consumption of highly processed foods, which are considered unhealthy, and their impact on health. The concept of processed food, which is more and more referred to as unhealthy food, is increasingly recognized by its negative effect on diet quality and as a risk factor for diet-related diseases, disorders, and conditions.
... Thus, the real issue appears more linked to added industrial and highly processed fats, sugars, salt and some additives, which are disconnected from a complex matrix (i.e. a-matrix nutrients) and conveyed by degraded and artificialised food matrices such as UPFs (Fardet and Rock 2019). Thus, the consumption of excess sugars, fats, salt and/or additives appears to be only an effect, not the real root cause, these latter being linked to the degree of processing (Fardet and Rock 2022); and the apparent "hyper-formulation" of foods with added cosmetic compounds (effects) seems to result from the ultraprocessing of foods (cause) to compensate for the degradation of food matrices (Fardet and Rock 2020). ...
Worldwide, foods are scored with composition indices. However, processing scores are now emerging. The objective of this study was to study the interconnectedness of the degree of processing and composition for 28,747 industrially packaged foods (71.6% of ultra-processed foods, UPFs) representative of retail assortments. The Nutri-score and Traffic Light Labelling System (TLLS) were used to assess the composition, and the Siga index was used to assess the degree of processing. On average, the more nutritionally favourable Nutri-score and TLLS groups exhibited 56.5 and 50.0% UPFs, respectively. Among markers of ultra-processing non-additives mostly included added fat/sugar/fibre/vitamin, animal and/or plant protein isolates, and taste exhausters, while additives mostly included sweeteners and taste exhausters, suggesting that markers of ultra-processing (MUP) are added to foods to improve composition scores. In conclusion, both types of scores are not complementary as such but obey to a fundamental hierarchy: processing first, then composition if necessary.
... The novel aspect considered here is the scale at which they are proposed to replace conventional food with the aim to reduce both negative health and environmental impacts. To fully realise the health benefits, dietary shifts should also encompass a reduction in consumption of added sugars, salt, saturated fats, and potentially harmful additives(Curtain and Grafenauer 2019;Fardet and Rock 2019;Petersen et al. 2021). ...
... This is true for several of the major criticisms of UPFs, such as their high energy density (95,96), high glycemic index (GI) (97) or high glycemic glucose equivalent (98), hyper-palatability (95), and low satiety potential (97). However, as noted by others, processing can lead to textural and structural changes to the food matrix not identified by nutritional rating systems that can speed up the rate at which UPFs are consumed (96,99,100). Reducing the orosensory exposure time of a food can delay the onset of satiation (101). ...
In many non-Asian countries, soy is consumed via soy-based meat and dairy alternatives, in addition to the traditional Asian soyfoods, such as tofu and miso. Meat alternatives are typically made using concentrated sources of soy protein, such as soy protein isolate (SPI) and soy protein concentrate (SPC). Therefore, these products are classified as ultra-processed foods (UPFs, Group 4) according to NOVA (not an acronym), an increasingly widely used food classification system that classifies all foods into one of four groups according to the processing they undergo. Furthermore, most soymilks, even those made from whole soybeans, are also classified as UPFs because of the addition of sugars and emulsifiers. Increasingly, recommendations are being made to restrict the consumption of UPFs because their intake is associated with a variety of adverse health outcomes. Critics of UPFs argue these foods are unhealthful for a wide assortment of reasons. Explanations for the proposed adverse effects of UPFs include their high energy density, high glycemic index (GI), hyper-palatability, and low satiety potential. Claims have also been made that UPFs are not sustainably produced. However, this perspective argues that none of the criticisms of UPFs apply to soy-based meat and dairy alternatives when compared to their animal-based counterparts, beef and cow's milk, which are classified as unprocessed or minimally processed foods (group 1). Classifying soy-based meat and dairy alternatives as UPFs may hinder their public acceptance, which could detrimentally affect personal and planetary health. In conclusion, the NOVA classification system is simplistic and does not adequately evaluate the nutritional attributes of meat and dairy alternatives based on soy.
... Recent studies indicate that over 60% of total calories consumed among children in the United Kingdom and in the United States are from UPFs [3e5] and their consumption is now increasing most rapidly in low-and middle-income countries [6]. UPFs undergo substantial industrial processing, contain highlyprocessed/purified ingredients and additives [7] and often have higher energy density, higher content in free sugars and salt, saturated and trans-fats, and lower fibre and micronutrient content, compared to minimally processed foods and freshly prepared meals [8]. The worldwide shift toward a dramatic increase in the consumption of UPFs appears partly responsible for the global obesity epidemic [9] and may contribute to an increased risk of cardiometabolic diseases. ...
... Llavero-Valero et al. reported that the highest vs. lowest tertile of UPF intake was associated with a 53% (1.06, 2.22) increased risk of T2DM, which was unaltered (HR: 1. 50 (1.02, 2.21)) after adjusting for Mediterranean diet pattern adherence [123]. ...
Prospective cohort studies show that higher intakes of ultra-processed food (UPF) increase the risk of obesity and obesity-related outcomes, including cardiovascular disease, cancer and type 2 diabetes. Whether ultra-processing itself is detrimental, or whether UPFs just have a lower nutritional quality, is debated. Higher UPF intakes are inversely associated with fruit, vegetables, legumes and seafood consumption. Therefore, the association between UPFs and poor health could simply be from excess nutrient intake or from a less healthful dietary pattern. If so, adjustment for dietary quality or pattern should explain or greatly reduce the size of the significant associations between UPFs and health-related outcomes. Here, we provide an overview of the literature and by using a novel approach, review the relative impact of adjusting for diet quality/patterns on the reported associations between UPF intake and health-related outcomes in prospective cohort studies. We find that the majority of the associations between UPFs, obesity and health-related outcomes remain significant and unchanged in magnitude after adjustment for diet quality or pattern. Our findings suggest that the adverse consequences of UPFs are independent of dietary quality or pattern, questioning the utility of reformulation to mitigate against the obesity pandemic and wider negative health outcomes of UPFs.
... Additionally, women with high likelihood of being underweight during periods of food scarcity could depend on these foods to avert such a phenomenon. It must, however, be noted that highly processed foods enriched and fortified with nutrients could still have a low-calorie quality due to the loss of the food matrix during processing, and thus may not prevent the occurrence of chronic diseases [52]. ...
Overweight and obesity are rapidly rising in Sub-Saharan Africa including in rural areas. However, most studies focus on urban centers, and have attributed this epidemic to the consumption of processed foods without their clear characterization. This study investigated food intake patterns defined by food processing levels and their association with overweight/obesity in rural areas. Four 24-h dietary recalls, anthropometric measurements, and socio-demographic characteristics were collected from 1152 women in Kenya, Tanzania, and Uganda. The PCA method was used to extract patterns characterized by food processing levels. The association between patterns and overweight/obesity was ascertained with regression models. The overweight/obesity rate was 47%, 42%, 26%, and 38% in Kenya, Tanzania, Uganda, and East Africa (as pooled data), respectively. Several patterns were identified, yet a “plant-based pattern” largely characterized by unprocessed and minimally processed foods and a “purchase pattern” mainly distinguished by highly processed foods were dominant. The “plant-based pattern” was inversely or not associated with overweight/obesity, while the “purchase pattern” had a positive association or no association. A clear distinction on processed foods as healthy and unhealthy should be made based on their nutrient provision to avoid their mischaracterization as unhealthy. Policies to reverse consumption of unhealthy processed foods while promoting healthy ones should be pursued.
... It is well established that the majority of ultra-processed foods are energy dense and nutrient poor, and that there is a link between a high consumption of ultra-processed foods and negative health outcomes [46][47][48][49]. This relationship may further be exacerbated by the manufacturing process, the presence of non-nutritive additives, and the disruption of the food matrix [50,51]. Despite a substantial reduction in ultra-processed foods in the healthier, low-cost diets, a quarter of the diet remained to consist of ultra-processed foods. ...
