Article

The holistico-reductionist Siga classification according to degree of food processing: An evaluation of ultra-processed foods in French supermarkets

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Abstract

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.

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... In effect, numerous additives are markers of ultra-processing (A-MUPs), but there are also many nonadditive ingredient markers of ultra-processing (NA-MUPs; Davidou et al. 2021) that are not restricted to organic foods, e.g. protein and fibre isolates, glucose syrup, dextrose and refined oils. Organic foods may also be potentially subjected to drastic processes such as extrusion-cooking or puffing and are then also considered MUPs (Monteiro et al. 2019;Davidou et al. 2020). Therefore, despite the proposal 'to connect organic processing to related systems such as minimal, sustainable and careful, gentle processing, and to describe clear principles and related criteria' (Kahl et al. 2014), organic foods are still potentially subjected to ultra-processing. ...
... As regards to human health, and in the continuation of our two previous studies (Davidou et al. 2020(Davidou et al. , 2021, the objective of this new study was therefore to evaluate the percentage of UPFs in industrially packaged organic foods in comparison with conventional foods sold in food retailing and to describe their MUP profiles to detect the most used MUPs as well as those that cooccur the most in organic foods. ...
... The Siga classification and its methodology have been previously described in detail (Davidou et al. 2020(Davidou et al. , 2021. In this study, for optimal description and analysis, the UPF group, initially described by three technological groups (C01, C02, C1; Davidou et al. 2020), was subdivided into five groups according to the number and nature of MUPs; the presence of risk-associated additives; and the quantity of added sugar, salt and/or fat contents, i.e. ...
Article
In France, around 70% of conventional industrial foods are ultra-processed, with no data for organic foods. The objectives of this study were to evaluate the percentage of ultra-processed foods (UPFs) in industrially packaged organic (n = 8,554) and conventional (n = 45,791) foods, and to describe their marker of ultra-processing (MUP) profiles. The percentage of UPFs and MUP profiles were determined with the Siga methodology. UPF percentages were 53% in organic foods and 74% in conventional foods, and there was 8% more organic UPFs in conventional stores than in organic stores. The more additive MUPs are used, the greater the quantity of nonadditive MUPs. Conventional UPFs contained twice as many total MUPs as organic UPFs. Main MUPs in organic UPFs were refined oils, extracts and natural aromas, native starches, glucose syrup, lecithins, and citric acid. Organic foods are therefore overall less ultra-processed although still containing high levels of nonadditive MUPs.
... Therefore, from a preventive perspective, a holistic approach based on the degree of processing appears relevant for society. New way of classifying foods according to their degree of processing has emerged with several proposed classifications, such as NOVA (Moubarac et al. 2014), Siga (Davidou et al. 2020), andothers (Gonz alez-Castell et al. 2007;Slimani et al. 2009;Asfaw 2011;Poti et al. 2015;Sanchez-Siles et al. 2019). Contrary to composition indices, they consider food health potential more holistically because processing affects both the food matrix and composition Rock 2018, 2020). ...
... Recently, a classification using the concept of markers of ultra-processing (MUPs) has been developed to systematically identify UPFs independently of their nutritional composition . They contain industrial ultra-processed ingredients and additives that generally modify the colour, aroma, texture and taste of foods (Davidou et al. 2020). Some of these MUPs may be potentially used to replace salt, sugar and/or fat within packaged foods. ...
... Within this context, the main objective of this study was to characterise the degree of processing of foods in relation with their nutritional quality in order to determine how these two dimensions are interconnected. For this, we used two different developed French scores, i.e. the Nutri-score to assess food composition based on some nutrients to favour or to limit (Julia et al. 2014) and the Siga score to assess the degree of processing, including added fat, salt and/or sugar (Davidou et al. 2020). For UPF only, a comparison was also realised with the TLLS based on only the amount of four nutrients (sugar, salt, fat, saturated fat) and energy. ...
Article
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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.
... Characterised by the NOVA classification, our sample (n = 1155) is mainly made up of ultra-processed products (87.97%; n = 1016), and although it does not reflect a child's total diet, it suggests a strong trend in food products marketed to children, with no less than 12 categories made up entirely of UPFs. Past studies on packaging (which were not focused on children's products) found lower percentages of UPFs: 83% in supermarkets in New Zealand [66], 71% in the United States (for n = 230,156 foods and beverages) [67], 64.64% in France based on the collaborative database Open Food Facts [68], 67% [69] and 69% [70] using the SIGA method, which suggests that products marketed to children are highly ultra-processed. UPF markers are different for SIGA and NOVA (e.g., SIGA includes refined oils), but the two classifications nevertheless allow for a relevant comparison. ...
... UPF markers are different for SIGA and NOVA (e.g., SIGA includes refined oils), but the two classifications nevertheless allow for a relevant comparison. As in our sample, UPFs have longer lists of ingredients: 13.2 components vs. 3.7 in minimally process/unprocessed foods [69], and 15.2 vs. 3.29 in NOVA group 1 and 5.89 in NOVA group 3 in our sample. The number of additives is also significantly higher in UPFs, as found in previous works [69,70]. ...
... As in our sample, UPFs have longer lists of ingredients: 13.2 components vs. 3.7 in minimally process/unprocessed foods [69], and 15.2 vs. 3.29 in NOVA group 1 and 5.89 in NOVA group 3 in our sample. The number of additives is also significantly higher in UPFs, as found in previous works [69,70]. The main UPF markers are not additives but flavourings, glucose syrup, and starch. ...
Article
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Food packaging marketing techniques which appeal to children (such as cartoon characters and brand mascots) affect children’s choices, preferences, and eating habits. Several studies have assessed the nutritional quality of food intended to children in various countries and concluded that most were high in fat, salt, and sugar (HFSS) and ultra-processed foods. The aim of this study is to analyse products intended for children over the age of 3 (foods and beverages with relevant marketing elements on the packaging) available on the French market as regards: (1) nutritional quality, based on the Nutri-Score labelling system, (2) compliance with expected nutritional profile suitable for children, according to the criteria of the WHO Europe Nutrient Profile Model, and (3) degree of processing, as defined by the NOVA classification, from packaging collected in 20 stores (hyper/supermarkets, hard-discount retail chains, and organic food stores). The marketing strategies most often used on children’s products are cartoons (97.22%; n = 1120) and mascots (77.78%; n = 896). A total of 1155 products were included in the study, most of which were sugary foods: almost a quarter of the products in the sample (23.81%; n = 275) list a sweetener as the first ingredient, and most of them (89.52%; n = 1034) contain free sugars according to the WHO definition. All the products included in our study feature marketing elements targeting on the packaging, yet 94.88% do not meet the criteria of the WHO Europe Nutrient Profile Model. Most (58.68%; n = 676) belong to Nutri-Score groups D and E, with the highest proportion in group D (39.32%; n = 453) and are ultra-processed (87.97%; n = 1016), especially through the use of flavourings and ultra-processed sugars. Using the Nutri-Score, the WHO Europe Nutrient Profile Model, and the NOVA classification, this study suggests that a significant share of pre-packaged foods marketed to children do not have an adequate nutritional profile. As such, measures are needed to regulate what marketing elements aimed at children can be included on packaging, based on these criteria.
... This indirectly suggests that even though the various definitions of processed foods refer to various types of processing used by the industry, relevant research into how exactly these techniques affect the properties of the final food products, and how the various processing conditions and the continuous refinement of these techniques can affect the composition and healthfulness of these foods, is practically non-existent; and is therefore not considered in any of the classification systems. In fact, the technological process is rarely considered in studies of nutritional epidemiology and can be found mainly in the form of binary comparisons [64], such as red meat versus processed meats [65], fresh fruit versus fruit juices [66], fruit juices versus sweetened beverages [67], milk versus yogurt or cheese [68], and whole-grain versus refined cereals [69]. These studies tend to show that compared with the minimally or less processed alternative, the more processed version of the food is less protective against NCDs [58]. ...
... A qualitative approach for improving current processing-based classifications (and particularly, the NOVA) has been suggested [3]; this approach takes into account the nature, quantity, function, and degree of transformation of the ingredients or additives, and the loss of the food matrix effect, in order to achieve a more holistic and realistic classification [3]. Consequently, the Siga ("go forward" in Portuguese, meaning "go further" or "improve the existent") classification was developed by combining the four NOVA groups with four new subgroups [64]. This classification considers 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" (termed MUPs); and the levels of at-risk additives. ...
... This classification considers 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" (termed MUPs); and the levels of at-risk additives. The eight new food categories are: unprocessed (A0); minimally processed foods (A1); culinary ingredients (A2); nutritionally-balanced processed foods (B1); high-salt, high-sugar or high-fat processed foods (B2); nutritionally-balanced UPFs (C0.1); high-salt, high-sugar or high-fat UPFs (C0.2); and UPFs with more than one MUP (C1) [64]. ...
Article
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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.
... UPFs can also be created by the direct application of a deterioration process (e.g., extrusion-cooking) to the food matrix. These substances are named MUPs and can be indifferently an ingredient or an additive, most of which are obtained by technological processes relating to cracking or synthesis" (pages 2031-2032) (Davidou et al., 2020). Therefore, Siga distinguishes additive MUPs (A-MUPs) and non-additive MUPs (NA-MUPs). ...
... aromas), and ultra-processed carbohydrates, fats, proteins and fibre; for example, hydrolysed sugars, hydrogenated fats and protein/fibre isolates. Additives that are minimally processed are not included in the definition of UPFs (Davidou et al., 2020). Therefore, A-MUPs are highly processed additives such as lecithins and diacetyl tartaric acid ester of mono-and diglycerides (i.e., DATEM); additives such as sodium bicarbonate or acacia gum are not A-MUPs. ...
