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The holistico-reductionist Siga classification according to degree of food processing: An evaluation of ultra-processed foods in French supermarkets
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.
... Based on Brazilian research works, an UPF may be simply and briefly defined as containing at least one marker of ultra-processing (MUP) (Davidou et al., 2020) or cosmetic agents (Monteiro et al., 2019) of strictly industrial use to modify organoleptic properties such as color, aroma, taste, and texture. Therefore, the intent of ultra-processing is cosmetic, since other added agents that prolong product duration, protect original properties, and prevent proliferation of microorganisms (e.g., preservative, antioxidants, and anti-microbial compounds) are not considered MUPs (Monteiro et al., 2019). ...
... Otherwise, NOVA being holistic and qualitative in essence, it does not include all scientific criteria relating foods and human health (Fardet, 2018). Based on this observation, we incremented it via the addition of new and previously scientifically validated qualitative/quantitative and more reductionist criteria in the Siga score (Davidou et al., 2020). We took into account, first, food matrix modification in NOVA 1, which is split into two sub-groups, that is, unprocessed and minimally processed foods. ...
... We also took into account the level of added salt, fat, and/or sugars in NOVA 3 and 4 (splitting into two sub-groups according to the published Food Standard Agency/FSA thresholds). Finally, we considered the number of MUPs in NOVA 4 group, finally leading to seven food groups according to a decision tree combining NOVA groups first, and then, applying more reductionist criteria (Davidou et al., 2020). But, again, the matrix effect is at the core of the Siga classification, not nutrient composition. ...
The ultra‐processed food (UPF) concept first emerged 15 years ago, and is now studied worldwide in different contexts, for example, human health, food behavior, socio‐economic, food consumption, food scoring, and food system sustainability. Briefly, UPFs are defined as containing at least one marker of ultra‐processing (MUP). MUPs are (1) cosmetic additives, (2) aromas, (3) some highly processed carbohydrates, proteins, fats, and/or fiber, and (4) drastic processes directly applied to food such as extrusion cooking or puffing. The first three categories of MUPs are on the food packaging in the list of ingredients, and are extracted, then purified, from raw foods or coming from artificial syntheses, leading to a‐matrix/a‐cellular compounds. Therefore, the core paradigm to define MUP is extreme food matrix degradation, and for UPF, matrix artificialization. Besides, UPFs are more than just junk food, encompassing numerous industrialized foods, falsely presented as healthy, for example, animal‐based food analogs, but also organic, vegan, gluten‐free, micronutrient‐enriched, and/or light foods. In this way, UPFs are “high‐quality junk foods.” Otherwise, UPF being a holistic and indivisible concept by essence, we propose in this review to analyze ultra‐processing at four holistic levels corresponding to four important scientific issues: the food matrix, the dietary pattern, food system, and food scoring. We reached the main conclusion that UPFs should be first studied with a holistic and scientifically based approach, not a reductionist one. Otherwise, we take the risk of performing greenwashing and create still more new health threats at a global level.
... A food product is defined as NOVA group 4 if its ingredient list contains at least one cosmetic additive or non-culinary ingredient (13) . Even in the absence of cosmetic additives or non-culinary ingredients, a food item is also regarded as UPF if some drastic processes are applied directly to the food, for example, extrusion, hydrogenation, hydrolysation, moulding, pre-frying or puffing (3,13,14) . ...
... Focusing on cosmetic additives and non-culinary ingredients has been suggested as one approach to simplify the assessment of UPF (13) . Davidou and co-workers were the first to define a specific and exhaustive list of markers of ultra-processing (MUP) for the NOVA-based Siga classification (14) . However, more than 100 different MUP have been described (3,13,14) which makes the detection of UPF difficult. ...
... Davidou and co-workers were the first to define a specific and exhaustive list of markers of ultra-processing (MUP) for the NOVA-based Siga classification (14) . However, more than 100 different MUP have been described (3,13,14) which makes the detection of UPF difficult. Therefore, the present study elucidates which MUP and combinations of them are best suited to detect UPF in a UK food market analysis. ...
Objective
To elucidate which markers of ultra-processing (MUPs) and their combinations are best suited to detect ultra-processed food (UPF).
Design
The study was based on the 206 food and 32 beverage items of the Oxford WebQ which encompass all major foods consumed in the UK. For each Oxford WebQ question, ingredient lists of up to ten matching different commercial products (n = 2,146) were researched online using data from the two market leaders of groceries in the UK sorted by relevance (Tesco) and by top sellers (Sainsbury’s), respectively. According to the NOVA classification, 65 MUPs were defined and if the ingredient list of a food product was positive for at least one MUP, it was regarded as UPF. The percentage of UPF items containing specific MUPs was calculated. In addition, all combinations of two to six different MUPs were assessed concerning the percentage of identified UPF items.
Setting
Cross-sectional analysis
Participants
None
Results
A total of 990 products contained at least one MUP and were, therefore, regarded as UPF. The most frequent MUPs were flavour (578 items, 58.4 % of all UPF), emulsifiers (353 items, 35.7 % of all UPF), and colour (262 items, 26.5 % of all UPF). Combined, these three MUPs detected 79.2 % of all UPF products. Detection rate increased to 88.4 % of all UPF if ingredient lists were analysed concerning three additional MUPs, i.e., fibre, dextrose, and firming agent.
Conclusions
Almost 90 % of all UPF items can be detected by six 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. ...
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. ...
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]. ...
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.
... 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. ...
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.
... 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. ...
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.
... Recent studies suggest that a new classification system combining the level of processing and nutritional profile may be a valid alternative to existing methods [23][24][25]. In accordance with this evidence and other previously developed systems available in the literature [26], a modified version of the NOVA classification, called 'modified NOVA' (mNOVA), was developed. In the mNOVA, the groups 3 (processed foods) and 4 (UPFs) are in turn divided into two subgroups of foods (3a and 3b, 4a and 4b), based on the salt, sugar, and fat thresholds recommended by the Food Standard Agency (FSA) [27] (Figure 1). ...
... In the mNOVA, the groups 3 (processed foods) and 4 (UPFs) are in turn divided into two subgroups of foods (3a and 3b, 4a and 4b), based on the salt, sugar, and fat thresholds recommended by the Food Standard Agency (FSA) [27] (Figure 1). literature [26], a modified version of the NOVA classification, called 'modified NOVA' (mNOVA), was developed. In the mNOVA, the groups 3 (processed foods) and 4 (UPFs) are in turn divided into two subgroups of foods (3a and 3b, 4a and 4b), based on the salt, sugar, and fat thresholds recommended by the Food Standard Agency (FSA) [27] ( Figure 1). ...
Background: Over the last decade, while studies on the detrimental effects of ultra-processed food (UPF) consumption have increased, methodological limitations on the quality of available evidence have emerged. Starting from a critical reassessment of the NOVA classification, this project will aim to develop and validate a food frequency questionnaire (FFQ), which is based on the processing of consumed foods and specifically designed to estimate the UPF consumption and total dietary intake of macro- and micronutrients in the Italian adult population. Methods: This study will take place in selected workplaces and include healthy males and females aged ≥18 years, residing in Italy and with Italian citizenship. The FFQ will be online, voluntary, self-administered, semi-quantitative, and designed to assess food intake over the past year and distinguish between industrial, artisanal, and home-made products. This project will consist of two phases. First, a pilot study will be conducted to obtain the final version of the FFQ. The current food consumption of the target population will be investigated, through a 24 h dietary recall, and the face validity of the new tool will be tested. The second phase will involve at least 436 participants. To assess reproducibility, the FFQ will be administered twice (at an interval of 3–10 months), and the test–retest method will be used. A 7-day weighed dietary record (WDR) will also be completed after each FFQ administration. To evaluate criterion validity, data from the two WDRs will be compared against those from the first FFQ administration. Conclusions: The results will provide a new valid tool focused on food processing, potentially useful for future studies.
... Going one step further, Siga introduces markers of ultra-processing, defining them as "deliberately added substances obtained by synthesis or by a succession of physical, chemical, biological processes leading to their purification and/or high deterioration compared to the original material". According to this classification, ultraprocessed foods contain at least one marker of ultra-processing (Davidou et al. 2020(Davidou et al. , 2021. However, this does not solve the semantical problem, as the strict understanding of the prefix "ultra" (Merriam-Webster 2023c) may imply that "ultra-processed foods" have simply gone through more extensive processing than "processed foods", which may not necessarily be the case (Levine & Ubbink 2023). ...
... Even though the presence of certain ingredients (or their combination) is used as an indication of (ultra-) processing, some proponents of Nova and Siga questioned the value of a "reductionistic approach", referring to the calculation of nutritional values of a food item, citing that "considering foods as only sums of nutrients" fails to note "all unhealthy foods that can be well rated nutritionally, although they are highly processed and contain many additives or hidden sugars and have lost their "matrix" effect through fractionation or extrusioncooking" (Davidou et al. 2020;Fardet & Rock 2018, 2019, 2022b. The argument is that the "health potential" of a food is not "primarily and only associated with its nutritional composition", and that the key is in preserving the original food "matrix" (Fardet & Rock 2022a). ...
There are several classifications of foods that also include the level of their processing, with NOVA classification appearing to be the most adopted. However scientific consensus is still missing on how to define, characterize and classify food processing. The classifications are typically based on the health impacts of foods and do not fully include the engineering perspective of processing, i.e., the application of physical, chemical, or biotechnological unit operations during food manufacturing, and the composition of a food product.
This review offers an engineering perspective and definition of food processing, based on the change of mass and energy, allowing distinguishment of the impacts caused by food processing during the biomass transformation to food products. The improved understanding of the causes of undesired changes in food properties could be used for nutritional public policy recommendations and would contribute to combating some of the chronic diseases related to food consumption patterns.