Food costs are a barrier to healthier diet selections, particularly for low socioeconomic households who regularly choose processed foods containing refined grains, added sugars, and added fats. In this study, the objectives were to: (i) identify the nutrient density-to-cost ratio of Australian foods; (ii) model the impact of substituting foods with lower nutrient density-to-cost ratio with those with the highest nutrient density-to-cost ratio for diet quality and affordability in low and medium socioeconomic households; and (iii) evaluate food processing levels. Foods were categorized, coded for processing level, analysed for nutrient density and cost, and ranked by nutrient density-to-cost ratio. The top quartile of nutrient dense, low-cost foods included 54% unprocessed (vegetables and reduced fat dairy), 33% ultra-processed (fortified wholegrain bread and breakfast cereals <20 g sugars/100 g), and 13% processed (fruit juice and canned legumes). Using substitution modelling, diet quality improved by 52% for adults and 71% for children across all households, while diet affordability improved by 25% and 27% for low and medium socioeconomic households, respectively. The results indicate that the quality and affordability of the Australian diet can be improved when nutritious, low-cost foods are selected. Processing levels in the healthier modelled diets suggest that some ultra-processed foods may provide a beneficial source of nutrition when consumed within national food group recommendations.
... Indeed, in 20 wt-stable adults, a 20 % increase in calorie intake was observed with UPF consumption over two weeks, mainly in the form of fat and carbohydrates (Hall et al., 2019). Since minimally processed and ultra-processed diets were matched for presented calories, energy density, macronutrients, sugar, sodium, and fibre, the increased consumption may be mainly due to their hyperpalatable and artificialised matrices (Hall et al., 2019;Fardet and Rock, 2019). Therefore, it is not surprising that UPFs have been consistently associated with increased risks of overweight/obesity among adults and children (Canella et al., 2014;Canhada et al., 2020;Eaton, 2020;Juul and Hemmingsson, 2015;Khandpur et al., 2020;Louzada et al., 2015;Nardocci et al., 2019;Rauber et al., 2020), children being particularly targeted by advertising for sweet UPFs (including beverages) (Allemandi et al., 2017;Fagerberg et al., 2019;Mallarino et al., 2013). ...
Ultra-processed foods (UPFs) are characterized by the presence of markers of ultra-processing (MUP), either additives (A-MUP) or non-additive ingredients (NA-MUP). The present study aims to characterize the MUP profile of approximately 22,000 UPFs, representative of assortments in French supermarkets. UPFs were ranked according to Siga classification within five UPF technological groups, from C01 to C3, depending on the nature and number of MUPs (MUP1 and MUP2), presence of risk-associated additives, and contents of salt, sugar and/or fat. Then, UPFs were categorized within 10 food categories. The results showed that UPFs contain more NA-MUPs than A-MUPs, on average 1.3 more by UPF. The main MUPs are NA-MUPs, i.e., refined oils (52.5 % of UPFs), extracts and natural aromas (42.7 %), synthetic aromas (26.5 %), glucose syrup (20.0 %), native starches (19.1 %), and dextrose (16.2 %). The NA-MUP/UPF and A-MUP/UPF ratios were not correlated in the 10 food categories. Among UPFs, 19 % contained only one MUP, and 31 % contained more than five MUPs. In conclusion, additives are not a sufficient marker of ultra-processing. It is proposed that NA-MUPs in UPFs should be taken into greater consideration and that foods be scored with indices based on the degree of processing, not compositional scores, which fail to filter MUPs.
... The industrial revolution in the past century impacted not only society, but also changed the techniques of food production, and resulted in the emergence of a new type of processed food, reconstituted from isolated nutrients and added of a myriad of ingredients and additives. This category of new foods has raised many questions related to health and sustainability [7][8][9][10][11][12], particularly from an allergenicity point of view, as these foods may contain one or more allergens. It is now established that processing techniques, either old or new ones, could have positive or negative effects on the allergenic potential of a food, in consequence of modifications in the structure of allergens at molecular level (hydrolysis, aggregation, deamidation) and interactions with other food components (formation of complexes, Maillard reaction) [13][14][15][16][17][18]. ...
Food allergy is an IgE-mediated abnormal response to otherwise harmless food proteins, affecting between 5% and 10% of the world preschool children population and 1% to 5% adults. Several physical, chemical, and biotechnological approaches have been used to reduce the allergenicity of food allergens. Fermentation processes that contribute to technological and desirable changes in taste, flavor, digestibility, and texture of food products constitute one of these approaches. Lactic acid bacteria (LAB), used as starter cultures in dairy products, are a subject of increasing interest in fermentation of plant proteins. However, the studies designed to assess the impact of LAB on reduction of allergenicity of seed proteins are at an early stage. This review presents the current knowledge on food fermentation, with a focus on seed proteins that are increasingly used as ingredients, and its impacts on food potential allergenicity.
... In these three dimensions, the foodtriad was capable of reflecting the advantages of consuming in natura or minimally processed food items when compared to processed and ultra-processed items. The index encompassed previous evidences of the impact of consuming processed and ultra-processed food on chronic diseases and mortality risks, such as those related to obesity, type 2 diabetes, and cardiovascular diseases in many cases (Aune et al., 2013(Aune et al., , 2016Fardet and Boirie, 2014;Fardet and Rock, 2019;Micha et al., 2010;Moreira et al., 2015). ...
This study proposes an index for food labeling in order to promote sustainable consumption. The index is calculated by ranking multiple features from the environmental, health and nutritional dimensions of the target product in relation to a pre-set reference value; the obtained scores from each dimension are plotted in a radar chart resulting in a triangular area. An increase in area represents a greater impact. As examples, tuna and the potato-based foods at three different processing levels (in natura or minimally processed, processed and ultra-processed) were analyzed. For both cases, the index increases according to the processing grades and has proved to be capable of expressing in numbers and graphically a wide range of environmental, nutritional and health issues.
Present food systems threaten population and environmental health. Evidence suggests reduced meat and increased plant-based food consumption would align with climate change and health promotion priorities. Accelerating this transition requires greater understanding of determinants of plant-based food choice. A thriving plant-based food industry has emerged to meet consumer demand and support dietary shift towards plant-based eating. ‘Traditional’ plant-based diets are low-energy density, nutrient dense, low in saturated fat and purportedly associated with health benefits. However, fast-paced contemporary lifestyles continue to fuel growing demand for meat-mimicking plant-based convenience foods which are typically ultra-processed. Processing can improve product safety and palatability and enable fortification and enrichment. However, deleterious health consequences have been associated with ultra-processing, though there is a paucity of equivocal evidence regarding the health value of novel plant-based meat alternatives (PBMAs) and their capacity to replicate the nutritional profile of meat-equivalents. Thus, despite the health halo often associated with plant-based eating, there is a strong rationale to improve consumer literacy of PBMAs. Understanding the impact of extensive processing on health effects may help to justify the use of innovative methods designed to maintain health benefits associated with particular foods and ingredients. Furthering knowledge regarding the nutritional value of novel PBMAs will increase consumer awareness and thus support informed choice. Finally, knowledge of factors influencing engagement of target consumer subgroups with such products may facilitate production of desirable, healthier PBMAs. Such evidence-based food manufacturing practice has the potential to positively influence future individual and planetary health.
Background
A high consumption of ultra-processed foods (UPFs) is often associated with low nutritional quality, but data on associations with biomarkers are scarce. We aimed to explore associations between UPF intake, diet quality, and concentrations of biomarkers of nutrition and inflammation measured in mid-pregnancy.