... Therefore, A-MUPs are highly processed additives such as lecithins and diacetyl tartaric acid ester of mono-and diglycerides (i.e., DATEM); additives such as sodium bicarbonate or acacia gum are not A-MUPs. Finally, the risk assessment of additives is complementary to the evaluation of the degree of processing, and some "at risk" additives may also send foods into the UPF category, but were not considered as MUPs (e.g., talc or E553b) (Davidou et al., 2020). They correspond to additives that have been noted to present a risk for health (safety concerns of the European Food Safety Authority reports, EFSA), notably when regularly consumed, e.g., phosphate additives (Ritz et al., 2012) and sodium nitrite (Jiang et al., 2012). ...
Article
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.
... Regarding the places of purchase, convenience stores, discounters, supermarkets and hypermarkets are often the primary suppliers of UPFs worldwide: this is the case in Latin America (Pan American Health Organization, 2015); UPFs represented 83% of packaged foods in a sample of New Zealand supermarkets in 2013 (Luiten et al., 2016), and 67% of packaged foods in a sample of super-and hypermarkets in France in 2019 (Davidou et al., 2020). In France, in 2020, hypermarkets, supermarkets and hard discounters represented 55, 38 and 7% of all national employees, respectively (FCD, 2020), with the six leading large food retailers accounting for around 89% of the total food market (Leclerc, 2020). ...
... Rule 2: 'Vrai' (real, i.e., non-UPF) UPFs can be found in plant, animal and mixed products. The degree of processing of each of the 38,168 foods purchased was assessed using the Siga methodology, which identifies UPFs from the ingredient list (Davidou et al., 2020). The Siga score according to the degree of processing (A: not or minimally processed, B: processed and C: ultra-processed) was assigned to the 19,670 food items for which ingredient lists were available. ...
... Of the remaining 18,498 food items for which the list of ingredients was not available, all fresh unpackaged foods, bulk foods and catered foods were considered non-UPF (i.e., 60.7% of the 18,498 foods). For the remaining 7269 packaged industrial foods, we applied the percentages of UPFs found in each of the 126 Siga food categories (defined to be representative of the food assortments of French super and hypermarkets) (Davidou et al., 2020) which we matched to the 338 French retailer food categories for this study. This allowed us to calculate the calorie share of UPFs based on the amount of food purchased and the net weight for each food purchased. ...
Article
In France, hypermarkets are the main shopping sites for food products. Therefore, the food-purchasing profiles of their regular customers may be a relevant indicator of the sustainability and health potentials of consumed diets. Knowing this information can be a step to address the issue of global health. The main objective of this study was to assess the sustainability and health potential of food-purchasing behaviors among regular adult customers, with or without children, of a leading French retailer. Secondarily, the cost of a sustainable food shopping cart was evaluated as regards the regular one, as calculated in this study. Purchasing receipts corresponding to 38,168 different food products were collected during one consecutive month for each four seasons in 2019 to assess compliance with a newly developed holistic indicator of food system sustainability, i.e., the 3V rule, recommending food consumption to be ‘Vegetal’/plant-based (≈15% animal calories/day), ‘Vrai’/real (max. 15% ultra-processed food calories/day, UPF) and ‘Varié’/varied. Participants were 708 regular buyers (aged ≥18 with different socio-economic profiles, with and without children) in 122 French hypermarkets. The plant rule was based on the animal and plant origin of food ingredients, including mixed products; the ‘real’ rule was evaluated with the Siga score according to the degree of processing to identify UPFs. The varied rule was defined based on a combination of food ‘categories × families’. The effect of children and season on the purchased animal and UPF calories and on the variety index was also evaluated. Multivariate and decision tree analyses were applied to compare consumers for their 3V rule profile similarities and differences, and to look for impacts of the presence or absence of children. Customers' purchases were far from the 3V rule, with a median of 41% animal and 61% UPF calories and a median variety index of 25% (compared to the consumer with the highest index set to 100%). There was no difference in purchased animal and UPF percentages neither according to seasons nor the presence of children. However, the presence of children was associated with a higher variety index (+33%, P < 0.05). Finally, the more the consumers purchased varied, the less they purchased UPFs. Compared to the average food basket, a 3V-based basket would cost 4.6% less. To make this basket accessible to everyone and to orientate consumer's purchasing behaviors toward more sustainable and healthier products, and hence food systems, hypermarkets should promote healthy eating and reassess their food offerings.
... Another solution could be to replace sugars with other ingredients to keep the same percentages of fat and proteins within the defined food. However, in this last case, it is highly likely that the food will contain more industrial markers of ultra-processing or "cosmetic" ingredients/additives (Davidou et al. 2020), as observed with light foods and gluten-free products. As a result, a food with a high sugar content that is normally processedsuch as homemade biscuits or cakesmay become ultra-processed. ...
... In this way, the food scores proposed by NOVA ("new" in Portuguese) (Moubarac et al. 2014) or the derived Siga ("go forward" in Portuguese) (Davidou et al. 2020), primarily based on the degree of food processing, not nutrients, appear to have a greater impact on public health because they consider that processing has an impact on both the food matrix and composition (Figure 3). In addition, the application of these scores will lead to the technological development of innovative processes resulting in less unstructured foods or ingredients, fewer chemical additives with unknown health effects, and more wholesome and real foods that do not necessarily include refined ingredients. ...
Article
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.
... Correspondingly, freezing and drying would not be considered minimal processes (Botelho et al., 2018), despite NOVA and Poti defining them as such. Davidou, Christodoulou, Fardet, and Frank (2020) found that products classified as ultra-processed have on average 13 ingredients, vs. less than 4 ingredients in other processed products. As discussed by Botelho, from a food science and technology perspective, adding ingredients does not define the level of food processing (Botelho et al., 2018), while the classification systems conflate ingredients and processes. ...
... Scrinis and Monteiro (2017) recommend "wholefoods reformulation" -instead of exchanging ingredients such as fat, sugar or salt with other processed-refined-reconstituted ingredients, replace them with intact or minimally processed ingredients. Davidou et al. state that while minimally processed foods may be altered by processes, such as grinding, the ingredients "have not been highly modified from the initial food matrix" and are "not devoid of protective bioactive compounds" (Davidou et al., 2020). ...
Article
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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.
... Original raw food C Recombinant artificial ultraprocessed food made of food ingredients A, B, C ... + cosmetic additives (± real foods) … Figure 2. Schematic representation of UPFs through fractionation of original raw foods and ingredient recombination with 'cosmetic' additives. 3 Refined oils are not strictly characteristic of UPFs in NOVA classification; however, due to the high level of processing that refined oils undergo, they were considered in this analysis, as in the Siga score methodology [13]. 4 Includes artificial and natural aromas. ...
... In supermarkets, UPFs constitute more than two-thirds of packaged foods in France [13], more than 70% in the USA [85], and even more than 83% in New Zealand [16]. Therefore, it is very likely that returning to more fresh food should drastically alleviate plastic waste. ...
Article
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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.
... First, beyond only nutrients, foods are interlinked with cultural identity while playing a key role in many local economies, as highlighted by Dembska et al. [18] in their double pyramids models connecting food culture, health, and climate. These authors and others [18,[57][58][59][60][61] call attention to the need of leveraging the various dimensions of foods, which are closely related, under the so-called one-health approach [18,57]. ...
... For example, the newly developed Siga score [59] is hierarchically combined with the first degree of processing, then the food matrix effect, added salt, fat, and/or sugar, and the number of markers of ultra-processing (including some cosmetic additives and non-additive markers) [60]. To be elaborated, this score typically needs not only the food composition data, but also the list of ingredients and the presence or not of added sugar, salt, and/or fat. ...
Article
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Food provides humans with more than just energy and nutrients addressing both vital needs and pleasure. Food habits are determined by a wide range of factors, from sensorial stimuli to beliefs, and once commanded by local and seasonal availability, are nowadays driven by mar-keting campaigns promoting unhealthy and non-sustainable foodstuffs. Top-down and bottom-up changes are transforming food systems, driven by policies on SDGs and by consumer’s con-cerns about environmental and health impacts. Food quality, in terms of taste, safety and nutri-tional value are determined by its composition, described in food composition databases (FDB). FDB are then useful resources to agronomists, food and mechanical engineers, nutritionists, marketers and others in their efforts to address at maximum human nutrient needs. In this work we analyse some relevant food composition databases (viz. purpose, type of data, ease of access, regularity of updates), inspecting information on the health and environmental nexus, as food origin, production mode as well as nutritional quality. The usefulness and limitations of food databases are discussed in what concerns sustainable diets, food “matrix effect”, missing com-pounds, safe processing and in guiding innovation in foods, as well as in shaping consumers’ perceptions and food choices.
... Food processing has an impact on the food matrix and affects the functionality of foods [44], making them unhealthy foods despite satisfying the nutritional properties estimated from their nutrient content. This can be seen in the data obtained in Figure 4, where foods classified as NOVA 4 had relatively low Nutri-Score values (11 [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]). ...
... Knowing the existing evidence of the negative effect that the consumption of ultra-processed foods has on the different aspects of health [26,36,47] and the WHO recommendations to reduce the consumption of this type of food as much as possible, the front-of-pack labelling with Nutri-Score should at least be accompanied by other complementary labelling indicating the level of processing. Several tools are now available that focus on food processing [48], such as the SIGA classification [44,49], which classifies foods based on the NOVA classification and degree of processing, in addition to other factors. The application of these classifications in a label would allow consumers to know that they are choosing an ultra-processed food, and once the consumer knows this information, they could interpret the nutritional quality of the product through the Nutri-Score. ...