Proposed is the definition of “Food processing” as a sum of all intentional additions or removals of either edible matter or energy (except for any transport or for removal of inedible parts of food) between the harvest of ingredients and consumption of the product.
... This leads to an unconscious consumption that alters neural and digestive functions, which dysregulate hunger perception and satiety levels, which in turn leads to excessive consumption [73,74]. Furthermore, it has been shown that these foods-precisely because they are poor from a nutritional point of view (in particular in fiber, micronutrients and bioactive compounds [21,63]) but rich in saturated and trans fatty acids, sodium, and refined sugars-reduce satiety levels and therefore increase the glycemic response, altering the insulin response [75], which leads to a greater search for food, favoring a greater energy intake [76] and establishing a serious vicious circle which over time leads to excess weight. ...
... What are the consequences? At this point, we need to introduce the term "reconstitution": ingredients used in the manufacturing process are reconstituted through various operations such as the hydrogenation of fats, the extrusion of cereals, and the mechanical extraction of meat which modify the chemical-physical structure of the food matrix, generating new substances [75,76]. The list of ingredients present in UPF foods is very long, among which we also find colorants, artificial sweeteners such as aspartame, saccharin, and acesulfame K, and emulsifiers [88,89]. ...
The prevalence of obesity has become a global health concern, with significant impacts on quality of life and mortality rates. Recent research has highlighted the role of ultra-processed foods (UPFs) in driving the obesity epidemic. UPFs undergo extensive processing, often containing high levels of sugars, fats, and additives, while lacking essential nutrients. Studies have linked UPF consumption to obesity and cardiometabolic diseases, underscoring the importance of dietary patterns rich in whole foods. Thus, the aim of this narrative review is to elucidate the correlation between ultra-processed foods and the increased trend of obesity and its related complications. These foods, prevalent in modern diets, contribute to nutritional deficiencies and excessive caloric intake, exacerbating obesity rates. Lifestyle factors such as busy schedules and quick meal management further drive UPF consumption, disrupting hunger regulation and promoting overeating. UPF consumption correlates with adverse health outcomes, including dyslipidemia, hypertension, and insulin resistance. Promoting whole, minimally processed foods and implementing school-based nutrition education programs are crucial steps. Also, numerous challenges exist, including unequal access to healthy foods, the industry’s influence, and behavioral barriers to dietary change. Future research should explore innovative approaches, such as nutrigenomics and digital health technologies, to personalize interventions and evaluate policy effectiveness. Collaboration across disciplines and sectors will be vital to develop comprehensive solutions and improve public health outcomes globally.
... There are currently at least six different systems that are used to classify foods by their degree of processing including the European Prospective Investigation into Cancer (3) , the International Food Information Council (4) , the Siga classification (5) , the University of North Carolina (6) , NOVA and more recently the Food Compass system (7) . The NOVA system has evolved considerably since its initial introduction, initially focusing on number of ingredients and processes and more recently evolving to include the 'purpose of processing' as a central component of the definition (8) . ...
... Despite the demonstrated efficacy of reformulation and fortification efforts to enhance public health, there remains resistance among some opponents of food processing that believe that any effort to reformulate the food supply can only make a food even more ultraprocessed (56) . Similarly efforts to support the protein transition from animal to plant-based sources of meat Beyond ultra-processed: considering the future role of food processing in human health 5 and dairy have been criticised as promoting a UPF environment (18) . Irrespective of these concerns, reformulation remains a fact of life, and will continue to be central to efforts to improve the nutrient density and sustainability of food production and distribution (37) . ...
Food-based dietary guidelines have been the basis of public health recommendations for over half a century, but more recently, there has been a trend to classify the health properties of food not by its nutrient composition, but by the degree to which it has been processed. This concept has been supported by many association studies, narrative reviews and the findings from one randomised controlled feeding trial, which demonstrated the sustained effect of ultra-processed diets on increasing both energy intake and body weight. This has led to widespread speculation as to specific features of ultra-processed foods that promote increased energy intakes. Rising interest in the ultra-processed topic has led to proposals to include guidance and restrictions on the consumption of processed foods in national dietary guidelines, with some countries encouraging consumers to avoid highly processed foods completely, and only choose minimally processed foods. However, there remains a lack of consensus on the role of processed foods in human health when faced with the challenges of securing the food supply for a growing global population, that is, healthy, affordable and sustainable. There has also been criticism of the subjective nature of definitions used to differentiate foods by their degree of processing, and there is currently a lack of empirical data to support a clear mechanism by which highly processed foods promote greater energy intakes. Recommendations to avoid all highly processed foods are potentially harmful if they remove affordable sources of nutrients and will be impractical for most when an estimated two-thirds of current energy purchased are from processed or ultra-processed foods. The current review highlights some considerations when interpreting the dietary association studies that link processed food intake to health and offers a critique on some of the mechanisms proposed to explain the link between ultra-processed food and poor health. Recent research suggests a combination of higher energy density and faster meal eating rates are likely to influence meal size and energy intakes from processed foods and offers new perspectives on how to manage this in the future. In going beyond the ultra-processed debate, the aim is to summarise some important considerations when interpreting existing data and identify the important gaps for future research on the role of processed food in health.
... such as the Health Star Rating (HSR) in Australia and Aotearoa New Zealand (65), and the Nutri-Score in Europe (66). Alternatively, Davidou et al. have proposed the Siga classification as a variation on the NOVA criteria, whereby the UPF category is subdivided into three subcategories, enabling further classification and differentiation of UPFs (67). Nutritionally balanced UPFs (i.e., lower in added sugar, fat, and salt content), with one marker of ultra-processing (MUP), were assessed more favorably than nutritionally unbalanced UPFs with one MUP, or products with more than one MUP (67). ...
... Alternatively, Davidou et al. have proposed the Siga classification as a variation on the NOVA criteria, whereby the UPF category is subdivided into three subcategories, enabling further classification and differentiation of UPFs (67). Nutritionally balanced UPFs (i.e., lower in added sugar, fat, and salt content), with one marker of ultra-processing (MUP), were assessed more favorably than nutritionally unbalanced UPFs with one MUP, or products with more than one MUP (67). The Siga classification could also serve as a tool to nudge upcycled food production toward healthier end products. ...
One of the aims of the United Nations Sustainable Development Goals (SDG) is to end hunger and ensure access by all people to safe, nutritious, and sufficient food all year round. An obvious synergy exists between the second SDG “Zero Hunger” and SDG target 12.3 which focuses on halving food waste and reducing food losses. In addition to helping improve global food security, reducing food waste provides financial and environmental benefits. Upcycling food is a technical solution for food waste reduction that retains the nutritional and financial value of food by-products. However, many of the upcycled foods produced are discretionary foods such as biscuits, crackers, and other snack food that are not part of a healthy dietary pattern, and should only be eaten sometimes in small amounts. Given the importance of ensuring a sustainable healthy diet, this paper discusses opportunities for upcycled food manufacturers to produce more nutritious products.
... 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]. ...
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.
... 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. ...
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.
... 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. ...
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.
... To teach the algorithm how to score processing from nutrients, labels provided by NOVA-the most widely used system for classifying foods based on processing-related criteria-were leveraged, offering a rich array of epidemiological literature for comparative analysis 9,38,39 . However, the FPro algorithm can accommodate different food processing classification systems such as the European Prospective Investigation into Cancer and Nutrition (EPIC) 40 , University of North Carolina (UNC) 41 or Système d'Information et de Gestion des Aliments (SIGA) 42 . The predictive power of FPro was rigorously tested for epidemiological outcomes with an Environment-Wide Association Study, leveraging multiple cycles of the USDA model food databases and national food consumption surveys 37 . ...
The offering of grocery stores is a strong driver of consumer decisions. While highly processed foods such as packaged products, processed meat and sweetened soft drinks have been increasingly associated with unhealthy diets, information on the degree of processing characterizing an item in a store is not straightforward to obtain, limiting the ability of individuals to make informed choices. GroceryDB, a database with over 50,000 food items sold by Walmart, Target and Whole Foods, shows the degree of processing of food items and potential alternatives in the surrounding food environment. The extensive data gathered on ingredient lists and nutrition facts enables a large-scale analysis of ingredient patterns and degrees of processing, categorized by store, food category and price range. Furthermore, it allows the quantification of the individual contribution of over 1,000 ingredients to ultra-processing. GroceryDB makes this information accessible, guiding consumers toward less processed food choices.
... 50 The SIGA classification may be preferable as it offers a more nuanced categorisation based on the extent of processing and formulation. 51 However, the assessment of the SIGA classification necessitates detailed information from manufacturers, which is not readily accessible from dietary intake data. The NOVA classification was employed, as it is the most utilised in epidemiological research, thereby facilitating comparability across studies. ...
Objective
The aim was to assess ultra‐processed food (UPF) consumption, its impact on overweight and its association with weight trends from childhood and adolescence to young adulthood.
Methods
Long‐term UPF consumption (13.3 years) by NOVA was analysed (children/adolescents and adults, n = 182) in the Kiel Obesity Prevention Study (KOPS, n = 10 750).
Results
In children/adolescents (13.1 ± 1.9 years), a UPF‐based dietary pattern showed an inverse association with BMI‐SDS and fat mass index (males: r = −0.301, p = 0.01; r = −0.376, p = 0.001; females: r = −0.315, p < 0.001; r = −0.282, p = 0.003). Longitudinal analysis indicated that UPF consumption in childhood and adolescence was correlated with UPF consumption in adulthood among females (r = 0.272; p = 0.004) but not among males. In young adults (26.7 ± 2.2 years), UPF consumption accounted for nearly 50% of daily energy intake and was higher with overweight compared to normal weight and in incident overweight compared to persistent normal weight (both p < 0.05). High UPF consumption was associated with markers of poor diet quality (lower intake of fibre, higher intake of salt and energy‐dense food, all p < 0.05).