Methods
This cross-sectional study included n = 2,984 pregnant women recruited during 2002–2008 in the Norwegian Mother, Father, and Child Cohort Study (MoBa). Concentrations of C-reactive protein (CRP) and 21 nutritional biomarkers including carotenes (α-carotene, β-carotene, γ-carotene, α-cryptoxanthin, β-cryptoxanthin, lutein, lycopene), vitamins [α-tocopherol, γ-tocopherol, 25-hydroxyvitamin D (25-OH-D), retinol], creatinine, elements (K, Na, Co, Cu, Mn, Mo, Se, Zn), and ferritin (Fe) were measured in blood and urine collected in mid-pregnancy. Habitual diet in pregnancy was assessed using a validated semi-quantitative food frequency questionnaire. We calculated the relative (%) energy contribution of UPF to overall intake according to the NOVA classification. We also applied a diet quality index (DQI) adapted to assess adherence to Norwegian dietary guidelines (DQI; min–max: 0–110, higher score meaning higher adherence). We present summary statistics for biomarker concentrations and explored associations between UPF intake or the DQI and measured biomarkers using adjusted linear, logistic, and generalized additive regression models.
Results
Ultra-processed food intake was positively associated with biomarker concentrations of vitamin E (γ-tocopherol), creatinine, K, and Na [βs: 5.6 to 17% increase in biomarker concentration per interquartile range (IQR) increase in UPF intake] and negatively associated with carotenoids (α-carotene, β-carotene, γ-carotene, α-cryptoxanthin, β-cryptoxanthin, lutein, lycopene), vitamin A, Mo, and Se (βs: −2.1 to −18%). Inversely, high diet quality (i.e., the DQI) was positively associated with concentrations of carotenoids, vitamins [vitamin A (retinol) and D (25-OH-D)], and Se (β: 1.5 to 25%) and negatively associated with vitamin E (γ-tocopherol), creatinine, and Na (β: −4.8 to −8.3%). A weak, positive association was found between UPF and CRP (β: 5.4%, 95% CI 0.12–11%).
Conclusion
High UPF intake was associated with reduced concentrations of nutrition biomarkers in mid-pregnancy. Associations in the opposite direction were found with high adherence to the Norwegian dietary guidelines, suggesting that the two dietary scoring systems capture diet quality in a mirrored manner in this population.
Background
Processed foods, and particularly “ultra-processed foods” (UPFs), as categorized by NOVA (Monteiro et al., 2016), have been highly criticized over the last few years. At the same time, consumers consistently perceive processed foods as less healthy and less natural than unprocessed foods.
Scope and approach
This commentary aimed to examine the relationship between the degree of food processing, healthiness, and naturalness. A case study was included wherein the naturalness (measured through the Food Naturalness Index, Sanchez-Siles et al., 2019) and healthiness (measured through the Nutri-score, julia & hercberg, 2017) of 734 snack bars (classified as UPFs by NOVA) were analyzed.
Key findings and conclusions
The degree of processing, food healthiness, and naturalness are different aspects of food. Our results show that not all snacks analyzed are necessarily unhealthy and unnatural. Importantly, there were significant differences between them in terms of Nutri-score and FNI values, which suggests that it is not appropriate to rate an overall product category (i.e., snack bars) as nutritionally poor and unnatural. Our findings can help stimulate an interdisciplinary dialogue routed in scientific evidence to clarify the role of so-called UPFs in the food system.
The gut microbiota plays a crucial role in the regulation of mucosal immunity and of the function of the intestinal barrier. Dysbiosis is accordingly associated with rupture of mucosal immune homeostasis, leading to inflammatory intestinal diseases. In this context, probiotic bacteria, including a new generation of intestinal probiotics, can maintain intestinal homeostasis and promote health. Surprisingly, little is known about the impact of fermented dairy products in this context, while they represent our main source of live and active bacteria. Indeed, they provide, through our daily diet, a high number of bacteria whose effect on mucosal immunity deserves attention. Among bacteria ingested in fermented dairy products, Streptococcus thermophilus, Lactobacillus delbrueckii, Lactobacillus helveticus, Lactococcus lactis and Propionibacterium freudenreichii are on top, as they are ingested in high concentrations (close to 10⁹ per gram of product) in fermented milks or cheeses. This review gives an overview of the potential immunomodulatory effects of these main dairy starters. It further explores studies dealing with fermented dairy products containing theses starters, in a context of inflammation.
Background & aims
Higher consumption of ultra-processed foods (UPF) has been associated with childhood obesity, but underlying mechanisms remain unclear. We investigated plasma nuclear magnetic resonance metabolic profiles of higher UPF consumption and their role in obesity risk in the British ALSPAC cohort.
Methods
We performed cross-sectional and prospective metabolome wide association analyses of UPF, calculated from food diaries using the NOVA classification. In cross-sectional analysis, we tested the association between UPF consumption and metabolic profile at 7 years (N= 4528), and in the prospective analysis we tested the association between UPF consumption at 13 years and metabolic profile at 17 years (N= 3086). Effects of UPF-associated metabolites at 7 years on subsequent fat mass accumulation were assessed using growth curve models.
Results
At 7 years, UPF was associated with 115 metabolic traits including lower levels of branched-chain and aromatic amino acids and higher levels of citrate, glutamine, and monounsaturated fatty acids, which were also associated with greater fat mass accumulation. Reported intake of nutrients mediated associations with most metabolites, except for citrate.
Conclusions
In conclusion, UPF consumption among British children is associated with perturbation of multiple metabolic traits, many of which contribute to child obesity risk.
The NOVA classification of food items has become increasingly popular and is being used in several observational studies as well as in nutritional guidelines and recommendations. We propose that there is a need for this classification and its use in the formulation of public health policies to be critically discussed and re-appraised. The terms "processing" and "ultra-processing," which are crucial to the NOVA classification, are ill-defined, as no scientific, measurable, or precise reference parameters exist for them. Likewise, the theoretical grounds of the NOVA classification are unclear and inaccurate. Overall, the NOVA classification conflicts with the classic, evidence-based evaluation of foods based on composition and portion size because NOVA postulates that the food itself (or how much of it is eaten) are unimportant, but rather that dietary effects are due to how the food is produced. We contend that the NOVA system suffers from a lack of biological plausibility so the assertion that ultra-processed foods are intrinsically unhealthful is largely unproven, and needs further examination and elaboration.
The fundamental biological drivers of dietary intake are no different in humans than other species, from insects in laboratory studies to wild primates in natural ecologies. In this chapter, the authors show how research, initially on insects and subsequently many other species (from single cellular slime molds to apes in the wild), has suggested a new ecologically inspired approach for understanding the roles of biology, environment, and their interactions in driving the obesity epidemic, and potentially identifying solutions. They explain the theoretical foundations for the approach, illustrate its application to addressing relevant questions in some non‐human species, and show how it has been applied in studies of humans. Recent research suggests that the protein leverage hypothesis might provide a new approach for integrating with existing public health frameworks to understand how human biology interacts with transitioning food environments to generate epidemics of obesity and associated disease.
Ultra-processed foods (UPFs) have become increasingly dominant globally, contributing to as much as 60% of total daily energy intake in some settings. Epidemiological evidence suggests this worldwide shift in food processing may partly be responsible for the global obesity epidemic and chronic disease burden. However, prospective studies examining the association between UPF consumption and cancer outcomes are limited. Available evidence suggests that UPFs may increase cancer risk via their obesogenic properties as well as through exposure to potentially carcinogenic compounds such as certain food additives and neoformed processing contaminants. We identify priority areas for future research and policy implications, including improved understanding of the potential dual harms of UPFs on the environment and cancer risk. The prevention of cancers related to the consumption of UPFs could be tackled using different strategies, including behaviour change interventions among consumers as well as bolder public health policies needed to improve food environments.
Zusammenfassung
Hochverarbeitete Lebensmittel sind Teil eines modernen Lebensstils und machen in Deutschland ca. 46 % der täglichen Energieaufnahme aus. Querschnitts- und Kohortenstudien belegen Assoziationen zwischen dem Verzehr hochverarbeiteter Lebensmittel und nichtübertragbaren Erkrankungen (Übergewicht, Diabetes, Krebs, Herz-Kreislauf-Erkrankungen sowie Depressionen). Als Ursache für diesen Zusammenhang werden neben einer hohen Energiedichte und einer veränderten Lebensmittelmatrix eine ernährungsphysiologisch unausgewogene Zusammensetzung, ein hoher glykämischer Index, sowie abträgliche Zusatzstoffe und Kontaminanten durch Verarbeitung und Verpackung diskutiert. Um die anteilige Bedeutung dieser potenziellen Mechanismen zu verstehen und eine wissenschaftlich begründete, risikoassoziierte Definition hochverarbeiteter Lebensmittel zu geben, sind sowohl Interventionsstudien als auch eine bessere Erfassung der Zusammensetzung der verzehrten verarbeiteten Lebensmittel in prospektiven Kohortenstudien nötig.