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Front-of-pack labels can improve the ability of consumers to identify which foods are healthier, making them a useful public health tool. Nutri-Score is a front-of-pack labelling system adopted by several European countries. This system ranks foods according to their nutritional quality, but does not consider other dimensions such as the degree of food processing. The aim of this study is to compare the nutritional quality (as assessed by Nutri-Score) and the ultra-processing (as assessed by the NOVA classification) of foods in the Open Food Facts database. A simple correspondence analysis was carried out to study the relationship between the two systems. Ultra-processed foods (NOVA 4) were found in all Nutri-Score categories, ranging from 26.08% in nutritional category A, 51.48% in category B, 59.09% in category C, 67.39% in category D to up to 83.69% in nutritional category E. Given the negative effect that the consumption of ultra-processed foods has on different aspects of health, front-of-pack labelling with Nutri-Score should at least be accompanied by complementary labelling indicating the level of processing, such as the NOVA classification.
... More terms and definitions have recently been added to address some of the classification problems within the original NOVA criteria. The Siga classification of processed foods extends the NOVA classification system by combining the original 4 categories of food processing with 5 more specific subgroups [33]. This classification system accounts for added sugar, fat, and salt contents; "at risk" additives; "matrix" effects; ultra-processed ingredients; and the number of markers of ultra-processing (MUPs). ...
... This classification system accounts for added sugar, fat, and salt contents; "at risk" additives; "matrix" effects; ultra-processed ingredients; and the number of markers of ultra-processing (MUPs). Most of the literature to date still utilizes the original NOVA criteria; there have not yet been many studies published utilizing the Siga criteria [33]. ...
Article
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Purpose of Review The purpose of this review is to provide an update on the available data regarding the associations of Ultra-processed food (UPF) consumption with food intake and possible underlying mechanisms relating UPF consumption to weight gain and co-morbidities. Recent Findings In primarily observational studies, UPF consumption is consistently associated with an increased risk for weight gain among adults and children and increased risk for adiposity-related co-morbidities in adults. In a single mechanistic study, consumption of UPFs led to increased energy intake and weight gain relative to whole foods. Summary UPFs tend to be more energy-dense than nutrient-dense, and UPF consumption is associated with increased adiposity and co-morbidity risk. These data suggest that recommendations to limit UPF consumption may be beneficial to health — though further mechanistic studies are needed.
... This constant increase led us to consider that IPFs have been progressively substituted with UPF. In France, UPFs were evaluated to correspond to 67 % of packaged IPFs (59) . And, the increase in the UPF calorie share has been consistently associated with the prevalence of overweight and obesity and with the prevalence of chronic diseases (4,8,9) , e.g. ...
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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).
... The percentage of UPF calories in the INCA1-3 surveys was assessed based on the Siga score according to the degree of processing [66]. First, the percentages of UPFs in each INCA food category were imputed from the UPF percentages in 127 Siga categories (n = 47,358 food products) that were matched with INCA categories (n = 32 categories for INCA1, n = 43 categories for INCA2, and n = 44 categories for INCA3 with the supplemental "infant milk and beverages" category compared to INCA2). ...
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In France, the evolution of dietary pattern relative to sustainability and global health remains insufficiently studied. The objective of this study was to assess dietary changes during 1998-2015 through three generic metrics potentially related to sustainability. Food consumption data were collected from three French National Individual Study of Food Consumption surveys (INCA) for children (0-17 years) and adults (18-79 years) representative of the French population. The consumed foods were converted into plant (metric 1) and non-ultra-processed (UPF, metric 2) calories, and analyzed in meeting dietary recommended intakes (metric 3). French children and adults consumed high levels of animal and UPF calories, and nutrient deficiencies were observed in adults from the 2015 survey, e.g., fiber, EPA, DHA, magnesium, retinol, and vitamin C. In children, UPF daily calories increased from 42.8 to 45.5% and decreased in adults from 39.2 to 35.0%. In children and adults, diet revegetation was observed. While the level of physical activity decreased, overweight , obesity and type 2 diabetes prevalence increased in French adults. The French dietary pattern is not sustainable for global health unless public health policy is reinforced, with at least a twofold decrease in animal and UPF calories and improved food diversity.
... The Siga classification follows NOVA, with additional reductionist criteria to try to fit still better with reality, as seen by consumers in their societal context, i.e., in the kitchen and in food retail (Davidou et al. 2020). In this view, such classifications based on degree of processing of foods appear more in line with what we eat during meals than food classifications according to their nutrient profiles. ...
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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.
... Certains proviennent de l'industrie agroalimentaire. C'est le cas de composants tels que les huiles hydrogénées, les amidons modifiés et isolats de protéines, ainsi que l'ajout d'agents aromatisants, de colorants, d'émulsifiants, d'édulcorants souvent utilisés pour imiter les propriétés sensorielles des aliments non transformés ou peu transformés [54,55], qui nous l'avons vu sont néfastes pour le microbiote et la santé (par exemple [49]). En outre, ces aliments dits ultratransformés se caractérisent généralement par des teneurs en fibres et en micro-nutriments plus faibles que les produits peu transformés du fait des opérations de raffinage et cracking 6 . ...
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Résumé Le rôle clef du microbiote intestinal sur la santé et son lien avec l’alimentation est maintenant démontré. On sait que ses besoins sont spécifiques : les fibres et certains acides gras à longue chaîne (oméga-3) ont un effet favorable sur sa diversité et son fonctionnement, mais leur déficit, de même que certains résidus de pesticides, émulsifiants et édulcorants, entraînent une dysbiose intestinale. Or au cours des cinquante dernières années, les changements dans l’alimentation des animaux d’élevage, dans la protection des cultures (pesticides), de même que l’offre croissante en produits prêts à consommer et l’évolution induite dans les préférences des consommateurs, ont été sources de perturbations du microbiote. A tel point que 90 pour cent des Français manquent d’omégas 3 et que les produits ultra-transformés représentent 35 % des calories consommées. Une santé reposant sur un microbiote sain nécessite un changement de paradigme dans la façon de se nourrir. Pour cela il faut agir à tous les maillons du système alimentaire, par une révision de certaines pratiques agricoles et de l’industrie agroalimentaire afin d’améliorer l’offre en produits de qualité, mais aussi par un vaste effort d’éducation et de formation pour aider aux choix des aliments et à la composition des menus.
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Face aux enjeux environnementaux, il n'est plus suffisant de manger sain pour soi, mais aussi pour protéger la santé globale (humaine et planétaire). Dans cette étude nous nous sommes focalisés sur la durabilité potentielle du régime alimentaire de la population française âgée de plus de 65 ans, et dont environ les deux-tiers sont atteints de maladies chroniques et 4,4% vivent en institutions spécialisées. Pour cette analyse, nous avons appliqué la règle nouvellement développée des 3V BLS (Végétal, Vrai, Varié, si possible Bio, Locale et/ou de Saison), qui gouverne la relation alimentation-santé globale. Elle préconise un optimum de 15% de calories animales et 15% de calories ultra-transformées par jour pour atteindre la durabilité à l'horizon 2050. Ainsi, le régime alimentaire des plus de 65 ans a été caractérisé au regard des 3V-BLS dans la population INCA3 (2014-2015) et illustré par un menu hebdomadaire en EHPAD. Puis nous avons modélisé un régime 3V-BLS en EHPAD et à domicile et discuté sa faisabilité dans le cas de 14 pathologies chroniques les plus fréquentes. Les résultats montrent que les plus de 65 ans consomment respective-ment 36 et 27% de calories animales et ultra-transformées/jr dans INCA3, et 33 et 49% dans l'exemple choisi en EHPAD. L'application du régime 3V-BLS en EHPAD est difficile dans le cadre des contraintes du GEMRCN a en produits animaux et parce que les EHPAD s'approvisionnent souvent en restauration collective avec un fort pourcentage d'aliments ultra-transformés. Cependant, à domicile il est possible de tendre vers un régime 3V-BLS pour un coût d'environ 8 euros/jour. Au final, le régime 3V-BLS serait applicable à au moins 33% de la population âgée sans maladies chroniques, et potentiellement au deux-tiers incluant certaines maladies chroniques.
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A debate is ongoing on the significance and appropriateness of the NOVA classification as a tool for categorizing foods based on their degree of processing. As such, the role of ultra-processed food (UPF) on human health is still not completely understood. With this review, we aimed to investigate the actual level of consumption of UPF across countries and target populations to determine the impact in real contexts. Suitable articles published up to March 2021 were sourced through the PubMed and SCOPUS databases. Overall, 99 studies providing data on the level of UPF consumption expressed as the percentage of total energy intake were identified, for a total of 1,378,454 participants. Most of them were published in Brazil (n = 38) and the United States (n = 15), and the 24 h recall was the most-used tool (n = 63). Analysis of the results revealed that the United States and the United Kingdom were the countries with the highest percent energy intake from UPF (generally >50%), whereas Italy had the lowest levels (about 10%); the latter was inversely associated with adherence to the Mediterranean diet. High variability was also observed based on sex, age, and body mass index, with men, young people, and overweight/obese subjects generally having higher levels of consumption compared to older subjects. Overall, our findings underline the large differences in UPF intake. Since most of the observations derived from studies conducted with food questionnaires are not specifically validated for UPF, further efforts are essential to confirm the results previously obtained and to investigate further the association between UPF consumption and health status, also considering the actual contribution within different dietary patterns, which has been less investigated to date.