Conclusions
High UPF consumption in young adults was associated with both prevalence and incidence of overweight from childhood and adolescence to adulthood.
... Individuare gli UPF non sempre è semplice, pertanto sono state create numerose classificazioni per poter definire i cibi in base alle loro caratteristiche e poterli classificare in base al loro grado di preparazione. Ne esistono di numerose, le principali sono: la classificazione NOVA ideata dal ricercatore brasiliano Carlos Augusto Monteiro con la sua equipe (5) ; la classificazione SIGA (6) (Système d'Information sur la Composition et la Transformation des Aliments) sviluppata in Francia per valutare gli alimenti, basata sul livello di trasformazione degli ingredienti e la qualità nutrizionale; la classificazione Food Compass (7) sistema di valutazione sviluppato dal Friedman School of Nutrition Science and Policy della Figura 1 | Esempi di cibi distribuiti nella piramide alimentare basata sulla classificazione NOVA, secondo i criteri stabiliti da Monteiro et al (5) . I diversi colori (verde chiaro, verde, arancione e rosso) rappresentano il grado di lavorazione; i colori verdi (MPF e PCI) hanno il livello più basso di lavorazione industriale, l'arancione (PF) ha un livello modesto e il rosso (UPF) ha il livello più intensivo. ...
Da sempre l’uomo ha sviluppato tecniche per trasformare e conservare gli alimenti. Con l’evolvere della tecnologia, si sono affinate tecniche volte non solo alla conservazione ma anche al miglioramento nutrizionale e della palatabilità dei cibi. I cibi ultra-processati (UPF) sono alimenti che hanno subito una serie di trasformazioni industriali comprendenti processi chimici e fisici complessi. Sono alimenti pronti al consumo o da riscaldare, che contengono, tra gli altri, ingredienti inusuali nella cucina tradizionale, come coloranti, conservanti, esaltatori di sapidità, edulcoranti e altri additivi. Il consumo di UPF è in aumento e rappresenta oggi una porzione significativa dell’energia alimentare nei paesi ad alto reddito. Questo articolo esamina criticamente la letteratura scientifica per chiarire la relazione tra il consumo tra UPF e la salute. Analizza anche i meccanismi biologici sottostanti e valuta l’impatto a lungo termine di questi alimenti sulla salute umana. La classificazione NOVA, utilizzata per identificare gli UPF, divide gli alimenti in quattro gruppi basati sul grado di trasformazione. Studi epidemiologici collegano il consumo eccessivo di UPF a obesità, malattie cardiovascolari, diabete mellito tipo 2. Anche se sono necessari studi per migliorare la classificazione degli UPF, ridurre il loro consumo e promuovere una dieta equilibrata, ricca di cibi minimamente trasformati, potrebbe avere un impatto positivo a lungo termine sulla salute pubblica. PAROLE CHIAVE: alimenti ultra-processati; trasformazione alimentare; classificazione NOVA; additivi; diabete mellito tipo 2.
... On distingue quatre types d'agents cosmétiques que vous n'utilisez pas en cuisine, ou marqueur d'ultratransformation (MUT) (FARDET, 2023) : 1) les additifs cosmétiques (texturants, colorants et modificateurs de goût types édulcorants, correcteur d'acidité…), 2) les arômes (naturels, de synthèse, extraits), 3) les autres protéines, graisses, fibres et sucres ultra-transformés (sirop de glucose, dextrose, sucre inverti, graisses inter-estérifiées, isolats de fibres et protéines…), et 4) des procédés technologiques drastiques comme la cuissonextrusion (snacks sucrés/salés, céréales du petit-déjeuner pour enfants…) ou le soufflage (galettes de riz blanc soufflées, popcorns industriels…). Au-delà de 5 ingrédients sur l'emballage, on a 8 chances sur 10 au minimum que l'aliment soit un AUT (DAVIDOU & al., 2020). En outre, les AUT ont souvent des emballages très colorés et attractifs, avec souvent des personnages de l'univers des enfants, des mentions nutritionnelles trompeuses du type « enrichi en… », « source de… », « allégés en… », « céréales complètes… », des portions individualisées, et/ou des promotions. ...
L’alimentation préventive et durable est une discipline scientifique holistique par essence. Pour éviter l’écueil de l’approche en silo et réductionniste, entrainant du greenwashing, à savoir « verdir » une dimension seulement de l’ensemble, nous avons développé en 2016 la règle simple, générique, holistique et qualitative des 3VBLS (Vrai, Végétal, Varié, si possible Bio, Local et/ou de Saison) pour protéger la santé globale, humaine et planétaire (approche « one health »). Dans cet article nous en expliquerons brièvement sa genèse empirique, basée sur la redéfinition du potentiel santé d’un aliment et sur la dimension émergeante du degré de transformation des aliments. Puis nous présenterons son application dans trois pays, la France, la Chine et l’Inde. Au final, les 3VBLS constituent une métrique simple d’appropriation et facile d’utilisation au quotidien.
... The Siga classification scheme combines the 4 NOVA group classifications with additional subgroups (applied only within ultra-processed and processed food classifications) that consider elements including contents of added sugar, salt and fat and the number and type of markers of ultra-processing. 37 A similar 'top-down' (i.e. starting with processing and then nutritional composition) food classification system has been proposed by researchers for use in Australia. 38 The Pan American Health Organisation's Nutrient Profile Model employs nutrient-criteria, but only applies the criteria to processed and ultra-processed products. ...
Aim
To modify the Australian and New Zealand Health Star Rating to account for ultra‐processing and compare the alignment of the modified ratings with NOVA classifications and the current Australian Dietary Guidelines classifications of core (recommended foods) and discretionary (foods to limit).
Methods
Data was cross‐sectionally analysed for 25 486 products. Four approaches were compared to the original Health Star Rating: (1) five ‘negative’ points added to ultra‐processed products ( modification 1; inclusion approach ); (2) ultra‐processed products restricted to a maximum of 3.0 Health Stars ( modification 2; capping approach ); (3 and 4) same approach used for modifications 1 and 2 but only applied to products that already exceeded 10 ‘negative’ points from existing Health Star Rating attributes ( modifications 3 and 4 , respectively; hybrid approaches). Alignment occurred when products (i) received <3.5 Health Stars and were NOVA group 4 (for NOVA comparison) or discretionary (for Dietary Guidelines comparison), or (ii) received ≥3.5 Health Stars and were NOVA groups 1–3 or core.
Results
All Health Star Rating modifications resulted in greater alignment with NOVA (ranging from 69% to 88%) compared to the original Health Star Rating (66%). None of the modifications resulted in greater alignment to the Dietary Guidelines classifications overall (69% to 76%, compared with 77% for the original Health Star Rating), but alignment varied considerably by food category.
Conclusions
If ultra‐processing were incorporated into the Australian and New Zealand Health Star Rating, consideration of ultra‐processing within the broader dietary guidance framework would be essential to ensure coherent dietary messaging to Australians.
... Therefore, we believe that the present findings are not only an overview of the remaining Portuguese food retailers but may reflect a wider market as the main plant-based food brands are multinational. Furthermore, the fact that the degree of processing was assessed according to NOVA classification could be somewhat of a limitation as this system is based on a qualitative approach that brings ambiguity and differences in interpretation [88][89][90] that may underestimate the healthiness of some nutrient-dense foods, adding no value to existing nutrient profile systems [91]. However, new classification systems of processing degree evaluation, such as SIGA, intended to address NOVA limitations, suggest that foods with over five ingredients are highly likely to be UPFs [92], indicating that products with longer ingredient lists are more likely to contain multiple markers of ultra-processing (MUPs), supporting our study results. ...
The plant-based food market is rapidly growing, offering innovative options to meet consumer expectations. However, a comprehensive analysis of the nutritional quality of these foods is lacking. We aimed to characterize industrial plant-based food products’ nutritional value and degree of processing. A cross-sectional study was conducted on two market-leading Portuguese food retail chains by assessing the nutritional composition of all the available pre-packaged plant-based food products (n = 407). These products were categorized into meal alternatives, dairy alternatives, and other products containing dairy/meat alternative ingredients including ready meals and desserts. The products’ nutritional quality was assessed according to the cut-offs established by the Portuguese Directorate General of Health [DGS] on total fat, saturated fat, sugar, and salt, and considering the degree of processing using NOVA classification. One-tenth of the products were classified as having a high total fat, saturated fat, sugars, or salt content. In some sub-categories, half of foods were classified as high in saturated fat, and over two-thirds were considered high salt products. Less than one-third exhibit a good nutritional profile based on the national cut-offs. A total of 84.3% of plant-based food products were ultra-processed. These findings emphasize the need to improve the nutritional profile of plant-based options.
... The number of UPF markers might be linked to the industry's desire to save production costs (18) and produce ultra-palatable products, replacing unprocessed products in the shopping trolley. According to these findings and in line with other authors (36), considering the number of UPF markers in foods is a promising way to identify adverse products and empower consumers to easily identify UPFs as they shop. This could be useful to manufacturers, retailers, and the community and could set grounds for improving the health potential of highly influential businesses and food products. ...
BACKGROUND. The United States (U.S.) is the leading country in ultra-processed food (UPF) consumption, accounting for 60% of caloric intake, compared to a range of 14 to 44% in Europe. Given the increasingly evident health risks of UPF consumption, this is a major health problem. Common UPFs include soft drinks, snacks, processed meats, cookies, and candy. We hypothesized that even basic staple foods in the United States are ultra processed and aimed to study the UPF prevalence in food staples from popular U.S. supermarkets compared with European countries.