Objetivo:
Desde hace milenios, el maíz nativo ha sido un fundamento de la cultura material y espiritual de los pueblos mesoamericanos, en primer lugar, por ser el núcleo de sus sistemas alimentarios locales. Al día de hoy, sigue siendo central en la alimentación moderna por ser un ingrediente clave en la industria agroalimentaria. Frente a estos cambios en el manejo y uso del maíz, se habló de la emergencia de una nueva relación metabólica entre el hombre y esta planta milenaria. La meta del presente artículo es aportar algunos elementos para ilustrar esta afirmación, tomando como ejemplo la producción y los usos del maíz en el ámbito de la industria agroalimentaria.
Metodología:
Para alcanzar el objetivo se llevó a cabo un trabajo exploratorio no exhaustivo, de tipo cualitativo. Se basó, en primer lugar, en la recuperación de los aportes teóricos de Karl Marx sobre el concepto de metabolismo entre hombre y naturaleza, centrando el proceso de trabajo -en general y en su forma específicamente capitalista- como su principal determinante. En segundo lugar, se llevó a cabo el análisis de documentos científicos, económicos e institucionales, y de las estrategias comerciales de grandes grupos pertenecientes a la industria agroalimentaria en México.
Resultados:
El maíz se encuentra hoy en el centro de procesos de trabajo reconfigurados a partir de las necesidades de la industria alimentaria capitalista y basados mayoritariamente en maíz transgénico e importado, procesado a partir de técnicas de fragmentación del grano que permiten la elaboración de productos ultratransformados.
Limitaciones:
No se tomaron en cuenta otros aspectos de la nueva relación hombre-maíz fuera del ámbito de la industria agroalimentaria. Se analizó el papel del maíz en la industria agroalimentaria a partir del estudio de solamente cuatro grandes empresas agroalimentarias. No se consideró la función del maíz en la producción de piensos.
Conclusión:
Los usos del maíz en el marco de la industria agroalimentaria pueden ser buenos elementos, aunque limitados, para ejemplificar la afirmación según la cual se está reconfigurando drásticamente la relación entre el hombre y el maíz.
Objective: To extend analyses of nutrition transition in developed countries to China within the framework of the 3Vs rule considering degree of processing starting with industrially processed foods (IPFs, Rule 1), plant/animal calorie ratio (Rule 2), and food diversity through nutrient intakes (Rule 3).
Design: Total and main food group (n = 13) calorie intakes, percentages of animal and IPF calories, adequacy of the Dietary Reference Intake (DRI) and prevalence of chronic diseases were retrieved from scientific literature and international databases.
Setting: China, 1990-2019
Participants: Overall population
Results: The total calorie intake decreased by 9% over thirty years while the prevalence of chronic diseases substantially increased. Percentages of IPFs (Rule 1) and animal (Rule 2) calorie intake shifted from 9 to 30% and 2 to 30%, respectively. Meanwhile, the overall DRI adequacy (Rule 3) did not improve, with calcium and retinol deficiencies in 2019, and, although remaining above DRI, iron, copper, magnesium, and vitamins E, C and B1-B9 intakes regularly decreased. Notably, the prevalence of obesity increased five-fold, paralleling the exponential increase in IPF calorie intake. Both sources of calories were highly correlated with prevalence of main chronic diseases.
Conclusions: Despite a slight decreased of total calorie consumption and rather good compliance with DRI, the farther the Chinese population moved away from the 3Vs rule during the 1990-2019 period, the more the prevalence of chronic diseases increased. Further analyses on foods’ transitions will be better assessed when advocating sources/quality of calories (Rules 1/2), rather than only nutrient composition (Rule 3).
Objective
To analyse the process for the development and implementation of mandatory nutritional warning labels in Uruguay, in order to inform future nutrition policy making and strategic engagement by public health actors.
Design
The study design drew on policy analysis methodology and case study research methodology. Two main sources of information were selected and analysed for the current study: eighteen official documents from the Uruguayan government and 259 news reports, published between June 2017 and February 2021.
Setting
Uruguay, Latin America.
Results
The Uruguayan Ministry of Public Health led a cross-sectoral working group composed of diverse governmental stakeholders, international organisations and the academia to develop the front-of-package nutrition labelling policy. A robust evidence-based approach, based on rigorous scientific knowledge generated in the country, was followed. However, changes in the systemic governing coalition as a consequence of a change in government led to a delay in the entry into force and changes in the regulation. The food industry was the main opponent to the warning label regulation and relied on widely reported corporate political activities to influence the policy process: information and messaging, legal action, policy substitution, opposition, fragmentation and destabilisation.
Conclusions
Key insights to inform future policy action in Uruguay and other jurisdictions were derived. Results stressed the importance of an evidence-based approach for policy design and the early engagement with actors from all the political system.
Objective: To define a generic diet to protect human health and food system sustainability based on three dimensions: animal/plant ratio, degree of food processing, and food diversity.
Design/Setting: The percentages of maximum animal and ultra-processed calories were evaluated from scientific papers (Web of Science database) and reports (websites of international scientific institutions). Then, a weekly French standard diet, including these percentages and food diversity (≥ 42 different foods), has been designed to calculate adequacy to nutrient needs.
Results: Based on traditional and scientifically-based healthy diets, and on foresight scenarios for sustainable diets at horizon 2050, a median of 15% daily animal calories intake was found to be protective towards both human health and environment. Based on epidemiological studies associating ultra-processed calorie consumption with increased overweight/obesity risk, a precautionary threshold of 15% ultra-processed calories was observed. The French diet allows addressing all nutrient needs, except vitamin D, and other nutritional indicators such as maximum salt and simple sugar consumption, ALA/LA ratio, and essential amino acids. This diet was named the “3V rule” for Végétal (Plant), Vrai (Real), and Varié (Varied, if possible organic, local and seasonal). This generic diet can adapt according to regional traditions and environmental characteristics. Excluding only one dimension of this diet leads to threaten both health and food system sustainability.
Conclusions: Tending towards a 3V-based diet, while respecting local constraints, should allow preserving human health, environment (GHGE, pollution, deforestation, etc.), small farmers, animal welfare and biodiversity, culinary traditions, and socioeconomics (including an alleviation of public health cost).
Global food systems are no longer sustainable for health, the environment, animal biodiversity and wellbeing, culinary traditions, socioeconomics, or small farmers. The increasing massive consumption of animal foods has been identified as a major determinant of unsustainability. However, today, the consumption of ultra-processed foods (UPFs) is also questioned. The main objective of this review is therefore to check the validity of this new hypothesis. We first identified the main ingredients/additives present in UPFs and the agricultural practices involved in their provision to agro-industrials. Overall, UPF production is analysed regarding its impacts on the environment, biodiversity, animal wellbeing, and cultural and socio-economic dimensions. Our main conclusion is that UPFs are associated with intensive agriculture/livestock and threaten all dimensions of food system sustainability due to the combination of low-cost ingredients at purchase and increased consumption worldwide. However, low-animal-calorie UPFs do not produce the highest greenhouse gas emissions (GHGEs) compared to conventional meat and dairy products. In addition, only reducing energy dense UPF intake, without substitution, might substantially reduce GHGEs. Therefore, significant improvement in food system sustainability requires urgently encouraging limiting UPF consumption to the benefit of mildly processed foods, preferably seasonal, organic, and local products.