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Background Ultra-processed food (UPF) consumption has been associated with higher cardiovascular disease (CVD) and mortality risks. Objectives The aim of this study was to assess the relationship between UPF consumption and incident dyslipidemia in older adults, where evidence is limited. Methods We studied a prospective cohort of 1082 community-dwelling adults in Spain, older than 60 (mean age, 68 ± 6 years old). Participants (52% were women) were recruited between 2008–10 and followed up to 2015. At baseline, food intake data were collected using a validated computerized face-to-face dietary history. UPFs were identified according to the nature and extent of their industrial processing (NOVA classification). Triglycerides, HDL cholesterol, and LDL cholesterol were measured in fasting plasma samples collected at baseline and at follow-up. Statistical analyses were performed with logistic regression adjusted for the main potential confounders. Results Among those free of corresponding dyslipidemia at baseline, and after a follow-up of between 5 to 7 years, 60 (out of 895) developed incident hypertriglyceridemia (≥150 mg/dL), 112 (out of 878) had low HDL cholesterol (<40 in men/<50 mg/dL in women), and 54 (out of 472) had high LDL cholesterol (>129 mg/dL). The mean percentage of UPF consumption was 19% ± 11% of total energy intake. Those in the highest versus the lowest tertile of energy intake from UPFs had more than twice the odds of incident hypertriglyceridemia (OR, 2.66; 95% CI: 1.20–5.90; P-trend, 0.011) or low HDL cholesterol (OR, 2.23; 95% CI: 1.22–4.05; P-trend, 0.012). UPF consumption was not associated with high LDL cholesterol plasma concentrations. Conclusions Although UPF consumption in Spain was low among older adults, high consumption of UPFs was clearly associated with incident dyslipidemia. The increase in CVD risk recently found to be associated with UPF consumption might be mediated by these atherogenic lipid abnormalities.
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Notre santé et nos systèmes alimentaires ne sont plus durables. En cause notamment un excès de consommation de calories d’origine animales et ultra-transformées. La règle générique des 3VBLS a été élaborée pour répondre à cet enjeu : Végétal (15% max de calories de produits d’origine animales/jour, soit environ 2-3 portions de viandes, produits laitiers, œufs, poissons, etc.), Vrai (15% max de calories d’aliments ultra-transformés/jour, 1-2 portions), Varié, si possible Bio, Local et de Saison. S’affranchissant de l’approche par nutriments, elle permet de remplir tous les besoins nutritionnels chez l’adulte. L’objectif de cette nouvelle étude a été de tester l’applicabilité de la théorie des 3VBLS chez les enfants français de 3-10 ans au regard de leurs besoins nutritionnels, en comparaison avec leur régime standard moyen tel que rapporté dans l’étude INCA3 (2014-2015, n = 1035 enfants). Le régime standard INCA3 est composé d’environ 37% de calories animales et 47% de calories ultra-transformées avec une diversification assez limitée (faible représentativité des céréales complètes, légumineuses, fruits à coque, poissons et œufs, et forte représentativité des fruits frais et produits laitiers). Le régime 3VBLS, avec une grande diversité d’aliments, notamment végétaux, est nutritionnellement adéquat. Il reste la question de son acceptabilité et de son coût à plus long terme
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Depuis le milieu du XX e siècle, les impacts des activités humaines sur les écosystèmes sont croissants. À l’érosion de la biodiversité et au dérèglement climatique, ainsi qu’au développement de maladies chroniques que constituent l’obésité et le diabète, s’ajoute désormais la pandémie du coronavirus. Il s’agit d’un ensemble de crises environnementales ou sanitaires qui résultent pour partie de facteurs communs et dont les impacts peuvent se conjuguer et s’amplifier. Dans ce contexte inédit, nos modes de production, transformation, distribution et consommation des aliments sont particulièrement interrogés. Ils sont à l’origine d’une part importante des émissions de gaz à effet de serre, participent à la destruction de certains habitats naturels réservoirs d’agents pathogènes et contribuent à l’émergence de maladies chroniques chez l’homme. De ce fait, la nécessité d’une transition de notre système alimentaire est une idée qui fait consensus, même si le choix des changements à opérer concrètement pose de nombreuses questions. À travers une approche systémique de « santé globale », rendant compte de l’interdépendance de l’état de santé de l’Homme, des animaux et des écosystèmes dans lesquels ils évoluent, nous montrons qu’il faut prioriser aussi bien les enjeux environnementaux que de santé pour mener à bien ces arbitrages. Nous montrons qu’il est possible de faire des choix doublement vertueux pour l’environnement et la santé en transformant les modes de production, de transformation, de distribution et de consommation des aliments : réorienter l’élevage, abaisser le degré de transformation des aliments, diversifier les modes de distribution et « végétaliser » notre assiette. Ces changements participent à la territorialisation du système alimentaire.
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Background The impact of the Nutri-Score labelling system on renal function is unknown. Objective To assess the association between food consumption based on the nutrient profile system underlying the Nutri-Score and renal function decline in older adults. Methods We used data from the Spain-based Seniors-ENRICA cohort, a study with 1,312 community-dwelling adults aged ≥60 years recruited during 2008–2010 and followed up to December 2015. At baseline, a validated dietary history was obtained. Based on their nutritional quality, foods consumed were categorized into five labels (A/Green–best quality, B, C, D, E/Red–worst quality) using the established Nutri-Score algorithm. For each participant, a Nutri-Score dietary index (DI) was calculated in g/day/kg of weight. At baseline and at follow-up, measured serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) levels were obtained, and time changes were calculated. A combined outcome for renal decline was defined as: any increase in SCr or any decrease in eGFR beyond expected-for-age. Statistical analyses were performed with logistic regression adjusting for socioeconomic, lifestyle, total energy intake, fresh foods, and comorbidity confounders. Results A total of 183 cases of renal-function decline occurred over a mean 6-year follow-up. Participants with a higher (less favorable) Nutri-Score DI (interquartile range (IQR)13.2–17.7 (g/day/kg of weight); 46 cases) had higher probability of renal decline than those with a lower Nutri-Score DI (IQR 36.6–46.2; 44 cases); the corresponding odds ratios (95% confidence interval) across increasing quartiles of Nutri-Score DI were 1 (reference), 1.26 (0.78-2.04), 1.55 (0.92-2.62), and 1.82 (1.01-3.30), P-trend=0.045. Per each 10-point increase in the Nutri-Score DI the odds of renal decline increased by 27% (6%-52%). Conclusions Higher Nutri-Score DI, reflecting the consumption of foods with less favourable Nutri-Score rating, was associated with higher kidney function decline in older adults. Consequently, Nutri-Score labeling might be a useful policy tool for preventing kidney function decline, adding to the potential health benefits of this front-of-pack labelling system.
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Honey often referred to as ‘the drink of the gods’, is naturally sweet and a substantially rich source of carbohydrates, amino acids and antioxidants. In spite of being rich in carbohydrates, honey has a low glycemic index and therefore effectively used as a dietary compliance by diabetics. The fructose content of honey has hepatoprotective capability, while the antioxidants present in it provide effective protection against oxidative damage. The therapeutic attribute of honey makes it the food of choice even in infants and diabetics. Honey is endowed with antioxidant, immune modulating, and wound healing, anti-inflammatory, therapeutic, nutritional, antimicrobial and antidiabetic qualities. The present review aims at discussing these capabilities of honey with special reference to its antidiabetic benefits under one dome.
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The definition of what constitutes a healthy diet is continually shifting to reflect the evolving understanding of the roles that different foods, essential nutrients, and other food components play in health and disease. A large and growing body of evidence supports that intake of certain types of nutrients, specific food groups, or overarching dietary patterns positively influences health and promotes the prevention of common non-communicable diseases (NCDs). Greater consumption of health-promoting foods and limited intake of unhealthier options are intrinsic to the eating habits of certain regional diets such as the Mediterranean diet or have been constructed as part of dietary patterns designed to reduce disease risk, such as the Dietary Approaches to Stop Hypertension (DASH) or Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diets. In comparison with a more traditional Western diet, these healthier alternatives are higher in plant-based foods, including fresh fruits and vegetables, whole grains, legumes, seeds, and nuts and lower in animal-based foods, particularly fatty and processed meats. To better understand the current concept of a “healthy diet,” this review describes the features and supporting clinical and epidemiologic data for diets that have been shown to prevent disease and/or positively influence health. In total, evidence from epidemiological studies and clinical trials indicates that these types of dietary patterns reduce risks of NCDs including cardiovascular disease and cancer.
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This is a report published by the Food and Agriculture Organization of the United Nations. Jose Graziano da Silva, outgoing FAO director-general, says: ‘Glad to see FAO report on NOVA classification and ultra-processed food, by Carlos Monteiro and the NUPENS/USP team [ showing] consistent evidence on how the consumption of ultra-processed food causes obesity and many chronic non-communicable diseases’. Carlos Monteiro adds: ‘this is the first time that the peer-reviewed literature linking ultra-processed food intake to diet quality and to risk of non-communicable diseases has been brought together and analysed. This report as published by FAO is a great step forward'. The report examines the peer-reviewed literature on the effects of ultra-processed foods on diet quality and on health. Papers on the effects on diet quality reported results from nineteen nationally-representative studies. Papers on health outcomes reported results from nine nationwide cross-sectional studies, sixteen longitudinal studies and one randomized controlled trial. The results from the studies on diet quality show significant and graded associations between the dietary share of ultra-processed foods and dietary nutrient profiles prone to non-communicable diseases, including high or excessive content of free or added sugar, saturated and trans fats, and sodium, and also high dietary energy density; and low or insufficient content of protein and dietary fibre. The results from the studies on health outcomes show plausible, significant, graded associations between the dietary share of ultra-processed foods and the occurrence or incidence of several non-communicable diseases, including obesity and obesity-related outcomes, cardiovascular and metabolic diseases, breast and all cancers, depression, gastrointestinal disorders, frailty in the elderly, and also premature mortality. In the case of short-term increases in body weight and fat, this is solidly supported by a randomised controlled trial conducted by the US National Institutes of Health. These findings are all fully referenced in the report. Carlos Monteiiro adds: 'The conclusion is clear. Governments at all levels now need to agree and enact statutory including fiscal policies that support and protect enjoyment of freshly prepared meals. Worldwide, these are based on minimally processed foods and include processed culinary ingredients and processed foods. This means enormous opportunities for the food industry as a whole including producers of fresh foods, especially co-operative and family farmers that still produce most food all over the world, and also for producers of processed culinary ingredients and processed foods. At the same time, statutory measures must make ultra-processed foods, which are as great a menace to public health as tobacco, less attractive, affordable and available’. ISBN 978-92-5-131701-3
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The US food supply is dominated by highly-processed packaged food and beverage products that are high in energy, saturated fat, sugar, and salt. We report results of a cross-sectional assessment of the 2018 US packaged food and beverage supply by nutritional composition and indicators of healthfulness and level of processing. Data were obtained through Label Insight’s Open Data database, which represents >80% of all food and beverage products sold in the US over the past three years. Healthfulness and the level of processing, measured by the Health Star Rating (HSR) system and the NOVA classification framework, respectively, were compared across product categories and leading manufacturers. Among 230,156 food and beverage products, the mean HSR was 2.7 (standard deviation (SD) 1.4) from a possible maximum rating of 5.0, and 71% of products were classified as ultra-processed. Healthfulness and level of processing varied substantially by category (range: HSR 1.1–3.9; 0–100% ultra-processed) and manufacturer (range: HSR 0.9–4.6; 26–100% ultra-processed). The US packaged food and beverage supply is large, heterogeneous, highly processed, and generally unhealthy. The wide variability in healthfulness and level of processing demonstrates that opportunities exist, through reformulation or replacement, for large-scale improvements to the healthfulness of the US packaged food and beverage supply.