METHODOLOGY. We analyzed staple food products (bread, canned goods, cereals, eggs, milk, vegetables, and yogurt) stocked in U.S. supermarket chains (Walmart, Target, and Whole Foods), France (Carrefour), and Spain (Mercadona). Using an algorithm that identifies UPF values based on the NOVA and Food and Agriculture Organization of the United Nations guidelines, we identified the UPF prevalence and average number of UPF markers (cosmetic ingredients/additives).
RESULTS. The prevalence of UPFs in budget friendly supermarkets, Walmart, and Target, is 41-42% higher than Whole Foods, a store focused on quality. Furthermore, UPFs in Walmart and Target have 75% and 57% more UPF markers, respectively, than UPFs in Whole Foods. Around 58% of staples in U.S. leading supermarkets are ultra processed, which is 41% more than supermarkets in Europe. Furthermore, the U.S. UPFs contain 41% more UPF markers than their EU counterparts.
CONCLUSION. Most of the staple food products at mainstream U.S. budget friendly retailers are ultra processed, which is not the case at a more premium, quality focused store. Compared to supermarkets in Europe, the U.S. mainstream supermarkets have more UPFs, and those foods also have more UPF markers. Making healthy food choices in the United States is a challenge that is compromised by the high availability and accessibility of UPFs, even among everyday products that constitute the dominant part of the diet of a population. The European model shows the possibility of decreasing the UPF availability in large supermarkets. American consumers need more tools and guidance to identify UPFs along with greater regulation of UPF products to prioritize healthy choices and reduce UPF availability.
... Recently, the classification of foods according to their degree of processing instead of nutrient profiles became prominent. In general, different classification systems are available to define processed foods: e.g., the NOVA classification system, the Siga classification system, a system proposed by the International Agency for Research on Cancer (IARC), by the University of North Carolina (UNC) and by the International Food Information Council (IFIC) (Gibney and Forde 2022;Davidou et al. 2020). The NOVA classification system is the most used example consisting of four categories: unprocessed or minimally processed foods, processed culinary ingredients, processed foods, and ultra-processed foods (Monteiro et al. 2010). ...
Recently, ultra-processed foods received a lot of attention, but also criticism. Our aim was to provide an overview of the existing evidence of ultra-processed food consumption on human health. We conducted a systematic search in four databases until January 5th, 2024. Systematic reviews with meta-analyses on ultra-processed food consumption as defined by the NOVA classification system were included. The certainty of evidence was evaluated by the GRADE approach. We identified 16 publications. Moderate certainty of evidence was found for all-cause mortality (Summary Risk Ratio per 50 g: 1.02; 95% confidence Interval (CI): 1.01, 1.03), cardiovascular disease incidence and mortality (per 50 g/d: 1.04; 95% CI: 1.02, 1.06, and 1.05; 95% CI: 1.01, 1.08), type 2 diabetes incidence (per 10%: 1.12; 95% CI: 1.10, 1.13) and colorectal cancer (per 10%: 1.04; 95% CI: 1.01, 1.07). For several outcomes such as inflammatory bowel diseases, obesity, metabolic syndrome, nonalcoholic fatty liver disease, mental health as well as nutrient quality, similar estimates were observed, but certainty of evidence was limited. Discussing the NOVA concept, it remains unclear whether the processing of foods leads to increased health risks or if ultra-processed food consumption is only a measure for poor diet quality.
... This significant share of UPFs to supply and intake demonstrates how ubiquitous this food class is in the UK diet, a pattern observed in other high-income countries, such as the USA (6) , Canada (7) and Australia (8) . UPFs represent 83% of packaged supermarket foods in New Zealand (9) , and 67% in France (10) . ...
Objective
Ultra-processed foods (UPF), including those containing food-additive emulsifiers, have received research attention due to evidence implicating them in the pathogenesis of certain diseases. The aims of this research were to develop a large-scale, brand-level database of UPFs in the UK food supply and to characterise the occurrence and co-occurrence of food-additive emulsifiers.
Design
A database was compiled sampling UPF groups contributing to total dietary energy intake in the UK from the National Diet and Nutrition Survey (2008-2014). Every food in these UPF groups were identified from online supermarket provision from the ‘‘big four’’ supermarkets that dominate the market share in the UK, comprising Tesco, Sainsbury’s, Asda and Morrisons.
Results
A total of 32,719 food products in the UK supermarket food supply were returned in searches. Of these, 12,844 UPF products were eligible and manually reviewed for the presence of emulsifiers. Emulsifiers were present in 6,642 (51.7%) food products. Emulsifiers were contained in 95.0% of ‘‘Pastries, buns and cakes’’; 81.9% of ‘‘Milk-based drinks”, 81.0% in ‘‘Industrial desserts’’ and in 77.5% of “Confectionary”. Fifty-one percent of all emulsifier-containing foods contained multiple emulsifiers. Across emulsifier-containing foods there were a median of 2 emulsifiers (IQR 2) per product. The five most common emulsifiers were lecithin (23.4% of all UPF), mono- and diglycerides of fatty acids (14.5%), diphosphates (11.6%), xanthan gum and pectin (8.0%).
Conclusions
Findings from this study are the first to demonstrate the wide-spread occurrence and co-occurrence of emulsifiers in UPF in the UK food supply.
... One possible approach is stratification of UPFs by factors such as number of unit operations used to create the product, presence of additives and/or components of concern (e.g., added sugars, sodium), nutrient ratios (e.g., fiber: carbohydrate, potassium: sodium, energy: volume), and total number of ingredients. Similar schemes have been proposed previously to improve classification and account for ingredient quality, degree of transformation, food matrix effects, and nutrients of concern [61,62]. Predictive modeling approaches (e.g., principal component analysis, partial least-squares discriminant analysis) could explore common UPF characteristics or predictors of UPF designation. ...
Our objective was to convene interdisciplinary experts from government, academia, and industry to develop a Research Roadmap to identify research priorities about processed food intake and risk for obesity and cardiometabolic diseases (CMD) among United States populations. We convened attendees at various career stages with diverse viewpoints in the field. We held a “Food Processing Primer” to build foundational knowledge of how and why foods are processed, followed by presentations about how processed foods may affect energy intake, obesity, and CMD risk. Breakout groups discussed potential mechanistic and confounding explanations for associations between processed foods and obesity and CMD risk. Facilitators created research questions (RQs) based on key themes from discussions. Different breakout groups convened to discuss what is known and unknown for each RQ and to develop sub-RQs to address gaps. Workshop attendees focused on ultra-processed foods (UPFs; Nova Group 4) because the preponderance of evidence is based on this classification system. Yet, heterogeneity and subjectivity in UPF classification was a challenge for RQ development. The 6 RQs were: 1) What objective methods or measures could further categorize UPFs, considering food processing, formulation, and the interaction of the two? 2) How can exposure assessment of UPF intake be improved? 3) Does UPF intake influence risk for obesity or CMDs, independent of diet quality? 4) What, if any, attributes of UPFs influence ingestive behavior and contribute to excess energy intake? 5) What, if any, attributes of UPFs contribute to clinically meaningful metabolic responses? 6) What, if any, external environmental factors lead people to consume high amounts of UPFs? Uncertainty and complexity around UPF intake warrant further complementary and interdisciplinary causal, mechanistic, and methodological research related to obesity and CMD risk to understand the utility of applying classification by degree of processing to foods in the United States.
... The European Prospective Investigation into Cancer and Nutrition [117] proposed three main UPF categories: highly processed, moderately processed, and unprocessed foods. ...
Obesity and overweight are a major public health problem globally. Diet quality is critical for proper child development, and an unhealthy diet is a preventable risk factor for noncommunicable diseases (NCDs), such as obesity. Consumption of sugar-sweetened beverages and ultra-processed foods (UPFs) in childhood may increase the BMI/BMI z-score, body fat percentage, or likelihood of overweight. A strict feeding regulation system allows for sufficient food to be consumed to meet ongoing metabolic demands while avoiding overconsumption. This narrative review explores the issues of obesity and the regulation of food intake related to reward systems and UPF consumption. Nutrient composition alone cannot explain the influence of UPFs on the risk of obesity. Furthermore, the non-nutritional properties of UPFs may explain the mechanisms underlying the relationship with obesity and NCDs. UPFs are designed to be highly palatable, appealing, and energy dense with a unique combination of the main taste enhancer ingredients to generate a strong rewarding stimulus and influence the circuits related to feeding facilitation. How individual UPF ingredients influence eating behavior and reward processes remains not fully elucidated. To increase the knowledge on the relationship between UPFs and pediatric obesity, it may be useful to limit the rapid growth in the prevalence of obesity and subsequent related complications, and to develop new strategies for appropriate food and nutrition policies.
... Based on Law Number 18 of 2012 concerning Food "Food is anything that originates from biological products, whether processed or not that is used as a drink or food for human consumption, including food raw materials, food additives or other ingredients that are used during the process of preparation, manufacture and/or processing of the manufacture of drinks or food." (Ardani, 2020) From the way it is obtained, food can be divided into 3, namely fresh food, processed food, and certain processed food (Davidou et al., 2020). ...
Food is a primary need for humans and is mandatory to fulfill it. Without food, humans cannot survive because food is a source of energy for humans to carry out their daily activities. To maintain our health, we also need to consume healthy foods and avoid foods that can cause various diseases. Regulation of the Minister of Health Number 30 of 2013 concerning the Inclusion of Information on Sugar, Salt, and Fat Content and Health Messages on Processed Foods and Ready-to-Eat Foods. This research is included in qualitative research and is descriptive in nature. This study is an empirical study of laws and policies in Permenkes No. 30 of 2013. The policy for including information on sugar, salt, and fat content as well as health messages for processed food needs to be accompanied by changes to the Guidelines for Inclusion of Information on Nutritional Value on Food Labels. The food industry in Indonesia can carry out a policy of including information on sugar, salt, and fat content as well as health messages for processed food. But to implement it, the food industry offers a public-private partnership model, namely the Public Health Responsibility Deal as has been done in the UK. and the Millan Declaration in Switzerland.
