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Impact of ultra-processed food consumption on metabolic health
Abstract
Purpose of review:
Ultra-processed foods (UPF) have been associated with poor diet quality and adverse health outcomes. Our aim in this review is to summarize recent research assessing the impact of UPF consumption, classified according to the NOVA system, on outcomes related to metabolic health.
Recent findings:
Thirty recent studies with different design, quality and target population have investigated the impact of UPF consumption on parameters related to metabolic health, which were organized into: metabolic syndrome; body weight change and obesity indicators; blood pressure and hypertension; glucose profile, insulin resistance and type 2 diabetes; other metabolic risks and cardiovascular diseases and mortality. Most of the studies demonstrated adverse associations between high UPF consumption and metabolic health, mainly those with robust design and involving adults.
Summary:
Most of the latest findings have revealed an adverse impact of high UPF consumption on metabolic health, including cardiovascular diseases and mortality. Scientific evidence is accumulating towards the necessity of curbing UPF consumption worldwide at different life stages. Nevertheless, other studies are needed to confirm the causality between UPF consumption and metabolic health in diverse scenarios and to better elucidate all likely mechanisms involved in this relationship.
... Diversas evidências avançam no sentido de que o risco aumentado de morbidades como a obesidade, síndrome metabólica e as doenças cardiovasculares estão relacionadas ao consumo de AUP (Miranda;Rauber;Levy, 2021;Pagliali et al., 2021), o que fortalece a hipótese de que a alimentação pode de fato ser um dos pilares no mecanismo fisiopatológico do declínio cognitivo e das demências através do risco cardiometabólico. Neste cenário, é essencial estudar a alimentação como um dos fatores determinantes principais para a saúde cerebral, bem como se torna importante na estruturação do protocolo de cuidado em saúde e no embasamento teórico e cientifico de políticas públicas eficazes e contínuas que considerem esse consumo alimentar como prioridade. ...
... Diversas evidências avançam no sentido de que o risco aumentado de morbidades como a obesidade, síndrome metabólica e as doenças cardiovasculares estão relacionadas ao consumo de AUP (Miranda;Rauber;Levy, 2021;Pagliali et al., 2021), o que fortalece a hipótese de que a alimentação pode de fato ser um dos pilares no mecanismo fisiopatológico do declínio cognitivo e das demências através do risco cardiometabólico. Neste cenário, é essencial estudar a alimentação como um dos fatores determinantes principais para a saúde cerebral, bem como se torna importante na estruturação do protocolo de cuidado em saúde e no embasamento teórico e cientifico de políticas públicas eficazes e contínuas que considerem esse consumo alimentar como prioridade. ...
... Diversas evidências avançam no sentido de que o risco aumentado de morbidades como a obesidade, síndrome metabólica e as doenças cardiovasculares estão relacionadas ao consumo de AUP (Miranda;Rauber;Levy, 2021;Pagliali et al., 2021), o que fortalece a hipótese de que a alimentação pode de fato ser um dos pilares no mecanismo fisiopatológico do declínio cognitivo e das demências através do risco cardiometabólico. Neste cenário, é essencial estudar a alimentação como um dos fatores determinantes principais para a saúde cerebral, bem como se torna importante na estruturação do protocolo de cuidado em saúde e no embasamento teórico e cientifico de políticas públicas eficazes e contínuas que considerem esse consumo alimentar como prioridade. ...
Estudos mostram a associação da alimentação com a saúde cerebral. O alto consumo de alimentos ultraprocessados (AUP) é um dos possíveis fatores do risco aumentado para o declínio cognitivo e demência. O objetivo deste trabalho é estabelecer um protocolo de revisão sistemática para analisar se existe associação entre o tipo do processamento dos alimentos consumidos com o declínio cognitivo e as demências em adultos e idosos. O presente protocolo da revisão sistemática foi elaborado considerando as recomendações do checklist Preferred Reporting Items for Systematic Review and Metaanalysis Protocols (PRISMA-P) de 2015. A busca sistemática de literatura será feita nas bases de dados Web Of Science, Scopus, PubMed/MEDLINE, EMBASE e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). Serão incluídos na presente revisão estudos observacionais (coorte, caso-controle e transversal), com abordagem quantitativa, que apresentem em seus resultados a relação entre o tipo de processamento dos alimentos com o declínio cognitivo e a demência, sem limitação das causas. Assim como também, os estudos publicados de forma completa em periódicos científicos. O levantamento bibliográfico preliminar realizado nos apresenta um panorama que responde, parcialmente, nossa pergunta norteadora, em que há associação entre o consumo alimentar pela natureza, extensão e tipo de processamento dos alimentos consumidos com o declínio cognitivo e com as demências por todas as causas, principalmente a Doença de Alzheimer e a Demência Vascular.