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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 .
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Objective: To evaluate the association between consumption of ultra-processed foods and all cause mortality. Design: Prospective cohort study. Setting: Seguimiento Universidad de Navarra (SUN) cohort of university graduates, Spain 1999-2018. Participants: 19 899 participants (12 113 women and 7786 men) aged 20-91 years followed-up every two years between December 1999 and February 2014 for food and drink consumption, classified according to the degree of processing by the NOVA classification, and evaluated through a validated 136 item food frequency questionnaire. Main outcome measure: Association between consumption of energy adjusted ultra-processed foods categorised into quarters (low, low-medium, medium-high, and high consumption) and all cause mortality, using multivariable Cox proportional hazard models. Results: 335 deaths occurred during 200 432 persons years of follow-up. Participants in the highest quarter (high consumption) of ultra-processed foods consumption had a higher hazard for all cause mortality compared with those in the lowest quarter (multivariable adjusted hazard ratio 1.62, 95% confidence interval 1.13 to 2.33) with a significant dose-response relation (P for linear trend=0.005). For each additional serving of ultra-processed foods, all cause mortality relatively increased by 18% (adjusted hazard ratio 1.18, 95% confidence interval 1.05 to 1.33). Conclusions: A higher consumption of ultra-processed foods (>4 servings daily) was independently associated with a 62% relatively increased hazard for all cause mortality. For each additional serving of ultra-processed food, all cause mortality increased by 18%.
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Background: The NOVA food classification scheme divides foods into ultra-processed, processed, unprocessed, and culinary ingredients. Ultra-processed foods contribute >60% of energy to diets in the US. Objective: To characterize ultra-processed foods by energy density, nutrient density, and monetary cost. Methods: The 384 component foods of Fred Hutch (FHCRC) food frequency questionnaire (FFQ), were assigned to 4 NOVA categories and to 7 USDA MyPyramid food groups. Energy density was kcal/g. Nutrient density was measured using the Nutrient Rich Food index NRF9.3. Food prices were collected in local supermarkets from 2004 to 2016. Analyses examined time trends in food prices by NOVA category and by USDA food group. Results: The ultra-processed classification captured mostly grains (91%), fats and sweets (73%), dairy (71%), and beans, nuts and seeds (70%), but only 36% of meat, poultry and fish, 26% of vegetables, and 20% of fruit. Compared to unprocessed foods, ultra-processed foods had lower nutrient density (NRF9.3 per 100 kcal: 21.2 vs. 108.5),higher energy density (mean (SD): 2.2 vs. 1.10 in kcal/g), and lower per calorie cost (0.55 vs. 1.45 in $/100 kcal). Ultra-processed foods did not increase in price as much as unprocessed foods over the 12 year period. Conclusion: Ultra-processed foods tend to be energy-dense, low-cost, and nutrient-poor. Low energy cost could be one mechanism linking ultra-processed foods with negative health outcomes. Food-based Dietary Guidelines may need to address food processing in relation to economic aspects of food choice.
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We investigated whether ultra-processed foods affect energy intake in 20 weight-stable adults, aged (mean ± SE) 31.2 ± 1.6 years and BMI = 27 ± 1.5 kg/m2. Subjects were admitted to the NIH Clinical Center and randomized to receive either ultra-processed or unprocessed diets for 2 weeks immediately followed by the alternate diet for 2 weeks. Meals were designed to be matched for presented calories, energy density, macronutrients, sugar, sodium, and fiber. Subjects were instructed to consume as much or as little as desired. Energy intake was greater during the ultra-processed diet (508 ± 106 kcal/day; p = 0.0001), with increased consumption of carbohydrate (280 ± 54 kcal/day; p < 0.0001) and fat (230 ± 53 kcal/day; p = 0.0004), but not protein (-2 ± 12 kcal/day; p = 0.85). Weight changes were highly correlated with energy intake (r = 0.8, p < 0.0001), with participants gaining 0.9 ± 0.3 kg (p = 0.009) during the ultra-processed diet and losing 0.9 ± 0.3 kg (p = 0.007) during the unprocessed diet. Limiting consumption of ultra-processed foods may be an effective strategy for obesity prevention and treatment.
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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.
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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.
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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).
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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. This article is protected by copyright. All rights reserved.
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Background To improve nutritional status and prevent chronic nutrition-related diseases, international organizations have recommended the use of multiple strategies, including front-of-package nutrition labelling (FOPL). In France, the Nutri-Score has been selected by health authorities in March 2017. However, to be effective in purchasing situations, the label needs to be well understood, which may be influenced by label format and sociodemographic characteristics. This study aimed at investigating the objective understanding of the Nutri-Score compared to other label formats, and more particularly among specific at-risk populations. Methods The objective understanding of four FOPLs—namely Nutri-Score, Multiple Traffic Lights (MTL), the simplified nutrition labelling system (SENS), and modified Reference Intakes (mRIs)—was investigated in a sample from the NutriNet-Santé French cohort (n = 3,751). Logistic regression mixed models were computed to assess the association of the four FOPLs, compared to a “no label” situation, on the consumers’ ability to rank products according to their overall nutritional quality. Objective understanding was also investigated according to sociodemographic and lifestyle characteristics. Results Compared to a “no label” situation, all FOPLs were significantly associated to an increase in consumers’ ability to classify the products correctly, with wide disparities in results according to formats. The best performance was observed for the Nutri-Score (OR = 20.33(17.68–23.37)), followed by SENS (OR = 9.57(8.50–10.77)), MTL (OR = 3.55(3.20–3.93)) and mRIs (OR = 1.53(1.39–1.69)). This ranking was similar among all sub-populations and the ORs associated to the Nutri-Score were over 10, whichever the sub-group considered. Women, younger people, non-smokers, individuals with higher educational level and those with children had a higher capacity to identify healthier products (all P≤0.05). Conclusion Nutri-Score, with a summarized graded and color-coded format, using semantic colours, is associated to a higher objective understanding than monochrome and nutrient-specific labels. Furthermore, though objective understanding may differ according to individual characteristics of subjects, the magnitude of effect of the Nutri-Score largely outweighed this effect, even in the at-risk populations.
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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.
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We described the contribution of ultra-processed foods in the U.K. diet and its association with the overall dietary content of nutrients known to affect the risk of chronic non-communicable diseases (NCDs). Cross-sectional data from the U.K. National Diet and Nutrition Survey (2008–2014) were analysed. Food items collected using a four-day food diary were classified according to the NOVA system. The average energy intake was 1764 kcal/day, with 30.1% of calories coming from unprocessed or minimally processed foods, 4.2% from culinary ingredients, 8.8% from processed foods, and 56.8% from ultra-processed foods. As the ultra-processed food consumption increased, the dietary content of carbohydrates, free sugars, total fats, saturated fats, and sodium increased significantly while the content of protein, fibre, and potassium decreased. Increased ultra-processed food consumption had a remarkable effect on average content of free sugars, which increased from 9.9% to 15.4% of total energy from the first to the last quintile. The prevalence of people exceeding the upper limits recommended for free sugars and sodium increased by 85% and 55%, respectively, from the lowest to the highest ultra-processed food quintile. Decreasing the dietary share of ultra-processed foods may substantially improve the nutritional quality of diets and contribute to the prevention of diet-related NCDs.
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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.
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Different interpretative front-of-pack (FOP) nutrition labelling schemes have recently been implemented in several countries but it is still unclear which is the most effective. The present work compared three interpretative schemes (Nutri-score, health star rating and nutritional warnings) in terms of attentional capture, processing time, influence on perceived healthfulness and purchase intention of products with different nutritional profile. Two studies were conducted. In the first study, attention to and processing time for interpretation of FOP labels was evaluated using a visual search task with 112 participants. In the second study, an online survey with 892 participants was conducted to evaluate the influence of interpretive FOP labels on purchase intention and perceived healthfulness of a series of products. A between-subjects design was implemented to compare a control condition (without front-of-pack nutrition information) and the three interpretive FOP schemes. The health star rating was found to perform worse than the other two schemes in terms of capturing attention and altering perceived healthfulness and purchase intention. The latter effect depended on the degree of healthfulness of the food products in question, but the effect on consumer behaviour towards unhealthful product categories was more pronounced for the warning label scheme. From a nutrition policy effectiveness point of view, results suggest that nutritional warnings may have advantages over Nutri-score and the health star rating in the context of the current food environment, characterized by the wide availability of products with high content of nutrients associated with non-communicable diseases.
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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.