... The inclusion of % energy and fat criteria in the PAHO NPM also leads to a limited interpretation of what can be classified as a healthy food. The Siga scheme, developed and applied for commercial purposes, also employs a top-down approach, applying NOVA categories before overlaying nutrient criteria (62). However, the complexity of the system, which considers risk assessment of additives and the application of industrial processing techniques, may not be practical for policy purposes, potentially being overly burdensome on manufacturers, enforcement agencies, policy makers, and regulators. ...
Unhealthy diets are a leading risk factor for non-communicable diseases and negatively impact environmental sustainability. Policy actions recommended to address dietary risk factors, such as restrictions on marketing and front-of-pack labelling, are informed by nutrition classification schemes (NCSs). Ultra-processed foods are associated with adverse population and planetary health outcomes, yet the concept is rarely incorporated in nutrition classification schemes for policy actions. This study aims to develop a novel food processing-based nutrition classification scheme for guiding policy actions. A secondary aim is to validate the scheme by classifying food and beverage items in the Australian food supply (face validity) and comparing them to the classifications of existing NCSs (convergent validity). Two versions of a model were developed, classifying foods and beverages in two steps, first using the NOVA classification system and secondly by applying upper thresholds for added free sugars and sodium, producing a binary output of either healthy or unhealthy. All food and beverage items (n = 7,322) in a dataset combining the Australian Food Composition Database (AUSNUT 2011–2013) and Mintel’s Global New Product Database (2014–2019) were classified using the two models. The same dataset was also classified by the Health Star Rating system (HSR), The Australian Dietary Guidelines (ADGs), The Pan American Health Organization’s Nutrient Profile Model (PAHO NPM), and the NOVA classification scheme, and pairwise agreement between all NCSs and the two models was determined (using Cohen’s Kappa coefficient). A higher proportion of food categories consistent with dietary patterns that are associated with positive health outcomes, such and fruits, vegetables, and eggs were classified as healthy. And the clear majority of food categories consistent with dietary patterns associated with adverse health outcomes, such as confectionery, snack foods, and convenience foods were classified as unhealthy. The two versions of the model showed substantial agreement with NOVA and the PAHO NPM, fair agreement with the ADGs and slight to moderate agreement with the HSR system. A model NCS combining level of processing and nutrient criteria presents a valid alternative to existing methods to classify the health potential of individual foods for policy purposes.
... 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 . ...
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.
... 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. ...
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.
... 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. ...
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).
It has been 15 years since the introduction of the NOVA food-processing classification. While it was designed to identify ultra-processed foods linked to noncommunicable diseases, the NOVA system has a holistic concept that fits with sustainable nutrition. However, NOVA’s connection to other sustainable diet indicators has not been thoroughly explored. The aim was to summarize the research and methodological context of using the NOVA system with other sustainable diet indicators and to investigate NOVA’s synergies and discordance with them. A scoping review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses—Extension for Scoping Reviews (PRISMA-ScR). Studies published between 2009 and 2023 were collected from the Web of Science, Scopus, and PubMed databases. 1612 studies were initially screened; in the selected studies (n = 77), the NOVA system was applied in addition to other sustainable diet indicator(s). The studies were analyzed within a qualitative data analysis framework. 77 studies were analyzed in which healthiness (n = 66), environmental pressure (n = 9), affordability (n = 11), other processing classifications (n = 6), and other sustainable diet indicators (n = 10) were applied with NOVA. Among them, the identified relationships between the NOVA system and other healthfulness indicators were synergistic in the majority of studies (n = 70/93). For environmental pressure indicators, a mixed picture was observed; the NOVA classification was predominantly synergistic with greenhouse gas emissions (n = 8/13), while it was mostly discordant with fresh water use (n = 8/12). Economic affordability was also found to be discordant with the NOVA classification in the majority of studies (n = 10/16). To complete the NOVA classification with nutrient profiling would be beneficial to identify healthy diets. In the case of the integration of NOVA into sustainable nutrition research, environmental pressure and economic affordability indicators should be controlled to reach optimal trade-offs for more sustainable diets. The application of NOVA is gaining relevance; thus, its methodological adaptation to sustainable nutrition research is necessary.
Objective: Examine associations between ultra-processed food (UPF) intake and diet quality (DQ) in college students. Participants: Analysis included 695 participants ages 18–39 years. Methods: Dietary data were collected using the online Diet History Questionnaires II and III. The Healthy Eating Index 2020 (HEI-2020) adult score assessed DQ. NOVA classification was used to identify UPFs. Multivariable linear regression was used to examine associations between %EI from UPF and HEI-2020 total and component scores, controlling for gender, race, smoking, campus meal plan, and EI. Results: Mean age was 19.2 years. In fully adjusted models a statistically significant inverse association was found between %EI from UPF and HEI-2020 total scores (F = 37.81, p < 0.001, R2=0.26), all HEI adequacy scores except whole grains (not significant) and dairy (weak positive association), and for saturated fat, refined grains, and sodium scores. Conclusions: Addressing UPF intake in young adult college students could be a potential strategy to improve DQ.
Mango bagasse (MB) is a (poly)phenols and fiber (DF)-rich agroindustrial by-product exhibiting health-beneficial properties. This research aimed to design and characterize an MB-added confection and evaluate its prebiotic effect in vitro. A sensory analysis involving 51 children was conducted to select the most accepted formulation. Nine formulations (3k factorial design) were screened through texture profile analysis to select an MBC formulation that was hydrated (1:4 and 1:5 MBC:water) to reduce its hardness, where 1:4 was chosen. Compared to MB, 1:4 formulation showed a higher protein (+1.20-fold) but less DF (−0.62-fold). The confections contained gallic acid, mangiferin, quercetin, and (+)-catechin (234.82–479.69 g/100 g sample) but displayed a lower in vitro accessibility than those from MB. Selected bacterial strains exhibited fermentative activity using MBC as a substrate, which was even better than using MB fiber-only. The results showed the potential of MB to DF and (poly)phenol-rich confections with prebiotic potential.
Epidemiological studies show associations between the consumption of ultra-processed food (UPF) and numerous diseases. So far, however, there is no evidence of a causal relationship from randomised controlled trials. In addition, the individual UPFs differ considerably regarding their nutritional profiles and physiological effects. Differentiated analyses of epidemiological data indicate that the association of UPF consumption with adverse health effects is dominated by two food groups only (meat products, sugar-sweetened beverages). Other UPFs show no respective or even protective associations. The UPF concept therefore has no advantage compared to the established classification systems; this applies in particular with regard to the health assessment of foods with a high content of (saturated) fatty acids, salt, and sugar. The undifferentiated assessment of all UPFs, regardless of their nutritional profile, contradicts the current data and therefore lacks a scientific basis.
Les sciences de la vie sont des disciplines holistiques et multidimensionnelles par essence, faisant intervenir des systèmes complexes comme les paysages agricoles, la chaîne agro-alimentaire ou le corps humain. Jusqu’à aujourd’hui tous ces domaines ont principalement été étudiés par une approche réductionniste en silo, générant toujours plus de mauvaise santé des systèmes complexes (pollution des sols, élevage intensif et antibiotiques, maladies chroniques chez l’homme…) que de durabilité à long terme. En fractionnant les systèmes à outrance et en coupant les liens entre leurs parties on génère de la maladie, de l’amont à l’aval. Dans cet article, nous mettrons en avant la nécessité de revenir à une approche empirico-inductive et holistique tout au long de la chaîne agro-alimentaire jusqu’au métabolisme chez l’homme, afin de générer des solutions pour des systèmes vivants durables et régénérateurs ; sans oublier la nécessite d’une éducation alimentaire aussi holistique.
Processed foods have been part of the American diet for decades, with key roles in providing a safe, available, affordable, and nutritious food supply. The USDA Food Guides beginning in 1916 and the US Dietary Guidelines for Americans (DGA) since 1980 have included various types of commonly consumed processed foods (e.g., heated, fermented, dried) as part of their recommendations. However, there are multiple classification systems based on “level” of food processing, and additional evidence is needed to establish the specific properties of foods classified as “highly” or “ultra”-processed (HPF/UPFs). Importantly, many foods are captured under HPF/UPF definitions, ranging from ready-to-eat fortified whole grain breakfast cereals to sugar-sweetened beverages and baked goods. The consequences of implementing dietary guidance to limit all intake of foods currently classified as HPF/UPF may require additional scrutiny to evaluate the impact on consumers’ ability to meet daily nutrient recommendations and to access affordable food, and ultimately, on health outcomes. Based on a meeting held by the Institute for the Advancement of Food and Nutrition Sciences in May 2023, this paper provides perspectives on the broad array of foods classified as HPF/UPFs based on processing and formulation, including contributions to nutrient intake and dietary patterns, food acceptability, and cost. Characteristics of foods classified as UPF/HPFs are considered, including the roles and safety approval of food additives and the effect of food processing on the food matrix. Finally, this paper identifies information gaps and research needs to better understand how the processing of food affects nutrition and health outcomes.