The quality of food in terms of taste and nutritional value is primarily based on the composition. Plant-based foods contain phenols that may determine consumer’s acceptance of such foods. Besides their role in preventing the emergence of some diseases and in protecting our gut’s health, phenols play a cardinal role in shaping our perception of foods. In this specific ambit and during the last decade, many scientific researches have been revealing the health and nutritional benefits of polyphenols and have thus stimulated the creation and the development of a market niche linked to polyphenols. These molecules are mainly extracted from 12 vegetable matrices, including grape seeds, green tea, cocoa, olives (including fruit and oil) and coffee predominate. For these reasons, many of these food products are considered as ‘functional foods’. Interestingly, the Mediterranean Diet includes mainly foods of vegetable origin, many of which contain remarkable amounts and a wide variety of polyphenols. This chapter examines the consumers’ reaction to polyphenol-rich foods in terms of sensorial features, mainly flavours and colours. In addition, chemical properties and natural sources of phenolics have to be investigated.
The qualitative NOVA classification of foods according to their degree of processing is widely used worldwide by researchers. NOVA defines ultra-processed foods (UPFs) by the presence of processed industrial and cosmetic ingredients and additives to modify the sensory properties (aroma, taste, colour and texture) of the reconstituted food. Some drastic processes directly applied to food are also markers of ultra-processing. However, in the intent to develop an elaborated tool for industries and retailers, the Siga classification was developed by combining the four holistic NOVA groups with four new more reductionist subgroups considering the impact of processing on the food/ingredient matrix; the contents of added salt, sugar and fat; the nature and number of markers of ultra-processing (MUPs); and the levels of at-risk additives for health (groups are unprocessed, A0; minimally processed foods, A1; culinary ingredients, A2; balanced, B1/C0.1; greedy, B2/C0.2; processed/ultra-processed foods; and UPFs with more than one MUP, C1). The Siga algorithm was used to characterize 24 932 packaged foods in French supermarkets (baby foods and alcohol excluded), which were representative of the packaged food assortments. The main results showed that two-thirds of the products were ultra-processed. Products with more than one MUP (C1) corresponded to the most represented category, accounting for 54% of the products. Among foods with more than five ingredients, 75% were UPFs. Considering all products, the average numbers of ingredients, MUPs and at-risk additives were 10.1, 2.6 and 0.5, respectively. Among food categories, some contained a high percentage of UPFs: 94, 95, 95, 81, 80, and 87% for salted meats, cooked dishes, flavoured yogurts/white cheeses, energy and gourmet bars, breakfast cereals, and vegetarian dishes, respectively. Finally, the Siga algorithm presents a useful tool for improving the health potential of packaged food and for decision-making on search engine optimization (SEO) policy and assortment management in supermarkets.
Objective
To assess the prospective associations between consumption of ultra-processed foods and risk of cardiovascular diseases.
Design
Population based cohort study.
Setting
NutriNet-Santé cohort, France 2009-18.
Participants
105 159 participants aged at least 18 years. Dietary intakes were collected using repeated 24 hour dietary records (5.7 for each participant on average), designed to register participants’ usual consumption of 3300 food items. These foods were categorised using the NOVA classification according to degree of processing.
Main outcome measures
Associations between intake of ultra-processed food and overall risk of cardiovascular, coronary heart, and cerebrovascular diseases assessed by multivariable Cox proportional hazard models adjusted for known risk factors.
Results
During a median follow-up of 5.2 years, intake of ultra-processed food was associated with a higher risk of overall cardiovascular disease (1409 cases; hazard ratio for an absolute increment of 10 in the percentage of ultra-processed foods in the diet 1.12 (95% confidence interval 1.05 to 1.20); P<0.001, 518 208 person years, incidence rates in high consumers of ultra-processed foods (fourth quarter) 277 per 100 000 person years, and in low consumers (first quarter) 242 per 100 000 person years), coronary heart disease risk (665 cases; hazard ratio 1.13 (1.02 to 1.24); P=0.02, 520 319 person years, incidence rates 124 and 109 per 100 000 person years, in the high and low consumers, respectively), and cerebrovascular disease risk (829 cases; hazard ratio 1.11 (1.01 to 1.21); P=0.02, 520 023 person years, incidence rates 163 and 144 per 100 000 person years, in high and low consumers, respectively). These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet (saturated fatty acids, sodium and sugar intakes, dietary fibre, or a healthy dietary pattern derived by principal component analysis) and after a large range of sensitivity analyses.
Conclusions
In this large observational prospective study, higher consumption of ultra-processed foods was associated with higher risks of cardiovascular, coronary heart, and cerebrovascular diseases. These results need to be confirmed in other populations and settings, and causality remains to be established. Various factors in processing, such as nutritional composition of the final product, additives, contact materials, and neoformed contaminants might play a role in these associations, and further studies are needed to understand better the relative contributions. Meanwhile, public health authorities in several countries have recently started to promote unprocessed or minimally processed foods and to recommend limiting the consumption of ultra-processed foods.
Study registration
ClinicalTrials.gov NCT03335644 .
Purpose
A growing body of evidence shows that consumption of ultra-processed foods (UPF) is associated with a higher risk of cardiometabolic diseases, which, in turn, have been linked to depression. This suggests that UPF might also be associated with depression, which is among the global leading causes of disability and disease. We prospectively evaluated the relationship between UPF consumption and the risk of depression in a Mediterranean cohort.
Methods
We included 14,907 Spanish university graduates [mean (SD) age: 36.7 year (11.7)] initially free of depression who were followed up for a median of 10.3 years. Consumption of UPF (industrial formulations made mostly or entirely from substances derived from foods and additives, with little, if any, intact food), as defined by the NOVA food classification system, was assessed at baseline through a validated semi-quantitative 136-item food-frequency questionnaire. Participants were classified as incident cases of depression if they reported a medical diagnosis of depression or the habitual use of antidepressant medication in at least one of the follow-up assessments conducted after the first 2 years of follow-up. Cox regression models were used to assess the relationship between UPF consumption and depression incidence.
Results
A total of 774 incident cases of depression were identified during follow-up. Participants in the highest quartile of UPF consumption had a higher risk of developing depression [HR (95% CI) 1.33 (1.07–1.64); p trend = 0.004] than those in the lowest quartile after adjusting for potential confounders.
Conclusions
In a prospective cohort of Spanish university graduates, we found a positive association between UPF consumption and the risk of depression that was strongest among participants with low levels of physical activity.
Background
Ultra-processed food (UPF) consumption has increased over the last decades in Westernized countries. Our objective was to investigate for the first time the association between the proportion of UPF (%UPF) in the diet and incident depressive symptoms in the NutriNet-Santé cohort.
Methods
The sample included 20,380 women and 6350 men (aged 18–86 years) without depressive symptoms at the first Center for Epidemiologic Studies Depression Scale (CES-D) measurement, using validated cut-offs (CES-D score ≥ 17 for men and ≥ 23 for women). The proportion of UPF in the diet was computed for each subject using the NOVA classification applied to dietary intakes collected by repeated 24-h records (mean = 8; SD = 2.3). The association between UPF and depressive symptoms was evaluated using multivariable Cox proportional hazards models.
Results
Over a mean follow-up of 5.4 years, 2221 incident cases of depressive symptoms were identified. After accounting for a wide range of potential confounders, an increased risk of depressive symptoms was observed with an increased %UPF in the diet. In the main model adjusted for sociodemographic characteristics, body mass index, and lifestyle factors, the estimated hazard ratio for a 10% increase in UPF was 1.21 (95% confidence interval = 1.15–1.27). Considering %UPF in food groups, the association was significant only for beverages and sauces or added fats.
Conclusion
Overall, UPF consumption was positively associated with the risk of incident depressive symptoms, suggesting that accounting for this non-nutritional aspect of the diet could be important for mental health promotion.
Electronic supplementary material
The online version of this article (10.1186/s12916-019-1312-y) contains supplementary material, which is available to authorized users.