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Processing has major impacts on both the structure and composition of food and hence on nutritional value. In particular, high consumption of ultra-processed foods (UPFs) is associated with increased risks of obesity and diabetes. Unfortunately, existing food indices only focus on food nutritional content while failing to consider either food structure or the degree of processing. The objectives of this study were thus to link non-nutrient food characteristics (texture, water activity (aw), glycemic and satiety potentials (FF), and shelf life) to the degree of processing; search for associations between these characteristics with nutritional composition; search for a holistic quantitative technological index; and determine quantitative rules for a food to be defined as UPF using data mining. Among the 280 most widely consumed foods by the elderly in France, 139 solid/semi-solid foods were selected for textural and aw measurements, and classified according to three degrees of processing. Our results showed that minimally-processed foods were less hyperglycemic, more satiating, had better nutrient profile, higher aw, shorter shelf life, lower maximum stress, and higher energy at break than UPFs. Based on 72 food variables, multivariate analyses differentiated foods according to their degree of processing. Then technological indices including food nutritional composition, aw, FF and textural parameters were tested against technological groups. Finally, a LIM score (nutrients to limit) ≥ 8/100 kcal and a number of ingredients/additives > 4 are relevant, but not sufficient, rules to define UPFs. We therefore suggest that food health potential should be first defined by its degree of processing.
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A large body of research data suggests that traditional dietary habits and lifestyle unique to the Mediterranean region (Mediterranean diet, MD) lower the incidence of chronic diseases and improve longevity. These data contrast with troubling statistics in the United States and other high income countries pointing to an increase in the incidence of chronic diseases and the projected explosion in cost of medical care associated with an aging population. In 2013, the MD was inscribed by UNESCO in the “Representative List of the Intangible Cultural Heritage of Humanity.” The 2015–2020 Dietary Guidelines for Americans included the MD as a healthy dietary pattern. Therefore, specific objectives of this article are to provide an overview of the nutritional basis of this healthful diet, its metabolic benefits, and its role in multiple aspects of disease prevention and healthy aging. Whereas recommendations about the MD often focus on specific foods or bioactive compounds, we suggest that the eating pattern as a whole likely contributes to the health promoting effects of the MD.
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Objective To estimate the dietary share of ultra-processed foods and to determine its association with the overall nutritional quality of diets in Brazil. Design Cross-sectional. Setting Brazil. Subjects A representative sample of 32 898 Brazilians aged ≥10 years was studied. Food intake data were collected. We calculated the average dietary content of individual nutrients and compared them across quintiles of energy share of ultra-processed foods. Then we identified nutrient-based dietary patterns, and evaluated the association between quintiles of dietary share of ultra-processed foods and the patterns’ scores. Results The mean per capita daily dietary energy intake was 7933 kJ (1896 kcal), with 58·1 % from unprocessed or minimally processed foods, 10·9 % from processed culinary ingredients, 10·6 % from processed foods and 20·4 % from ultra-processed foods. Consumption of ultra-processed foods was directly associated with high consumption of free sugars and total, saturated and trans fats, and with low consumption of protein, dietary fibre, and most of the assessed vitamins and minerals. Four nutrient-based dietary patterns were identified. ‘Healthy pattern 1’ carried more protein and micronutrients, and less free sugars. ‘Healthy pattern 2’ carried more vitamins. ‘Healthy pattern 3’ carried more dietary fibre and minerals and less free sugars. ‘Unhealthy pattern’ carried more total, saturated and trans fats, and less dietary fibre. The dietary share of ultra-processed foods was inversely associated with ‘healthy pattern 1’ (−0·16; 95 % CI −0·17, −0·15) and ‘healthy pattern 3’ (−0·18; 95 % CI −0·19, −0·17), and directly associated with ‘unhealthy pattern’ (0·17; 95 % CI 0·15, 0·18). Conclusions Dietary share of ultra-processed foods determines the overall nutritional quality of diets in Brazil.
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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.
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Objective To assess the consumption of ultra-processed foods and analyse its association with the content of added sugars in the Chilean diet. Design Cross-sectional study of national dietary data obtained through 24 h recalls and classified into food groups according to the extent and purpose of food processing (NOVA classification). Setting Chile. Subjects A probabilistic sample of 4920 individuals (aged 2 years or above) studied in 2010 by a national dietary survey (Encuesta Nacional de Consumo Alimentario). Results Ultra-processed foods represented 28·6 ( se 0·5) % of total energy intake and 58·6 ( se 0·9) % of added sugars intake. The mean percentage of energy from added sugars increased from 7·7 ( se 0·3) to 19·7 ( se 0·5) % across quintiles of the dietary share of ultra-processed foods. After adjusting for several potential sociodemographic confounders, a 5 percentage point increase in the dietary share of ultra-processed foods determined a 1 percentage point increase in the dietary content of added sugars. Individuals in the highest quintile were three times more likely (OR=2·9; 95 % CI 2·4, 3·4) to exceed the 10 % upper limit for added sugars recommended by the WHO compared with those in the lowest quintile, after adjusting for sociodemographic variables. This association was strongest among individuals aged 2–19 years (OR=3·9; 95 % CI 2·7, 5·9). Conclusions In Chile, ultra-processed foods are important contributors to total energy intake and to the consumption of added sugars. Actions aimed at limiting consumption of ultra-processed foods are being implemented as effective ways to achieve WHO dietary recommendations to limit added sugars and processed foods, especially for children and adolescents.
Poster
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The reductionist approach has been predominant to date in human nutrition research and has unraveled some of the fundamental mechanisms at the basis of food nutrients (e.g., those that involve deficiency diseases). In Western countries, along with progress in medicine and pharmacology, the reductionist approach helped to increase life expectancy. However, despite 40 y of research in nutrition, epidemics of obesity and diabetes are growing each year worldwide, both in developed and developing countries, leading to a decrease in healthy life years. Yet, interactions between nutrition-health relations cannot be modeled on the basis of a linear cause-effect relation between 1 food compound and 1 physiologic effect but rather from multicausal nonlinear relations. In other words, explaining the whole from the specific by a bottom-up reductionist approach has its limits. A top-down approach becomes necessary to investigate complex issues through a holistic view before addressing any specific question to explain the whole. However, it appears that both approaches are necessary and mutually reinforcing. In this review, Eastern and Western research perspectives are first presented, laying out bases for what could be the consequences of applying a reductionist versus holistic approach to research in nutrition vis-a-vis public health, environmental sustainability, breeding, biodiversity, food science and processing, and physiology for improving nutritional recommendations. Therefore, research that replaces reductionism with a more holistic approach will reveal global and efficient solutions to the problems encountered from the field to the plate. Preventive human nutrition can no longer be considered as “pharmacology” or foods as “drugs.” Adv. Nutr. 5: 430–446, 2014.
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With a growing number of prospective cohort studies, an updated dose–response meta-analysis of milk and dairy products with all-cause mortality, coronary heart disease (CHD) or cardiovascular disease (CVD) have been conducted. PubMed, Embase and Scopus were searched for articles published up to September 2016. Random-effect meta-analyses with summarised dose–response data were performed for total (high-fat/low-fat) dairy, milk, fermented dairy, cheese and yogurt. Non-linear associations were investigated using the spine models and heterogeneity by subgroup analyses. A total of 29 cohort studies were available for meta-analysis, with 938,465 participants and 93,158 mortality, 28,419 CHD and 25,416 CVD cases. No associations were found for total (high-fat/low-fat) dairy, and milk with the health outcomes of mortality, CHD or CVD. Inverse associations were found between total fermented dairy (included sour milk products, cheese or yogurt; per 20 g/day) with mortality (RR 0.98, 95% CI 0.97–0.99; I² = 94.4%) and CVD risk (RR 0.98, 95% CI 0.97–0.99; I² = 87.5%). Further analyses of individual fermented dairy of cheese and yogurt showed cheese to have a 2% lower risk of CVD (RR 0.98, 95% CI 0.95–1.00; I² = 82.6%) per 10 g/day, but not yogurt. All of these marginally inverse associations of totally fermented dairy and cheese were attenuated in sensitivity analyses by removing one large Swedish study. This meta-analysis combining data from 29 prospective cohort studies demonstrated neutral associations between dairy products and cardiovascular and all-cause mortality. For future studies it is important to investigate in more detail how dairy products can be replaced by other foods. Electronic supplementary material The online version of this article (doi:10.1007/s10654-017-0243-1) contains supplementary material, which is available to authorized users.
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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)
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Food processing impacts both food structure and nutritional density. The effect of food structure on satiety and glycemic potentials is well recognized. However, association between processing, satiety and glycemic potentials and nutrient profiles has not been much studied, especially in the diets of elderly. Therefore, this study aimed at exploring relations between level of food processing and consumption and nutrient profiles, and satiety and glycemic potentials among 6,686 French elderly people (> 65 years). Dietary assessment was realized through a web-based 24-h dietary record tool. Among a total of 2688 foods, 280 generic foods were aggregated based on a consumption threshold of at least 5% by the population. Satiety potential was calculated by using the Fullness Factor equation, and glycemic potential by using the glycemic index and the glucose glycemic equivalent. Foods and dishes were ranked according to adapted international NOVA classification as raw/minimally-processed (G1), processed (G2) and ultra-processed (G3). ANOVA and correlation analyses showed that the more foods are processed the less their satiety potential and nutrient density and the higher their glycemic impact, especially when comparing G1 and G3. Besides, the foods consumed at the highest amount daily tends to be the most satiating, and ultra-processed foods were among the less frequently consumed both in percentage and daily quantity (around two-fold difference between minimally- and ultra-processed foods). In conclusion, because it is partly related to health food potential, degree of processing, especially for ultra-processed products, should be more taken into consideration in evaluating consumption profiles of different populations.