An increased consumption of ultra-processed foods (UPF) leads to a rising prevalence of chronic noncommunicable diseases. This study aims to characterise the nutrient profile of white-label pre-packaged foods and bakery products available in a market leader Portuguese food retail chain, according to the extent of processing proposed by NOVA classification system. The nutrient profile (energy, sugar, total fat, saturated fat and sodium) according to processing degree was analysed using non-parametric tests. UPF were the most energy dense (278 kcal/100 g, p < .001) and the highest in sugar (15.9 g/100 g, p < .001). Processed foods were the highest in sodium (538 mg/100 g, p < .001). Processed and UPF showed significantly higher total (12.4 and 10.8 g/100 g, respectively) and saturated fat content (6.10 and 4.61 g/100 g, respectively) than unprocessed/minimally processed foods (p < .001). Regarding the variation of the nutritional value across the extent of processing, different results were observed for some categories suggesting the importance of a stratified analysis. The consumption of less processed foods and the manufacture of processed/UPF with better nutrient profile should be promoted.
Aim/Objectives: The aim of this work is, to know the true essence and content of kombucha through the statistical analysis of the food classification and nutritional component of the world database of kombucha-registered trademarks, which has been provided to us by the OpenFoodFact Foundation.Method: To gain an understanding of kombucha, a study on the global market for this beverage has been conducted. A total of 2,818 kombucha brands are currently marketed and registered as of April 1, 2023.This research has been made possible thanks to the fact that OpenFoodFact. App provides us with detailed descriptions of the products, nutritional components, as well as Nutri-Score, Nova, and Eco-Score classifications for each registered trademark.Results: The statistical analysis of 2,673 brands from the 13 main Kombucha-producing countries reveals that, based on the Nutri-Score classification, 57% are deemed healthy (categories A, B, and C), while 43% are categorized as unhealthy (categories D and E). In terms of the Nova classification, 70% fall under the healthy categories (1, 2, 3), with the remaining 30% classified as unhealthy, specifically falling into category 4 as ultra-processed.Conclusions: The world market kombucha study shows contradictory results depending on the chosen food classification and the country. Global basic advice for its consumption and specific tips for groups such as people with diabetes or cardiovascular disease are proposed.Running Title: Global analysis market shows us kombucha´s distribution worldwide brands through the statistical analysis of OpenFoodFact database.Keywords: Kombucha, Probiotic fermented food, SCOBY, Nutri-Score food classification, Nova food classification, ultra-processed food.
Gıda, insanoğlunun belki de en temel yaşam desteğidir. İnsanoğlu tarih boyunca gıdanın bozulmaya dönük yapısı ile mücadele etmiş ve çeşitli yöntemlerle bu durumun önüne geçmeye çalışmıştır. Bu işlemler arasında kurutma, tuzlama, tütsüleme, pastörize etme, dondurma gibi birçok yöntem gelişen teknoloji ile insanoğlunun kullanımına sunulmuştur. Ancak sanayileşme ile birlikte gıda bilimi ve teknolojisinin getirdiği yenilikler, gıdanın özgün yapısını değiştirmekle kalmamış, yoğun ve standart üretim ile besin zenginleştirme gibi çeşitli uygulamaların geliştirilmesine de olanak sağlamıştır. Özellikle 1980'li yıllardan itibaren gıda katkı maddelerinin kullanımı ve gıda işleme oranlarındaki artış ile maliyetleri düşürmek için yapılan birçok işlem bazı sorunları ve tartışmaları da beraberinde getirmiştir. Bu tartışmalardan biri de işlenmiş gıdaların tüketimindeki artış ile obezite, diyabet, metabolik sendrom ve bazı kanser türleri gibi bulaşıcı olmayan hastalıklar arasında bir ilişki olduğu yönündedir. Bu konuda yapılan araştırmalar bu tezi desteklemektedir. Ayrıca saha çalışmaları özellikle genç nüfusun beslenme tercihlerinin çoğunlukla aşırı işlenmiş-ultra işlenmiş gıda gruplarından yana olduğunu göstermiştir. Gıda bilimi ve teknolojisi alanında çalışan bilim insanlarının gıdaları işlenme özelliklerine göre sınıflandırmak amacıyla ortaya koydukları birçok şablon bulunmaktadır. Giderek daha popüler hale gelen NOVA sistemi de bunlardan biridir. Bu sistem gıdaları işleme özelliklerine göre 4 ana grupta sınıflandırmaktadır. Bu çalışmada gıda işlemenin evrimi, gıdaların işleme özelliklerine göre sınıflandırılması kavramı, NOVA sistemi ve bu sistemle birlikte giderek daha fazla bilinir hale gelen ultra işlenmiş gıda kavramı ele alınmaktadır. Ayrıca ultra işlenmiş gıdalar, sağlık açısından ve özellikle bulaşıcı olmayan hastalıklar bağlamında değerlendirilmiş ve bazı araştırma sonuçlarına yer verilmiştir.
The 'ultra-processed food' (UPF) concept, with classification of foods by 'level of processing' rather than nutrient profiles, and its relationship with health outcomes, is currently a topic of debate among academics and increasingly referred to in the media. The British Nutrition Foundation convened a virtual roundtable on 6th July 2022 to gather views on the use of the term (and current definitions of) UPF for public health messaging, seeking to establish areas of consensus and disagreement and identify topics for further research. A small group of invited expert stakeholders attended, including representatives from academia, policy, behavioural science, communications, health, food science, retail and consumer interests. Participants' discussions clustered into cogent themes which included: problems with the use of definitions for UPF, the lack of causal evidence and defined mechanisms linking processing per se with poor health outcomes, and advice that may result in consumer confusion. There was agreement that many foods classified as UPF are high in fat, sugars and/or salt and public health messages should continue to focus on reducing these in the diet since it is unclear whether reported associations between high intakes of UPF and poor health reflect poorer dietary patterns (defined by nutrient intakes), and nutrient-health relationships are well established. Examples of misalignment were also highlighted (i.e. some foods are classified as UPF yet recommended in food-based dietary guidelines [featuring in healthy dietary patterns]). This raises challenges for consumer communication around UPF. Concern was also expressed about potential unintended consequences, particularly for vulnerable groups, where advice to avoid UPF could create stigma and guilt due to lack of time or facilities to prepare and cook meals from scratch. It could also impact on nutrient intakes, as some foods classified as UPF represent more affordable sources of important nutrients (e.g. packaged wholemeal bread). Discordance between the concept of UPF and current strategies to improve public health, such as reformulation, was also discussed. The group concluded that the use of the concept of UPF in UK policy (e.g. dietary guidelines) would be unhelpful at present. Overall, participants felt that it was more important to focus on providing practical advice around selection of healthier processed foods and making healthier foods more accessible rather than promoting the avoidance of UPF. The latter may act to demonise all foods classified as UPF by current definitions, including some affordable nutrient-dense foods.
Besin işleme; bireylere güvenilir ve uzun ömürlü besinler sağlamasının yanında lezzet ve görünüşü iyileştirmek adına uygulanan çeşitli uygulamaları da kapsayan işlemler bütünüdür. Ülkemizde çoğunlukla ambalajlı ve tüketime hazır tüm ürünler işlenmiş besin ana başlığı altında sınıflandırılmakta ve yapılan çalışmalarda katılımcıların işlenmiş besin kavramını sağlıksız, enerji içeriği yüksek ve besleyici değeri düşük besinler olarak ifade ettiği belirtilmektedir. Ancak besin işleme metotları arasında pastörizasyon, sterilizasyon, soğutma, dondurma gibi besin güvenliğinin ve raf ömrünün artırılmasına yönelik işlemler ile beraber besinlerin bazı mikro besin ögeleri ve biyoaktif bileşenler ile zenginleştirilmesi işlemleri de yer almaktadır. Bunların yanında, çoğunlukla düşük maliyetli, tüketimi artırmaya yönelik, enerji içeriğini artırıcı ve besin değerini azaltıcı çeşitli işlemler de tüm dünyada yaygın olarak kullanılmaktadır. Yapılan pek çok çalışma işlenmiş besin tüketimi ile obezite, diyabet, metabolik sendrom ve bazı kanser türleri gibi çeşitli bulaşıcı olmayan kronik hastalıklar arasında ilişki göstermiştir. Farklı epidemiyolojik çalışmalarda işlenmiş besinler, yapılan değişimin kapsamı, doğası, işlemin yeri ve amacına göre farklı şekillerde sınıflandırılmaktadır. Bu derleme kapsamında yapılan literatür taramasında dünyada kabul gören çeşitli besin işleme sınıflandırma sistemleri incelenmiş ve ülkemizde yapılan çalışmalarda kullanılmak üzere terim önerileri sunulmuştur. Buna göre çeşitli sınıflandırma sistemleri içinden NOVA sınıflama sisteminin özellikle besinlerin sağlık etkisinin araştırıldığı çalışmalar açısından daha kapsamlı ve uygulanabilir bir sistem olduğu belirtilmektedir. NOVA sistemi bir sözcüğün kısaltması değil, isimlendirilmesidir. Bu sisteme göre besinler dört temel gruba ayrılmaktadır. Bu terimlerin Türkçe terminolojideki karşılıkları açısından önerilerimiz işlenmemiş/yalın işlenmiş, yemeklerde kullanılan işlenmiş içerikler, işlenmiş besinler ve yoğun işlenmiş besinler ve içecekler olarak verilmiştir. Bu şekilde bir uygulamanın yapılan çalışmalarda yaygınlaşması hem tüketiciler açısından kolay ve anlaşılabilir, hem de araştırmacılar açısından toplum bazlı beslenme önerileri geliştirmek açısından faydalı olacaktır.