The present commentary contains a clear and simple guide designed to identify ultra-processed foods. It responds to the growing interest in ultra-processed foods among policy makers, academic researchers, health professionals, journalists and consumers concerned to devise policies, investigate dietary patterns, advise people, prepare media coverage, and when buying food and checking labels in shops or at home. Ultra-processed foods are defined within the NOVA classification system, which groups foods according to the extent and purpose of industrial processing. Processes enabling the manufacture of ultra-processed foods include the fractioning of whole foods into substances, chemical modifications of these substances, assembly of unmodified and modified food substances, frequent use of cosmetic additives and sophisticated packaging. Processes and ingredients used to manufacture ultra-processed foods are designed to create highly profitable (low-cost ingredients, long shelf-life, emphatic branding), convenient (ready-to-consume), hyper-palatable products liable to displace all other NOVA food groups, notably unprocessed or minimally processed foods. A practical way to identify an ultra-processed product is to check to see if its list of ingredients contains at least one item characteristic of the NOVA ultra-processed food group, which is to say, either food substances never or rarely used in kitchens (such as high-fructose corn syrup, hydrogenated or interesterified oils, and hydrolysed proteins), or classes of additives designed to make the final product palatable or more appealing (such as flavours, flavour enhancers, colours, emulsifiers, emulsifying salts, sweeteners, thickeners, and anti-foaming, bulking, carbonating, foaming, gelling and glazing agents).
Processed meat and red meat have been associated with increased mortality, but studies are inconsistent and few have investigated substitution by other protein sources. The relationship of overall and causes-specific mortality with red meat, processed meat, and other dietary protein sources was investigated in The Netherlands Cohort Study. In 1986, 120,852 men and women aged 55–69 years provided information on dietary and lifestyle habits. Mortality follow-up until 1996 consisted of linkage to statistics Netherlands. Multivariable case-cohort analyses were based on 8823 deaths and 3202 subcohort members with complete data on diet and confounders. Red meat (unprocessed) intake was not associated with overall and cause-specific mortality. Processed meat intake was significantly positively related to overall mortality: HR (95% CI) comparing highest versus lowest quintile, 1.21 (1.02–1.44) with Ptrend = 0.049. Significant associations were observed for cardiovascular [HR Q5 vs. Q1, 1.26 (1.01–1.26)] and respiratory [HR = 1.79 (1.19–2.67)], but not cancer mortality [HR = 1.16 (0.97–1.39)]. Adjustment for nitrite intake attenuated these associations which became nonsignificant: HRs Q5 versus Q1 (95% CI) were: 1.10 (0.77–1.55) for total, 1.09 (0.71–1.67) for cardiovascular, 1.44 (0.68–3.05) for respiratory, and 1.11 (0.78–1.58) for cancer mortality. Nitrite was significantly associated with overall, CVD and respiratory mortality. Poultry intake was significantly inversely related to cancer and overall mortality. While fish intake showed positive associations, nut intake showed inverse associations with all endpoints. Replacing processed meat with a combination of poultry, eggs, fish, pulses, nuts and low-fat dairy was associated with lower risks of overall, cardiovascular and respiratory mortality. Processed meat was related to increased overall, CVD and respiratory mortality, potentially due to nitrite. Substituting processed meat with other protein sources was associated with lower mortality risks.
Electronic supplementary material
The online version of this article (10.1007/s10654-019-00483-9) contains supplementary material, which is available to authorized users.
Background and aims:
Obesity and insulin resistance development are related to known risk factors (such as diet) that begin in childhood. Among dietary factors, the consumption of ultra-processed foods has received attention. The present study investigated the association between ultra-processed foods consumption at preschool age and changes in anthropometric measurements from preschool to school age and glucose profile at school age.
Methods and results:
The present study was a follow-up of a randomized controlled trial, conducted with 307 children of low socioeconomic status from São Leopoldo, Brazil. At ages 4 and 8 years, children's anthropometric assessments were collected from preschool to school age including body-mass index (BMI) for-age, waist circumference (WC), waist-to-height ratio (WHtR) and skinfold. At the age 8 years, blood tests were performed to measure glucose profile. Dietary data were collected through 24-h recalls and the children's ultra-processed food intake was assessed. Linear regression analysis was used to assess the relationship between ultra-processed food consumption and the outcomes. The percentage of daily energy provided by ultra-processed foods was 41.8 ± 8.7 (753.8 ± 191.0 kcal) at preschool age and 47.8 ± 8.9 (753.8 ± 191.0 kcal) at school age, on average. The adjusted linear regression analyses showed that ultra-processed food consumption at preschool age was a predictor of an increase in delta WC from preschool to school age (β = 0.07; 95%CI 0.01-0.14; P = 0.030), but not for glucose metabolism.
Conclusion:
Our data suggest that early ultra-processed food consumption played a role in increasing abdominal obesity in children. These results reinforce the importance of effective strategies to prevent the excessive consumption of ultra-processed foods, especially in early ages.
Objectives
To assess the association between consumption of ultra-processed foods and obesity in the Canadian population.
Methods
Cross-sectional study including 19,363 adults aged 18 years or more from the 2004 Canadian Community Health Survey, cycle 2.2. Ultra-processed food intake was estimated using daily relative energy intake of ultra-processed food (% of total energy intake) from data obtained by 24-h food recalls. Obesity was assessed using body mass index (BMI ≥ 30 kg/m²). Univariate and multivariate linear regressions were performed to describe ultra-processed food consumption according to socio-economic and demographic variables, and multivariate logistic regression was performed to verify the association between ultra-processed food consumption and obesity, adjusting for potential confounders, including socio-demographic factors, physical activity, smoking, immigrant status, residential location, and measured vs self-reported weight and height.
Results
Ultra-processed foods make up almost half (45%) of the daily calories consumed by Canadian adults. Consumption of these foods is higher among men, younger adults, those with fewer years of formal education, smokers, those physically inactive, and Canadian-born individuals. Ultra-processed food consumption is positively associated with obesity. After adjusting for confounding factors, individuals in the highest quintile of ultra-processed food consumption were 32% more likely of having obesity compared to individuals in the first quintile (predicted OR = e0.005 × 56 = 1.32; 95% CI = 1.05–1.57).
Conclusion
Canadians would benefit from reducing consumption of ultra-processed foods and beverages and increasing consumption of freshly prepared dishes made from unprocessed or minimally processed foods.
Prior studies on red and processed meat consumption with breast cancer risk have generated inconsistent results. We performed a systematic review and meta‐analysis of prospective studies to summarize the evidence regarding the relation of red meat and processed meat consumption with breast cancer incidence. We searched in MEDLINE and EMBASE databases through January 2018 for prospective studies that reported the association between red meat and processed meat consumption with incident breast cancer. The multivariable‐adjusted relative risk (RR) was combined comparing the highest with the lowest category of red meat (unprocessed) and processed meat consumption using a random‐effect meta‐analysis. We identified 13 cohort, 3 nested case‐control, and 2 clinical trial studies. Comparing the highest to the lowest category, red meat (unprocessed) consumption was associated with a 6% higher breast cancer risk (pooled RR,1.06; 95% confidence intervals (95%CI):0.99‐1.14; I²=56.3%), and processed meat consumption was associated with a 9% higher breast cancer risk (pooled RR, 1.09; 95%CI, 1.03‐1.16; I²=44.4%). In addition, we identified two nested case‐control studies evaluating the association between red meat and breast cancer stratified by N‐acetyltransferase 2 acetylator genotype. We did not observe any association among those with either fast (per 25 gram/day pooled odds ratio (OR), 1.18; 95%CI, 0.93‐1.50) or slow N‐acetyltransferase 2 acetylators (per 25 gram/day pooled OR, 0.99; 95%CI, 0.91‐1.08). In the prospective observational studies, high processed meat consumption was associated with increased breast cancer risk.