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Background: Questions remain about the strength and shape of the dose-response relationship between fruit and vegetable intake and risk of cardiovascular disease, cancer and mortality, and the effects of specific types of fruit and vegetables. We conducted a systematic review and meta-analysis to clarify these associations. Methods: PubMed and Embase were searched up to 29 September 2016. Prospective studies of fruit and vegetable intake and cardiovascular disease, total cancer and all-cause mortality were included. Summary relative risks (RRs) were calculated using a random effects model, and the mortality burden globally was estimated; 95 studies (142 publications) were included. Results: For fruits and vegetables combined, the summary RR per 200 g/day was 0.92 [95% confidence interval (CI): 0.90-0.94, I 2 = 0%, n = 15] for coronary heart disease, 0.84 (95% CI: 0.76-0.92, I 2 = 73%, n = 10) for stroke, 0.92 (95% CI: 0.90-0.95, I 2 = 31%, n = 13) for cardiovascular disease, 0.97 (95% CI: 0.95-0.99, I 2 = 49%, n = 12) for total cancer and 0.90 (95% CI: 0.87-0.93, I 2 = 83%, n = 15) for all-cause mortality. Similar associations were observed for fruits and vegetables separately. Reductions in risk were observed up to 800 g/day for all outcomes except cancer (600 g/day). Inverse associations were observed between the intake of apples and pears, citrus fruits, green leafy vegetables, cruciferous vegetables, and salads and cardiovascular disease and all-cause mortality, and between the intake of green-yellow vegetables and cruciferous vegetables and total cancer risk. An estimated 5.6 and 7.8 million premature deaths worldwide in 2013 may be attributable to a fruit and vegetable intake below 500 and 800 g/day, respectively, if the observed associations are causal. Conclusions: Fruit and vegetable intakes were associated with reduced risk of cardiovascular disease, cancer and all-cause mortality. These results support public health recommendations to increase fruit and vegetable intake for the prevention of cardiovascular disease, cancer, and premature mortality.
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Beyond nutritional composition, food structure is increasingly recognized to play a role in food health potential, notably in satiety and glycemic responses. Food structure is also highly dependent on processing conditions. The hypothesis for this study is, based on a data set of 98 ready-to-eat foods, that the degree of food processing would correlate with the satiety index (SI) and glycemic response. Glycemic response was evaluated according to two indices: the glycemic index (GI) and a newly designed index, the glycemic glucose equivalent (GGE). The GGE indicates how a quantity of a certain food affects blood glucose levels by identifying the amount of food glucose that would have an effect equivalent to that of the food. Then, foods were clustered within three processing groups based on the international NOVA classification: (1) raw and minimally processed foods; (2) processed foods; and (3) ultra-processed foods. Ultra-processed foods are industrial formulations of substances extracted or derived from food and additives, typically with five or more and usually many (cheap) ingredients. The data were correlated by nonparametric Spearman's rank correlation coefficient on quantitative data. The main results show strong correlations between GGE, SI and the degree of food processing, while GI is not correlated with the degree of processing. Thus, the more food is processed, the higher the glycemic response and the lower its satiety potential. The study suggests that complex, natural, minimally and/or processed foods should be encouraged for consumption rather than highly unstructured and ultra-processed foods when choosing weakly hyperglycemic and satiating foods.
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Objectives To investigate the contribution of ultra-processed foods to the intake of added sugars in the USA. Ultra-processed foods were defined as industrial formulations which, besides salt, sugar, oils and fats, include substances not used in culinary preparations, in particular additives used to imitate sensorial qualities of minimally processed foods and their culinary preparations. Design Cross-sectional study. Setting National Health and Nutrition Examination Survey 2009–2010. Participants We evaluated 9317 participants aged 1+ years with at least one 24 h dietary recall. Main outcome measures Average dietary content of added sugars and proportion of individuals consuming more than 10% of total energy from added sugars. Data analysis Gaussian and Poisson regressions estimated the association between consumption of ultra-processed foods and intake of added sugars. All models incorporated survey sample weights and adjusted for age, sex, race/ethnicity, family income and educational attainment. Results Ultra-processed foods comprised 57.9% of energy intake, and contributed 89.7% of the energy intake from added sugars. The content of added sugars in ultra-processed foods (21.1% of calories) was eightfold higher than in processed foods (2.4%) and fivefold higher than in unprocessed or minimally processed foods and processed culinary ingredients grouped together (3.7%). Both in unadjusted and adjusted models, each increase of 5 percentage points in proportional energy intake from ultra-processed foods increased the proportional energy intake from added sugars by 1 percentage point. Consumption of added sugars increased linearly across quintiles of ultra-processed food consumption: from 7.5% of total energy in the lowest quintile to 19.5% in the highest. A total of 82.1% of Americans in the highest quintile exceeded the recommended limit of 10% energy from added sugars, compared with 26.4% in the lowest. Conclusions Decreasing the consumption of ultra-processed foods could be an effective way of reducing the excessive intake of added sugars in the USA.
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To date, observational studies in nutrition have categorized foods into groups such as dairy, cereals, fruits, and vegetables. However, the strength of the association between food groups and chronic diseases is far from convincing. In most international expert surveys, risks are most commonly scored as probable, limited, or insufficient rather than convincing. In this position paper, we hypothesize that current food classifications based on botanical or animal origins can be improved to yield solid recommendations. We propose using a food classification that employs food processes to rank foods in epidemiological studies. Indeed, food health potential results from both nutrient density and food structure (i.e., the matrix effect), both of which can potentially be positively or negatively modified by processing. For example, cereal-based foods may be more or less refined, fractionated, and recombined with added salt, sugars, and fats, yielding a panoply of products with very different nutritional values. The same is true for other food groups. Finally, we propose that from a nutritional perspective, food processing will be an important issue to consider in the coming years, particularly in terms of strengthening the links between food and health and for proposing improved nutritional recommendations or actions.
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To present and discuss the dietary guidelines issued by the Brazilian government in 2014. The present paper describes the aims of the guidelines, their shaping principles and the approach used in the development of recommendations. The main recommendations are outlined, their significance for the cultural, socio-economic and environmental aspects of sustainability is discussed, and their application to other countries is considered. Brazil in the twenty-first century. All people in Brazil, now and in future. The food- and meal-based Brazilian Dietary Guidelines address dietary patterns as a whole and so are different from nutrient-based guidelines, even those with some recommendations on specific foods or food groups. The guidelines are based on explicit principles. They take mental and emotional well-being into account, as well as physical health and disease prevention. They identify diet as having cultural, socio-economic and environmental as well as biological and behavioural dimensions. They emphasize the benefits of dietary patterns based on a variety of natural or minimally processed foods, mostly plants, and freshly prepared meals eaten in company, for health, well-being and all relevant aspects of sustainability, as well as the multiple negative effects of ready-to-consume ultra-processed food and drink products. The guidelines' recommendations are designed to be sustainable personally, culturally, socially, economically and environmentally, and thus fit to face this century. They are for foods, meals and dietary patterns of types that are already established in Brazil, which can be adapted to suit the climate, terrain and customs of all countries.
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Associations between food and beverage groups and the risk of diet-related chronic disease (DRCD) have been the subject of intensive research in preventive nutrition. Pooled/meta-analyses and systematic reviews (PMASRs) aim to better characterize these associations. To date, however, there has been no attempt to synthesize all PMASRs that have assessed the relationship between food and beverage groups and DRCDs. The objectives of this review were to aggregate PMASRs to obtain an overview of the associations between food and beverage groups (n = 17) and DRCDs (n = 10) and to establish new directions for future research needs. The present review of 304 PMASRs published between 1950 and 2013 confirmed that plant food groups are more protective than animal food groups against DRCDs. Within plant food groups, grain products are more protective than fruits and vegetables. Among animal food groups, dairy/milk products have a neutral effect on the risk of DRCDs, while red/processed meats tend to increase the risk. Among beverages, tea was the most protective and soft drinks the least protective against DRCDs. For two of the DRCDs examined, sarcopenia and kidney disease, no PMASR was found. Overweight/obesity, type 2 diabetes, and various types of cardiovascular disease and cancer accounted for 289 of the PMASRs. There is a crucial need to further study the associations between food and beverage groups and mental health, skeletal health, digestive diseases, liver diseases, kidney diseases, obesity, and type 2 diabetes.
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This review aims at emphasizing the role played by physical characteristics and physico-chemical properties of food matrix on the digestive and metabolic fate, and health effects of grain products. It is today obvious that the food matrix conditions the health effects of food products and that we are able to modify this matrix to control the digestive fate of foods, and the metabolic fate of nutrients and bioactive compounds (reverse engineering). In other words, there is no more to consider nutrition in a quantitative perspective (i.e., a food is a only sum of macro-, micro- and phyto-nutrients) but rather according to a qualitative perspective involving concepts of interaction of nutrients within the matrix, of enzymatic bio-accessibility, bioavailability and metabolic fate in relation with release kinetics in the gastrointestinal tract, and food nutrient synergy. This new perspective on the food health potential also reflects the urge to consider preventive nutrition research according to a more holistic and integrative perspective after decades of reductionist researches based on the study of the health effects of food components in isolation. To illustrate the importance of food structure, a focus has been made on grain-based products such as rice, leguminous seeds and nuts, and on soft technological treatments that preserve food structure such as pre-fermentation, soaking and germination.
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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).
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Context: The degree of fruit processing is rarely considered in epidemiological studies of fruit consumption. Objective: Pooled analyses and meta-analyses of cohort studies and randomized controlled trials that linked fruit consumption with the risk of chronic disease and metabolic deregulation were reviewed systematically to examine the effects of fruit processing. Data sources: The Web of Science and Cochrane Library databases were searched until June 2018. Search terms, querying the article title only, were based on multiple combinations and included the following: type of publication, fruit products, and chronic diseases and their risk factors. Study selection: The selection of studies and the systematic review were carried out in accordance with the PRISMA statement. Data extraction: The literature search identified 189 pooled analyses and meta-analyses, 10 of which met the inclusion criteria. Results: The results showed that the degree of processing influences the health effects of fruit-based products. Fresh and dried fruits appeared to have a neutral or protective effect on health, 100% fruit juices had intermediary effects, and high consumption of canned fruit and sweetened fruit juice was positively associated with the risk of all-cause mortality and type 2 diabetes, respectively. Conclusions: The results support the need to consider the degree of food processing in future epidemiological studies and randomized controlled trials in order to adjust official recommendations for fruit consumption.