The lack of knowledge among adolescents makes them more sensitive to engage in unhealthy habits which might harm health and nutritional status. A high caloric diet and lack of physical activity are responsible for the generation of reactive oxygen species leading to neurological diseases. The gap in knowledge about Junk food and its complications poses a significant threat to public health policy. Metabolic Syndrome develops due to high fat-induced chronic inflammation and leads to cognition disturbances, stroke, and neurological diseases such as Alzheimer's disease. Adolescent age is the most devastating one where several Lifestyle associated diseases (Sophisticated and cozy lifestyle) occur and is linked with chronic diseases viz., Alzheimer, Non-Alcoholic Steatohepatitis, Type 2 Diabetes Mellitus, Non-Alcoholic Fatty liver disease, Obesity, Hypertension, etc. The unstructured eating behaviors should be prevented at the earliest to overcome the "Fast food Genocide" from eating Processed foods to obesity and nutritional deficiencies leading to neurological complications and destructing the brain cell. As we age, memory begins to decline, and thus by lowering our intake of high calorific foods and salt intake, we could reduce metabolic syndrome-related and age-related issues like blood pressure, T2DM, obesity, etc. Thus, to curb diseases linked with Junk foods, awareness about nutritional values of foods among adolescents and higher tax slabs of junks foods should be made to reduce the purchase of such products.
Background
Policy makers are increasingly using nutrition classification schemes (NCSs) to assess a food's health potential for informing nutrition policy actions. However, there is wide variability among the NCSs implemented and no standard benchmark against which their contrasting assessments can be validated.
Objective
This study aimed to compare the agreement of nutrient-, food-, and dietary-based NCSs in their assessment of a food's health potential within the Australian food supply, and examine the conceptual underpinnings and technical characteristics that explain differences in performance.
Methods
A dataset combining food compositional data from the Mintel Global New Products Database and the AUSNUT 2011-2012 database (n = 7,322) was assembled. Products were classified by seven prominent NCSs that were selected as representative of one or other of nutrient- (the Chilean nutrient profile model (NPM), Health Star Rating (HSR), Nutri-Score, the World Health Organization European Region's NPM (WHO-Euro NPM) the Pan American Health Organization's (PAHO) NPM, food- (NOVA), and dietary-based (the Australian Dietary Guidelines (ADGs)).
Results
The PAHO NPM classified the lowest proportion (22%) of products as ‘healthy’, and the HSR the highest (63%). The PAHO NPM, NOVA, WHO-Euro NPM, and the Chilean NPM classified >50% of products as ‘unhealthy’, and the ADGs, HSR and Nutriscore, classified <50% of products as ‘unhealthy’. The HSR and Nutri-score had the highest pairwise agreement (k = 0.7809, 89.70%), and the PAHO NPM and HSR the lowest (k = 0.1793, 53.22%). Characteristics of NCSs that more effectively identified ultra-processed and discretionary foods were: category-specific assessment, the classification of categories as always ‘healthy’ or ‘unhealthy’, consideration of level of food processing, thresholds for ‘risk’ nutrients that do not penalize whole foods; and no allowance for the substitution of ingredients.
Conclusions
Wide variation was observed in agreement of the assessment of a food's health potential among the NCSs analyzed due to differing conceptual underpinnings and technical characteristics.
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.
The offering of grocery stores is a strong driver of consumer decisions, shaping their diet and long-term health. While highly processed food like packaged products, processed meat, and sweetened soft drinks have been increasingly associated with unhealthy diet, information on the degree of processing characterizing an item in a store is not straightforward to obtain, limiting the ability of individuals to make informed choices. Here we introduce GroceryDB, a database with over 50,000 food items sold by Walmart, Target, and Wholefoods, unveiling how big data can be harnessed to empower consumers and policymakers with systematic access to the degree of processing of the foods they select, and the potential alternatives in the surrounding food environment. The extensive data gathered on ingredient lists and nutrition facts enables a large-scale analysis of ingredient patterns and degrees of processing, categorized by store, food category, and price range. Our findings reveal that the degree of food processing varies significantly across different food categories and grocery stores. Furthermore, this data allows us to quantify the individual contribution of over 1,000 ingredients to ultra-processing. GroceryDB and the associated http://TrueFood.Tech/ website make this information accessible, guiding consumers toward less processed food choices while assisting policymakers in reforming the food supply.
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.
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.
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.
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.
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
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.
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 .
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%.
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.
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.
Purpose
A growing body of evidence shows that consumption of ultra-processed foods (UPF) is associated with a higher risk of cardiometabolic diseases, which, in turn, have been linked to depression. This suggests that UPF might also be associated with depression, which is among the global leading causes of disability and disease. We prospectively evaluated the relationship between UPF consumption and the risk of depression in a Mediterranean cohort.
Methods
We included 14,907 Spanish university graduates [mean (SD) age: 36.7 year (11.7)] initially free of depression who were followed up for a median of 10.3 years. Consumption of UPF (industrial formulations made mostly or entirely from substances derived from foods and additives, with little, if any, intact food), as defined by the NOVA food classification system, was assessed at baseline through a validated semi-quantitative 136-item food-frequency questionnaire. Participants were classified as incident cases of depression if they reported a medical diagnosis of depression or the habitual use of antidepressant medication in at least one of the follow-up assessments conducted after the first 2 years of follow-up. Cox regression models were used to assess the relationship between UPF consumption and depression incidence.
Results
A total of 774 incident cases of depression were identified during follow-up. Participants in the highest quartile of UPF consumption had a higher risk of developing depression [HR (95% CI) 1.33 (1.07–1.64); p trend = 0.004] than those in the lowest quartile after adjusting for potential confounders.
Conclusions
In a prospective cohort of Spanish university graduates, we found a positive association between UPF consumption and the risk of depression that was strongest among participants with low levels of physical activity.
Background
Ultra-processed food (UPF) consumption has increased over the last decades in Westernized countries. Our objective was to investigate for the first time the association between the proportion of UPF (%UPF) in the diet and incident depressive symptoms in the NutriNet-Santé cohort.
Methods
The sample included 20,380 women and 6350 men (aged 18–86 years) without depressive symptoms at the first Center for Epidemiologic Studies Depression Scale (CES-D) measurement, using validated cut-offs (CES-D score ≥ 17 for men and ≥ 23 for women). The proportion of UPF in the diet was computed for each subject using the NOVA classification applied to dietary intakes collected by repeated 24-h records (mean = 8; SD = 2.3). The association between UPF and depressive symptoms was evaluated using multivariable Cox proportional hazards models.
Results
Over a mean follow-up of 5.4 years, 2221 incident cases of depressive symptoms were identified. After accounting for a wide range of potential confounders, an increased risk of depressive symptoms was observed with an increased %UPF in the diet. In the main model adjusted for sociodemographic characteristics, body mass index, and lifestyle factors, the estimated hazard ratio for a 10% increase in UPF was 1.21 (95% confidence interval = 1.15–1.27). Considering %UPF in food groups, the association was significant only for beverages and sauces or added fats.
Conclusion
Overall, UPF consumption was positively associated with the risk of incident depressive symptoms, suggesting that accounting for this non-nutritional aspect of the diet could be important for mental health promotion.
Electronic supplementary material
The online version of this article (10.1186/s12916-019-1312-y) contains supplementary material, which is available to authorized users.
The present commentary contains a clear and simple guide designed to identify ultra-processed foods. It responds to the growing interest in ultra-processed foods among policy makers, academic researchers, health professionals, journalists and consumers concerned to devise policies, investigate dietary patterns, advise people, prepare media coverage, and when buying food and checking labels in shops or at home. Ultra-processed foods are defined within the NOVA classification system, which groups foods according to the extent and purpose of industrial processing. Processes enabling the manufacture of ultra-processed foods include the fractioning of whole foods into substances, chemical modifications of these substances, assembly of unmodified and modified food substances, frequent use of cosmetic additives and sophisticated packaging. Processes and ingredients used to manufacture ultra-processed foods are designed to create highly profitable (low-cost ingredients, long shelf-life, emphatic branding), convenient (ready-to-consume), hyper-palatable products liable to displace all other NOVA food groups, notably unprocessed or minimally processed foods. A practical way to identify an ultra-processed product is to check to see if its list of ingredients contains at least one item characteristic of the NOVA ultra-processed food group, which is to say, either food substances never or rarely used in kitchens (such as high-fructose corn syrup, hydrogenated or interesterified oils, and hydrolysed proteins), or classes of additives designed to make the final product palatable or more appealing (such as flavours, flavour enhancers, colours, emulsifiers, emulsifying salts, sweeteners, thickeners, and anti-foaming, bulking, carbonating, foaming, gelling and glazing agents).
Prior studies on red and processed meat consumption with breast cancer risk have generated inconsistent results. We performed a systematic review and meta‐analysis of prospective studies to summarize the evidence regarding the relation of red meat and processed meat consumption with breast cancer incidence. We searched in MEDLINE and EMBASE databases through January 2018 for prospective studies that reported the association between red meat and processed meat consumption with incident breast cancer. The multivariable‐adjusted relative risk (RR) was combined comparing the highest with the lowest category of red meat (unprocessed) and processed meat consumption using a random‐effect meta‐analysis. We identified 13 cohort, 3 nested case‐control, and 2 clinical trial studies. Comparing the highest to the lowest category, red meat (unprocessed) consumption was associated with a 6% higher breast cancer risk (pooled RR,1.06; 95% confidence intervals (95%CI):0.99‐1.14; I²=56.3%), and processed meat consumption was associated with a 9% higher breast cancer risk (pooled RR, 1.09; 95%CI, 1.03‐1.16; I²=44.4%). In addition, we identified two nested case‐control studies evaluating the association between red meat and breast cancer stratified by N‐acetyltransferase 2 acetylator genotype. We did not observe any association among those with either fast (per 25 gram/day pooled odds ratio (OR), 1.18; 95%CI, 0.93‐1.50) or slow N‐acetyltransferase 2 acetylators (per 25 gram/day pooled OR, 0.99; 95%CI, 0.91‐1.08). In the prospective observational studies, high processed meat consumption was associated with increased breast cancer risk.