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Today, it seems that nutrition is in a state of great confusion, especially for the general public. For decades, some nutrients (e.g., cholesterol, saturated fats, sugars, gluten, salt) and food groups (e.g., dairy, cereals, meats) are regularly denigrated. In this position paper, we hypothesized that such a state of confusion is mainly the result of the reductionist paradigm applied to nutrition research for more than a century, and by being pushed to its extreme, this perspective has led to accusations about some nutrients and foods. However, the real issue is about foods taken as a whole and therefore about their degree of processing, which impacts both the food matrix and the composition. Indeed, we eat whole foods, not nutrients. Therefore, the objectives of this paper are to emphasize the need for more holistic approaches in nutrition to preserve our health, animal welfare and planet. We propose to first redefine food health potential on a holistic basis and then to demonstrate that reductionism and holism are interconnected approaches that should coexist. Then, we try to explain how extreme reductionism has been disconnected from reality and ethical considerations and has ultimately led to environmental degradation and loss of biodiversity, notably through very specific crops, and to an increased prevalence of chronic diseases. Otherwise, to address the confusion of the general public and to simplify nutritional messages, we propose three holistic golden rules based on scientific evidence to protect human health, animal welfare and the environment (climate and biodiversity). Finally, we try to show how these three rules can be easily applied worldwide while respecting the environment, cultural tradition and heritage.
Ultra-processed foods provide 58 % of energy intake and 89 % of added sugars in the American diet. Nevertheless, the association between ultra-processed foods and excess weight has not been investigated in a US sample. The present investigation therefore aims to examine the association between ultra-processed foods and excess weight in a nationally representative sample of US adults. We performed a cross-sectional analysis of anthropometric and dietary data from 15 977 adults (20–64 years) participating in the National Health and Nutrition Examination Survey 2005–2014. Dietary data were collected by 24-h recall. Height, weight and waist circumference (WC) were measured. Foods were classified as ultra-processed/non-ultra-processed according to the NOVA classification. Multivariable linear and logistic regression was used to evaluate the association between ultra-processed food consumption (% energy) and BMI, WC and odds of BMI≥25 kg/m ² , BMI≥30 kg/m ² and abdominal obesity (men: WC≥102 cm, women: WC≥88 cm). Prevalence of BMI≥25 kg/m ² , BMI≥30 kg/m ² and abdominal obesity was 69·2, 36·1 and 53·0 %, respectively. Consuming ≥74·2 v . ≤36·5 % of total energy from ultra-processed foods was associated with 1·61 units higher BMI (95 % CI 1·11, 2·10), 4·07 cm greater WC (95 % CI 2·94, 5·19) and 48, 53 and 62 % higher odds of BMI≥25 kg/m ² , BMI≥30 kg/m ² and abdominal obesity, respectively (OR 1·48; 95 % CI 1·25, 1·76; OR 1·53; 95 % CI 1·29, 1·81; OR 1·62; 95 % CI 1·39, 1·89, respectively; Pfor trend <0·001 for all). A significant interaction between being female and ultra-processed food consumption was found for BMI ( F4,79 =4·89, P =0·002), WC ( F4,79 =3·71, P =0·008) and BMI≥25 kg/m ² ( F4,79 =5·35, P <0·001). As the first study in a US population, our findings support that higher consumption of ultra-processed food is associated with excess weight, and that the association is more pronounced among women.
Objective
To assess the prospective associations between consumption of ultra-processed food and risk of cancer.
Design
Population based cohort study.
Setting and participants
104 980 participants aged at least 18 years (median age 42.8 years) from the French NutriNet-Santé cohort (2009-17). Dietary intakes were collected using repeated 24 hour dietary records, designed to register participants’ usual consumption for 3300 different food items. These were categorised according to their degree of processing by the NOVA classification.
Main outcome measures
Associations between ultra-processed food intake and risk of overall, breast, prostate, and colorectal cancer assessed by multivariable Cox proportional hazard models adjusted for known risk factors.
Results
Ultra-processed food intake was associated with higher overall cancer risk (n=2228 cases; hazard ratio for a 10% increment in the proportion of ultra-processed food in the diet 1.12 (95% confidence interval 1.06 to 1.18); P for trend<0.001) and breast cancer risk (n=739 cases; hazard ratio 1.11 (1.02 to 1.22); P for trend=0.02). These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet (lipid, sodium, and carbohydrate intakes and/or a Western pattern derived by principal component analysis).
Conclusions
In this large prospective study, a 10% increase in the proportion of ultra-processed foods in the diet was associated with a significant increase of greater than 10% in risks of overall and breast cancer. Further studies are needed to better understand the relative effect of the various dimensions of processing (nutritional composition, food additives, contact materials, and neoformed contaminants) in these associations.
Study registration
Clinicaltrials.gov NCT03335644.
Background
An increasingly large share of diet comes from ultra-processed foods (UPFs), which are assemblages of food substances designed to create durable, convenient and palatable ready-to-eat products. There is increasing evidence that high UPF consumption is indicative of poor diet and is associated with obesity and metabolic disorders. This study sought to examine the relationship between percent of energy intake from ultra-processed foods (PEI-UPF) during pregnancy and maternal gestational weight gain, maternal lipids and glycemia, and neonatal body composition. We also compared the PEI-UPF indicator against the US government’s Healthy Eating Index-2010 (HEI-2010).
Methods
Data were used from a longitudinal study performed in 2013–2014 at the Women’s Health Center and Obstetrics & Gynecology Clinic in St. Louis, MO, USA. Subjects were pregnant women in the normal and obese weight ranges, as well as their newborns ( n = 45). PEI-UPF and the Healthy Eating Index-2010 (HEI-2010) were calculated for each subject from a one-month food frequency questionnaire (FFQ). Multiple regression (ANCOVA-like) analysis was used to analyze the relationship between PEI-UPF or HEI-2010 and various clinical outcomes. The ability of these dietary indices to predict clinical outcomes was also compared with the predictive abilities of total energy intake and total fat intake.
Results
An average of 54.4 ± 13.2% of energy intake was derived from UPFs. A 1%-point increase in PEI-UPF was associated with a 1.33 kg increase in gestational weight gain ( p = 0.016). Similarly, a 1%-point increase in PEI-UPF was associated with a 0.22 mm increase in thigh skinfold ( p = 0.045), 0.14 mm in subscapular skinfold ( p = 0.026), and 0.62 percentage points of total body adiposity ( p = 0.037) in the neonate.
Discussion
PEI-UPF (percent of energy intake from ultra-processed foods) was associated with and may be a useful predictor of increased gestational weight gain and neonatal body fat. PEI-UPF was a better predictor of all tested outcomes than either total energy or fat intake, and a better predictor of the three infant body fat measures than HEI-2010. UPF consumption should be limited during pregnancy and diet quality should be maximized in order to improve maternal and neonatal health.
Objective
To (i) estimate the consumption of minimally processed, processed and ultra-processed foods in a sample of Lebanese adults; (ii) explore patterns of intakes of these food groups; and (iii) investigate the association of the derived patterns with cardiometabolic risk.
Design
Cross-sectional survey. Data collection included dietary assessment using an FFQ and biochemical, anthropometric and blood pressure measurements. Food items were categorized into twenty-five groups based on the NOVA food classification. The contribution of each food group to total energy intake (TEI) was estimated. Patterns of intakes of these food groups were examined using exploratory factor analysis. Multivariate logistic regression analysis was used to evaluate the associations of derived patterns with cardiometabolic risk factors.
Setting
Greater Beirut area, Lebanon.
Subjects
Adults ≥18 years ( n 302) with no prior history of chronic diseases.
Results
Of TEI, 36·53 and 27·10 % were contributed by ultra-processed and minimally processed foods, respectively. Two dietary patterns were identified: the ‘ultra-processed’ and the ‘minimally processed/processed’. The ‘ultra-processed’ consisted mainly of fast foods, snacks, meat, nuts, sweets and liquor, while the ‘minimally processed/processed’ consisted mostly of fruits, vegetables, legumes, breads, cheeses, sugar and fats. Participants in the highest quartile of the ‘minimally processed/processed’ pattern had significantly lower odds for metabolic syndrome (OR=0·18, 95 % CI 0·04, 0·77), hyperglycaemia (OR=0·25, 95 % CI 0·07, 0·98) and low HDL cholesterol (OR=0·17, 95 % CI 0·05, 0·60).