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There is increasing recognition of the link between the degree of processing of foods and their health potential, hence the need to rethink the classification of food to issue nutritional guidelines. In food technology, the impact of processes on this potential can be addressed through a holistic or reductionist approach, by focusing on the whole or the parties, or both at once. This seems to be the best compromise to avoid the pitfalls linked to the exclusive adherence to one or other of the approaches.
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Abstract The present study explored the consumption of ultra-processed foods and its association with food addiction in overweight children. The prevalence of food addiction was investigated using the Yale Food Addiction Scale for Children in overweight 9-11 year-old children (BMI/age ≥1 Z score) of both sexes from two schools (n = 139). Food intake was estimated by a food frequency questionnaire and the food items were classified into 4 categories: minimally processed, culinary ingredients, processed foods and ultra-processed foods (UPF), based on their degree of processing. Among the children, 95% showed at least one of the seven symptoms of food addiction and 24% presented with a diagnosis of food addiction. In analysis of covariance adjusted for age and sex, a tendency of higher consumption of added sugar (refined sugar, honey, corn syrup) and UPF was found among those diagnosed with food addiction. Multiple logistic regression adjusted for sugar, sodium and fat ingestion showed that consumption of cookies/biscuits (OR = 4.19, p = 0.015) and sausages (OR = 11.77, p = 0.029) were independently associated with food addiction. The identification of foods that may be associated with addictive behavior is very important for correctly treating and preventing childhood obesity, which continues to be one of the greatest health problems in the world.
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Objectives: Ultra-processed foods (UPF) consumption has increased over the last decades and is raising concerns about potential adverse health effects. Our objective was to assess the association between UPF consumption and four functional gastrointestinal disorders (FGIDs): irritable bowel syndrome (IBS), functional constipation (FC), functional diarrhea (FDh), and functional dyspepsia (FDy), in a large sample of French adults. Methods: We analyzed dietary data of 33,343 participants from the web-based NutriNet-Santé cohort, who completed at least three 24 h food records, prior to a Rome III self-administered questionnaire. Proportion (in weight) of UPF in the diet (UPFp) was computed for each subject. The association between UPFp quartiles and FGIDs was estimated by multivariable logistic regression. Results: Participants included in the analysis were mainly women (76.4%), and the mean age was 50.4 (SD = 14.0) years. UPF accounted for 16.0% of food consumed in weight, corresponding to 33.0% of total energy intake. UPF consumption was associated with younger age, living alone, lower incomes, higher BMI, and lower physical activity level (all p < 0.0001). A total of 3516 participants reported IBS (10.5%), 1785 FC (5.4%), 1303 FDy (3.9%), and 396 FDh (1.1%). After adjusting for confounding factors, an increase in UPFp was associated with a higher risk of IBS (aOR Q4 vs. Q1 [95% CI]: 1.25 [1.12-1.39], p-trend < 0.0001). Conclusions: This study suggests an association between UPF and IBS. Further longitudinal studies are needed to confirm those results and understand the relative impact of the nutritional composition and specific characteristics of UPF in this relationship.
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We propose an empirical study of French sales in conventional food retailing and in specialised organic stores for 2012. We examine the plant or animal origin of food products, as an indicator of the environmental and health impacts of sales, and their degree of processing, as an indicator of their health impact. The results indicate that sales of organic food products are more plant-based and less processed in specialised organic stores than in conventional retail stores, two criteria for a better health and environmental impact. In conventional stores, organic sales are more plant-based and less processed than conventional sales. Organic sales in conventional stores show some specificity, having the highest share of particular product ranges lacking a clear health or environmental impact, such as processed culinary ingredients or unprocessed or minimally processed animal products. Building a typology of buyers in conventional stores, we find that even purchases by buyers with the highest organic purchase intensity in conventional stores are less plant-based and more processed than average purchases in specialised organic stores. Our results characterise to what extent some of the holistic environmental and health impacts of organic agriculture are lower in conventional retail stores than in specialised organic stores in France in 2012.
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Pour prévenir les maladies chroniques liées à l’industrialisation, l’effet “matrice” d’un aliment participe davantage de son action sur la santé que sa composition nutritionnelle. Il influence notamment la cinétique de libération des nutriments dans le tube digestif, leur biodisponibilité et donc leurs effets métaboliques, mais aussi le sentiment de satiété. Il correspond à une vision holistique de l’aliment reflétant que le tout est supérieur à la somme des parties
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Objective Concerns have been raised about the potential health impact of ultra-processed foods (UPF) in the diet. Our objective was to investigate the contribution of UPF in the diet in a large French population and its association with sociodemographic factors and dietary patterns. Design Cross-sectional analysis of dietary data from 74 470 participants in the web-based NutriNet-Santé cohort. UPF were identified in repeated 24 h records and the proportion (in weight) of UPF in the total diet (UPFp) was computed for each participant. Associations of sociodemographic characteristics and UPFp in quartiles were assessed using multivariate multinomial logistic regression. Food group consumption and nutrient intakes across quartiles of UPFp were estimated using linear regression adjusted for sociodemographic factors and energy intake. Setting France. Results UPF contributed 18·4 % of the foods consumed in weight and 35·9 % of total energy intake. Higher UPFp consumption was independently associated with male gender, younger age, lower education, smoking, and overweight and obesity (all P <0·0001). Participants in the highest UPFp quartile consumed lower amounts of fruit and vegetables (difference between quartile 4 and quartile 1 of UPFp, Δ=−180·3 g/d) and higher amounts of sweet products (Δ=68·5 g/d) and soft drinks (Δ=98·6 g/d; all P <0·0001). They had higher intakes of energy (Δ=610 kJ/d (145·7 kcal/d)) and added sugar (Δ=17·1 g/d), and lower intakes of fibre (Δ=−4·04 g/d), β-carotene (Δ=−1019·6 μg/d) and Ca (Δ=−87·8 mg/d; all P <0·0001). Conclusions UPF represent an important part of the diet in adults from the French general population and are associated with unbalanced nutritional intakes.
Article
Objective To assess associations between three diet quality indices and metabolic syndrome (MetS) in the Cree (Eeyouch) of northern Québec, Canada, as well as to evaluate their pertinence in this Indigenous context. Design The alternative-Healthy Eating Index 2010 (aHEI-2010), the Food Quality Score (FQS) and the contribution of ultra-processed products (UPP) to total daily dietary energy intake using the NOVA classification were calculated from 24 h food recalls. MetS was determined with the latest harmonized definition. Logistic regressions assessed the relationship between quintiles of dietary quality scores with MetS and its components. Setting Study sample from the 2005–2009 cross-sectional Nituuchischaayihititaau Aschii Environment-and-Health Study. Subjects Eeyouch ( n 811) from seven James Bay communities (≥18 years old). Results MetS prevalence was 56·6 % with 95·4 % abdominal adiposity, 50·1 % elevated fasting plasma glucose, 43·4 % hypertension, 38·6 % elevated TAG and 44·5 % reduced HDL cholesterol. Comparing highest and lowest quintiles of scores, adjusted OR (95 % CI) of MetS was 0·70 (0·39, 1·08; P -trend=0·05) for aHEI-2010, 1·06 (0·63, 1·76; P -trend=0·87) for FQS and 1·90 (1·14, 3·17; P -trend=0·04) for the contribution of UPP to total daily dietary energy intake. Conclusions Although diet quality indices have been associated with cardiometabolic risk, only the dietary intake of UPP was significantly associated with MetS in the Eeyouch. Indices tailored to the food environment of northern communities are essential to further understand the impact of diet quality in this context.
Article
This study describes food consumption patterns in Canada according to the types of food processing using the Nova classification and investigates the association between consumption of ultra-processed foods and the nutrient profile of the diet. Dietary intakes of 33,694 individuals from the 2004 Canadian Community Health Survey aged 2 years and above were analyzed. Food and drinks were classified using Nova into unprocessed or minimally processed foods, processed culinary ingredients, processed foods and ultra-processed foods. Average consumption (total daily energy intake) and relative consumption (% of total energy intake) provided by each of the food groups were calculated. Consumption of ultra-processed foods according to sex, age, education, residential location and relative family revenue was assessed. Mean nutrient content of ultra-processed foods and non-ultra-processed foods were compared, and the average nutrient content of the overall diet across quintiles of dietary share of ultra-processed foods was measured. In 2004, 48% of calories consumed by Canadians came from ultra-processed foods. Consumption of such foods was high amongst all socioeconomic groups, and particularly in children and adolescents. As a group, ultra-processed foods were grossly nutritionally inferior to non-ultra-processed foods. After adjusting for covariates, a significant and positive relationship was found between the dietary share of ultra-processed foods and the content in carbohydrates, free sugars, total and saturated fats and energy density, while an inverse relationship was observed with the dietary content in protein, fiber, vitamins A, C, D, B6 and B12, niacin, thiamine, riboflavin, as well as zinc, iron, magnesium, calcium, phosphorus and potassium. Lowering the dietary share of ultra-processed foods and raising consumption of hand-made meals from unprocessed or minimally processed foods would substantially improve the diet quality of Canadian.
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Using the satiety cascade model as a framework, this paper describes how food texture can influence the strength and duration of sensory, cognitive and post-ingestive signals that determine when a meal ends (satiation) and the inhibition of appetite between meals (satiety). The influence of food texture on oro-sensory exposure time, expectations about the satiating effect of a food and processing of food in the gastrointestinal system is considered, as well how the interaction of these processes may impact on the overall experience of satiety. This body of work suggests that texture is one element of a food's flavour profile which could be a candidate for manipulation in the development of ‘high-satiety’ foods.