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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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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)
Background:
Some available evidence suggests that high consumption of ultra-processed foods (UPFs) is associated with a higher risk of obesity. Collectively, this association and the nutritional characteristics of UPFs suggest that UPFs might also be associated with hypertension.
Methods:
We prospectively evaluated the relationship between UPF consumption and the risk of hypertension in a prospective Spanish cohort, the Seguimiento Universidad de Navarra project. We included 14,790 Spanish adult university graduates who were initially free of hypertension at baseline who were followed for a mean of 9.1 years (SD, 3.9 years; total person-years: 134,784). UPF (industrial formulations of chemical compounds which, beyond substances of common culinary use such as salt, sugar, oils, and fats, include substances also derived from foods but not used in culinary preparations) consumption was assessed using a validated semi-quantitative 136-item food-frequency questionnaire. Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for hypertension incidence.
Results:
During follow-up, 1,702 incident cases of hypertension were identified. Participants in the highest tertile of UPF consumption had a higher risk of developing hypertension (adjusted HR, 1.21; 95% CI, 1.06, 1.37; P for trend = 0.004) than those in the lowest tertile after adjusting for potential confounders.
Conclusions:
In this large prospective cohort of Spanish middle-aged adult university graduates, a positive association between UPF consumption and hypertension risk was observed. Additional longitudinal studies are needed to confirm our results.
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.
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.
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.
Previous studies have provided evidence that the physical encapsulation of intracellular nutrients by cell walls of plant foods (i.e. dietary fibre) plays a predominant role in influencing macronutrient bioaccessibility (release) from plant foods during human digestion. One unexplored aspect of this is the extent to which digestive enzymes can pass through the cell-wall barrier and hydrolyse the intracellular lipid in almond seeds. The purpose of the present study was to assess the role played by cell walls in influencing the bioaccessibility and digestibility of almond lipid using a range of techniques. Digestibility experiments were performed on raw and roasted almond cells as well as isolated almond oil bodies using in vitro gastric and duodenal digestion models. Residual triacylglycerols and lipolysis products were extracted after 1 h of incubation and analysed by thin layer chromatography. The lipolysis kinetics of almond cells and oil bodies were also investigated using the pH-stat technique. Finally, the potential penetration of pancreatic lipase through the cell wall matrix was investigated using confocal microscopy. Differences in the rates and extent of lipolysis were clearly seen between almond cells and oil bodies, and these differences were observed regardless of the lipase(s) used. These results also showed that almond cell walls that are completely intact limit lipid digestibility, due to an encapsulation mechanism that hinders the diffusion of lipase into the intracellular environment and lipolysis products out of the cells.
OBJECTIVE
To evaluate the impact of consuming ultra-processed foods on the micronutrient content of the Brazilian population’s diet.
METHODS
This cross-sectional study was performed using data on individual food consumption from a module of the 2008-2009 Brazilian Household Budget Survey. A representative sample of the Brazilian population aged 10 years or over was assessed (n = 32,898). Food consumption data were collected through two 24-hour food records. Linear regression models were used to assess the association between the nutrient content of the diet and the quintiles of ultra-processed food consumption – crude and adjusted for family income per capita.
RESULTS
Mean daily energy intake per capita was 1,866 kcal, with 69.5% coming from natural or minimally processed foods, 9.0% from processed foods and 21.5% from ultra-processed foods. For sixteen out of the seventeen evaluated micronutrients, their content was lower in the fraction of the diet composed of ultra-processed foods compared with the fraction of the diet composed of natural or minimally processed foods. The content of 10 micronutrients in ultra-processed foods did not reach half the content level observed in the natural or minimally processed foods. The higher consumption of ultra-processed foods was inversely and significantly associated with the content of vitamins B12, vitamin D, vitamin E, niacin, pyridoxine, copper, iron, phosphorus, magnesium, selenium and zinc. The reverse situation was only observed for calcium, thiamin and riboflavin.
CONCLUSIONS
The findings of this study highlight that reducing the consumption of ultra-processed foods is a natural way to promote healthy eating in Brazil and, therefore, is in line with the recommendations made by the Guia Alimentar para a População Brasileira (Dietary Guidelines for the Brazilian Population) to avoid these foods.
Objectives:
The aim of this study was to evaluate the relationship between the consumption of ultra-processed foods and obesity indicators among Brazilian adults and adolescents.
Methods:
We used cross-sectional data on 30,243 individuals aged ≥10years from the 2008-2009 Brazilian Dietary Survey. Food consumption data were collected through 24-h food records. We classified food items according to characteristics of food processing. Ultra-processed foods were defined as formulations made by the food industry mostly from substances extracted from foods or obtained with the further processing of constituents of foods or through chemical synthesis, with little if any whole food. Examples included candies, cookies, sugar-sweetened beverages, and ready-to-eat dishes. Regression models were fitted to evaluate the association of the consumption of ultra-processed foods (% of energy intake) with body-mass-index, excess weight, and obesity status, controlling for socio-demographic characteristics, smoking, and physical activity.
Results:
Ultra-processed foods represented 30% of the total energy intake. Those in the highest quintile of consumption of ultra-processed foods had significantly higher body-mass-index (0.94kg/m(2); 95% CI: 0.42,1.47) and higher odds of being obese (OR=1.98; 95% CI: 1.26,3.12) and excess weight (OR=1.26; 95% CI: 0.95,1.69) compared with those in the lowest quintile of consumption.
Conclusion:
Our findings support the role of ultra-processed foods in the obesity epidemic in Brazil.
To examine the availability of packaged food products in New Zealand supermarkets by level of industrial processing, nutrient profiling score (NPSC), price (energy, unit and serving costs) and brand variety.
Secondary analysis of cross-sectional survey data on packaged supermarket food and non-alcoholic beverages. Products were classified according to level of industrial processing (minimally, culinary and ultra-processed) and their NPSC.
Packaged foods available in four major supermarkets in Auckland, New Zealand.
Packaged supermarket food products for the years 2011 and 2013.
The majority (84 % in 2011 and 83 % in 2013) of packaged foods were classified as ultra-processed. A significant positive association was found between the level of industrial processing and NPSC, i.e. ultra-processed foods had a worse nutrient profile (NPSC=11��63) than culinary processed foods (NPSC=7��95), which in turn had a worse nutrient profile than minimally processed foods (NPSC=3��27), P<0��001. No clear associations were observed between the three price measures and level of processing. The study observed many variations of virtually the same product. The ten largest food manufacturers produced 35 % of all packaged foods available.
In New Zealand supermarkets, ultra-processed foods comprise the largest proportion of packaged foods and are less healthy than less processed foods. The lack of significant price difference between ultra- and less processed foods suggests ultra-processed foods might provide time-poor consumers with more value for money. These findings highlight the need to improve the supermarket food supply by reducing numbers of ultra-processed foods and by reformulating products to improve their nutritional profile.
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.
We propose that highly processed foods share pharmacokinetic properties (e.g. concentrated dose, rapid rate of absorption) with drugs of abuse, due to the addition of fat and/or refined carbohydrates and the rapid rate the refined carbohydrates are absorbed into the system, indicated by glycemic load (GL). The current study provides preliminary evidence for the foods and food attributes implicated in addictive-like eating.
Cross-sectional.
University (Study One) and community (Study Two).
120 undergraduates participated in Study One and 384 participants recruited through Amazon MTurk participated in Study Two.
In Study One, participants (n = 120) completed the Yale Food Addiction Scale (YFAS) followed by a forced-choice task to indicate which foods, out of 35 foods varying in nutritional composition, were most associated with addictive-like eating behaviors. Using the same 35 foods, Study Two utilized hierarchical linear modeling to investigate which food attributes (e.g., fat grams) were related to addictive-like eating behavior (at level one) and explored the influence of individual differences for this association (at level two).
In Study One, processed foods, higher in fat and GL, were most frequently associated with addictive-like eating behaviors. In Study Two, processing was a large, positive predictor for whether a food was associated with problematic, addictive-like eating behaviors. BMI and YFAS symptom count were small-to-moderate, positive predictors for this association. In a separate model, fat and GL were large, positive predictors of problematic food ratings. YFAS symptom count was a small, positive predictor of the relationship between GL and food ratings.
The current study provides preliminary evidence that not all foods are equally implicated in addictive-like eating behavior, and highly processed foods, which may share characteristics with drugs of abuse (e.g. high dose, rapid rate of absorption) appear to be particularly associated with "food addiction."
A pilot study was conducted comparing glycemic responses to two starch ingredients vs maltodextrin (MD). A secondary objective was to compare two methods of blood glucose (BG) sampling – continuous interstitial glucose using an ambulatory glucose‐monitoring device (AGD), and capillary blood using a finger‐prick (FP) method. On three occasions, subjects consumed a breakfast of yogurt and 50 g of carbohydrate from a low‐fiber raw starch, a high‐fiber starch derived from high‐amylose maize (HI‐MAIZE ©260) or MD. Twelve men were tested with the FP method, and 8 with the AGD. For FP BG, a significant time*ingredient interaction was observed (p = 0.017). Higher values were observed for MD vs the two starches in the 90‐min period after breakfast. Over the remainder of the day, FP BG for MD tended to fall below the two starch conditions, but differences were small (~ 6 mg/dL, p = 0.07). In contrast, the AGD showed more differentiated profiles. In particular, a steep fall in BG was detected 3 hr after MD ingestion (~ 30% below baseline) whereas the FP method showed no fall. Both starches clearly mitigated this precipitous fall, with values at 3‐hr ~ 25% higher than MD (AGD), whereas the FP method showed little differences (~ 5%) between means. These results show that starch can prevent postprandial glycemic lows and that the FP method of sampling may lack the sensitivity needed to detect this effect. Supported by Ingredion Inc.
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).
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.
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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.