Conclusions
The study findings may be used for the development of evidence-based interventions aimed at encouraging the consumption of minimally processed foods.
Objective:
To estimate the impact of reducing saturated fat, trans-fat, salt and added sugar from processed culinary ingredients and ultra-processed foods in the Brazilian diet on preventing cardiovascular deaths by 2030.
Design:
A modelling study.
Setting:
Data were obtained from the Brazilian Household Budget Survey 2008/2009. All food items purchased were categorized into food groups according to the NOVA classification. We estimated the energy and nutrient profile of foods then used the IMPACT Food Policy model to estimate the reduction in deaths from CVD up to 2030 in three scenarios. In Scenario A, we assumed that the intakes of saturated fat, trans-fat, salt and added sugar from ultra-processed foods and processed culinary ingredients were reduced by a quarter. In Scenario B, we assumed a reduction of 50 % of the same nutrients in ultra-processed foods and processed culinary ingredients. In Scenario C, we reduced the same nutrients in ultra-processed foods by 75 % and in processed culinary ingredients by 50 %.
Results:
Approximately 390 400 CVD deaths might be expected in 2030 if current mortality patterns persist. Under Scenarios A, B and C, CVD mortality can be reduced by 5·5, 11·0 and 29·0 %, respectively. The main impact is on stroke with a reduction of approximately 6·0, 12·6 and 32·0 %, respectively.
Conclusions:
Substantial potential exists for reducing the CVD burden through overall improvements of the Brazilian diet. This might require reducing the penetration of ultra-processed foods by means of regulatory policies, as well as improving the access to and promotion of fresh and minimally processed foods.
The NOVA classification of foods proposes 4 categories: unprocessed or minimally processed foods, processed culinary ingredients, processed foods, and ultra-processed foods and drinks (UPFDs). It is argued that the latter relies heavily on modifications to foods, resulting in enhanced amounts of salt, added sugar, and fat as well as the use of additives in an attempt to make this food category highly palatable. It further argues that controlling food processing, rather than examining nutrients, should be foremost in shaping nutrition policy. This commentary challenges many of the basic arguments of using the NOVA food classification system to examine the link between food and health. We believe that there is no evidence to uphold the view that UPFDs give rise to hyperpalatable foods associated with a quasi-addictive effect and that the prevailing European Union and US data fail to uphold the assertion that UPFDs, which dominate energy intake, give rise to dietary patterns that are low in micronutrients. With regard to the use of the NOVA food classification in the development of food-based dietary guidelines, we show that the very broad definition of UPFDs makes this impossible. Finally, the available evidence does not support the view that the globalization of food is the driver of increased intakes of UPFDs in low- to middle-income countries but rather that this is driven by small indigenous companies. On balance, therefore, there seems to be little advantage from the use of the NOVA classification compared with the current epidemiologic approach, which relies on the linkage of nutrient intakes to chronic disease with subsequent identification of foods that merit consideration in public health nutrition strategies.
Objective
To assess household availability of NOVA food groups in nineteen European countries and to analyse the association between availability of ultra-processed foods and prevalence of obesity.
Design
Ecological, cross-sectional study.
Setting
Europe.
Subjects
Estimates of ultra-processed foods calculated from national household budget surveys conducted between 1991 and 2008. Estimates of obesity prevalence obtained from national surveys undertaken near the budget survey time.
Results
Across the nineteen countries, median average household availability amounted to 33·9 % of total purchased dietary energy for unprocessed or minimally processed foods, 20·3 % for processed culinary ingredients, 19·6 % for processed foods and 26·4 % for ultra-processed foods. The average household availability of ultra-processed foods ranged from 10·2 % in Portugal and 13·4 % in Italy to 46·2 % in Germany and 50·4 % in the UK. A significant positive association was found between national household availability of ultra-processed foods and national prevalence of obesity among adults. After adjustment for national income, prevalence of physical inactivity, prevalence of smoking, measured or self-reported prevalence of obesity, and time lag between estimates on household food availability and obesity, each percentage point increase in the household availability of ultra-processed foods resulted in an increase of 0·25 percentage points in obesity prevalence.
Conclusions
The study contributes to a growing literature showing that the consumption of ultra-processed foods is associated with an increased risk of diet-related non-communicable diseases. Its findings reinforce the need for public policies and actions that promote consumption of unprocessed or minimally processed foods and make ultra-processed foods less available and affordable.
Objective
To review the available literature on the association between consumption of ultra-processed foods and body fat during childhood and adolescence.
Design
A systematic review was conducted in the PubMed, Web of Science and LILACS databases. Studies that evaluated the association between consumption of ultra-processed food (exposure) and body fat (outcome) during childhood and adolescence were eligible.
Subjects
Healthy children and adolescents.
Results
Twenty-six studies that evaluated groups of ultra-processed foods (such as snacks, fast foods, junk foods and convenience foods) or specific ultra-processed foods (soft drinks/sweetened beverages, sweets, chocolate and ready-to-eat cereals) were selected. Most of the studies ( n 15) had a cohort design. Consumption was generally evaluated by means of FFQ or food records; and body composition, by means of double indirect methods (bioelectrical impedance analysis and skinfolds). Most of the studies that evaluated consumption of groups of ultra-processed foods and soft drinks/sweetened beverages found positive associations with body fat.
Conclusions
Our review showed that most studies have found positive associations between consumption of ultra-processed food and body fat during childhood and adolescence. There is a need to use a standardized classification that considers the level of food processing to promote comparability between studies.
Gut bacteria play an important role in several metabolic processes and human diseases, such as obesity and accompanying co-morbidities, such as fatty liver disease, insulin resistance/diabetes, and cardiovascular events. Among other factors, dietary patterns, probiotics, prebiotics, synbiotics, antibiotics, and non-dietary factors, such as stress, age, exercise, and climatic conditions, can dramatically impact the human gut microbiota equilibrium and diversity. However, the effect of minor food constituents, including food additives and trace contaminants, on human gut microbiota has received less attention. Consequently, the present review aimed to provide an objective perspective of the current knowledge regarding the impacts of minor food constituents on human gut microbiota and consequently, on human health.
Given evident multiple threats to food systems and supplies, food security, human health and welfare, the living and physical world and the biosphere, the years 2016–2025 are now designated by the UN as the Decade of Nutrition, in support of the UN Sustainable Development Goals. For these initiatives to succeed, it is necessary to know which foods contribute to health and well-being, and which are unhealthy. The present commentary outlines the NOVA system of food classification based on the nature, extent and purpose of food processing.
Evidence that NOVA effectively addresses the quality of diets and their impact on all forms of malnutrition, and also the sustainability of food systems, has now accumulated in a number of countries, as shown here. A singular feature of NOVA is its identification of ultra-processed food and drink products. These are not modified foods, but formulations mostly of cheap industrial sources of dietary energy and nutrients plus additives, using a series of processes (hence ‘ultra-processed’). All together, they are energy-dense, high in unhealthy types of fat, refined starches, free sugars and salt, and poor sources of protein, dietary fibre and micronutrients.
Ultra-processed products are made to be hyper-palatable and attractive, with long shelf-life, and able to be consumed anywhere, any time. Their formulation, presentation and marketing often promote overconsumption. Studies based on NOVA show that ultra-processed products now dominate the food supplies of various high-income countries and are increasingly pervasive in lower middle- and upper-middle-income countries. The evidence so far shows that displacement of minimally processed foods and freshly prepared dishes and meals by ultra-processed products is associated with unhealthy dietary nutrient profiles and several diet-related non-communicable diseases. Ultra-processed products are also troublesome from social, cultural, economic, political and environmental points of view.
We conclude that the ever-increasing production and consumption of these products is a world crisis, to be confronted, checked and reversed as part of the work of the UN Sustainable Development Goals and its Decade of Nutrition. (NOVA, Ultra-processing)