... Habitual consumption of substantial amounts of ultra-processed foods is consistently associated with overweight, obesity and related chronic diseases (Askari et al., 2020;Chen et al., 2020;Costa de Miranda et al., 2021;Lane et al., 2021;Meneguelli et al., 2020;Pagliai et al., 2021). For example, in the first randomized controlled study on the effect of ultra-processed foods on energy intake, participants in the US were randomly assigned to eat either ultraprocessed or unprocessed meals for two weeks, and then switch to the other diet (and they could eat as much or as little as desired). ...
... The ill-effects of ultra-processed foods extend well beyond weight gain. Compelling evidence from cross-sectional, prospective and longitudinal studies across the globe shows that high consumption of ultra-processed foods elevates the risk of a number of diseases and disorders, and increases risk of early death (Askari et al., 2020;Chen et al., 2020;Costa de Miranda et al., 2021;Elizabeth et al., 2020;Lane et al., 2021;Meneguelli et al., 2020;Pagliai et al., 2021). For example, prospective observational studies of adults from Spain and France show that consuming a diet high in ultra-processed foods increased the risk of obesity , hypertension , cancer (Fiolet et al., 2018), cardiovascular disease , gastrointestinal disorders (Schnabel et al., 2018), depression (Adjibade et al., 2019;Gómez-Donoso et al., 2020) and all-cause mortality (Rico-Campà et al., 2019;Schnabel et al., 2019). ...
Diet-related diseases and disorders in Canada are a national public health emergency, now and as projected. One main reason is that the national food supply has become increasingly dominated by ultra-processed food and drink products, mostly snacks, that displace dietary patterns based on fresh meals. Policies and practices that will enhance the good health and well-being of Canadians of all ages, regions, classes, and social and ethnic groups, and that will benefit society, the economy, and the environment forever, are immediate and imperative priorities. Current programs, including the 2019 Canada’s Food Guide, are moving in the right direction, but are too slow and have notable limitations. Compelling and consistent evidence from studies conducted in Canada and by independent research teams all over the world shows that the main issue with food, nutrition, and health is not nutrients, as has been assumed, but the nature, purpose, and degree of food processing. This is already recognized by UN agencies and an increasing number of national governments. This review examines the evidence on the impact of diets high in ultra-processed food on human and planetary health. It also comments on recent Canadian food guidance. It then introduces the NOVA classification, which takes food processing into account, and analyzes the recent Canadian diet in terms of food processing. Finally, this review proposes healthy eating and policy recommendations that strengthen the 2019 Food Guide, so as to reduce the burden of diet-related disease and enhance the health and well-being of the Canadian people.
... However, we argue that naive binary and reductionist approaches that wish to resolve our food system's problems by simply arguing for a maximised replacement of animal protein by 'plant protein' hold no merit due to the overwhelming complexity of (a) the global food system and its (agricultural) constraints and (b) the human digestive system and metabolism. Eventually, this may cause more harm than benefit by ignoring many other food-related sustainability issues, such as the potential health (Hall et al. 2019;Costa de Miranda et al. 2021) and environmental impact of excessive ultra-processed food production and intake (Fardet and Rock 2020;Seferidi et al. 2020), the protection of national economies and local livelihoods, and the cultural relationships with foods, including those of animal origin (Leroy and Praet 2015). To sum up, nutritionism substantially oversimplifies the nutritional and environmental implications of a far-reaching protein transition. ...
... Monteiro et al. 2018). As a larger category, and acknowledging that there is considerable heterogeneity within that group and often issues of confounding (Scrinis 2013), ultra-processed foods have been associated with health disorders (Costa de Miranda et al. 2021;Ostfeld and Allen 2021;Zhang et al. 2021) and are known to increase daily ad libitum calorie intake (Hall et al. 2019), while some of their specific constituents raise concern on a more mechanistic basis. It is only recently that we have begun to consider the possibility that several food additives, typically considered safe, could also have less measurable effects on health via modulation of the gut microbiota. ...
Reductionist approaches to food focus on isolated nutritional criteria, ignoring the broader physiological and societal benefits and trade-offs involved. They can lead to the inadvertent or, potentially, intentional labelling of foods as good or bad. Both can be considered worrisome. Among our present-day array of issues is the disproportionate stigmatisation of animal-source foods as harmful for human and planetary health. The case for a protein transition reinforces this trend, overemphasising one particular nutritional constituent (even if an important one). In its strongest formulation, animal-source foods (reduced to the notion of ‘animal protein’) are represented as an intrinsically harmful food category that needs to be minimised, thereby falsely assuming that ‘proteins’ are nutritionally interchangeable. We caution against using the word ‘protein’ in food policy-making to describe a heterogenous set of foods. Rather, we suggest referring to said foods as ‘protein-rich foods’, while acknowledging the expanded pool of non-protein nutrients that they provide and their unique capabilities to support a much broader range of bodily functions. Several essential or otherwise beneficial nutrients are generally more bioavailable in animal-source foods than in plant-source foods. A similar complementarity exists in reverse. Nutritional and environmental metrics should be carefully interpreted, as considerable contextuality is involved. This needs to be undertaken, for instance, with respect to the biochemistry of food and in light of individual and genetically inherited human physiology. Also, the assessments of the environmental impact need a fine-grained approach, especially when examining a product at the system scale. Harms and benefits are multiple, multi-dimensional, and difficult to measure on the basis of the narrow sets of descriptive metrics that are often used (e.g. CO2-eq/kg). A more appropriate way forward would consist of combining and integrating the best of animal and plant solutions to reconnect with wholesome and nourishing diets that are rooted in undervalued benefits such as conviviality and shared traditions, thus steering away from a nutrient-centric dogma. Humans do not consume isolated nutrients, they consume foods, and they do so as part of culturally complex dietary patterns that, despite their complexity, need to be carefully considered in food policy making.
... The impact of ultra-processed foods (defined as an industrially formulated edible substance derived from natural food or synthesized from other organic compounds) on muscle anabolism and metabolic health has also been questioned [96,97]. A transition to a more plant-based diet may encourage more healthy food choices that could, in theory, improve whole-body metabolic health with positive consequences to muscle health [98,99]. ...
The rise in interest of plant-based protein foods has been meteoric, often leading to calls to adopt exclusively plant-based diets to reduce the intake of animal-based foods. In addition to impacts on human health, moving to an exclusively plant-based (or indeed animal-based) diet may have detrimental implications in terms of environmental sustainability. The impact of a rapid growth in global population on the sustainability of food systems poses clear consequences for the environment and thus warrants careful consideration at a national and, in some cases, global level. The requirement for high-quality dietary protein in an ageing population to offset chronic disease, such as sarcopenia, is an additional consideration. A reductionist approach to this sustainability issue is to advise a global population switch to plant-based diets. From a dietary protein perspective, the sustainability of different non-animal-derived protein sources is a complex issue. In this review, first we describe the role of dietary protein in combatting the age-related decline in skeletal muscle mass. Next, we explore the efficacy and sustainability of protein sources beyond animal-based proteins to facilitate skeletal muscle remodelling in older age. Taking a holistic approach, we discuss protein sources in terms of the muscle anabolic potential, environmental considerations with a predominant focus on greenhouse gas emissions across the food chain, the relevance of global malnutrition, and nation- and local-specific nutritional needs for dietary protein choices and food systems. Finally, we discuss implications for environmental sustainability and explore the potential of a trade-off between diet quality and environmental sustainability with food choices and recommendations.
... This dietary pattern is linked not only to excessive caloric intake, but also to unfavorable metabolic outcomes. Research shows that adolescents consuming a higher proportion of UPFs tend to exhibit increased body mass index (BMI), along with elevated levels of inflammatory markers and metabolic syndrome components [8,9]. Furthermore, UPFs often contribute to poor dietary habits, reinforcing a cycle of unhealthy eating that increases the risk of obesity and related comorbidities. ...
Background/Objectives: The literature on consumption of ultra-processed food (UPF) using the NOVA classification is still limited. Therefore, the aim of the present study was twofold: (i) to compare the UPF consumption, sedentary behaviors, and well-being perception between boys and girls; and (ii) to investigate the association between the UPF consumption and risk of overweight, sedentary behaviors, and well-being in adolescents. Methods: The present cross-sectional study comprised a sample of 245 adolescents (131 boys) aged 12–17 years-old (M = 14.20; SD = 1.09). Height and weight were assessed, and subsequently, the BMI was computed; furthermore, total body fat percentage was measured with bioelectrical impedance. Daily consumption of UPF was assessed by the NOVA screener and time spent sedentary was assessed by the Midlands Behavior Health 2024 questionnaire. The Mental Health Continuum-Short Form (MHC-SF) was used to measure adolescents’ psychosocial well-being. Pearson’s correlations and logistic regression analysis were used, controlling for biological, behavioral, and socio-economic confounders. Results: No sex differences were observed for the different UPF NOVA subscales. Boys reported higher computer use levels than girls on the weekend (p = 0.025), and they spent more time playing electronic games during the week (p = 0.005) and on the weekend than their female counterparts (p < 0.001). Moreover, boys reported higher scores in all well-being dimensions (p < 0.001) than girls. Conclusions: The findings revealed, after controlling for sex, sedentary time, and active behaviors, adolescents who consumed UPF on the previous day tended to be associated with a higher risk of being overweight, but also marginally without statistical significance (OR = 0.91, 95% CI: 0.83–1.01, p = 0.06). Of relevance, the present study revealed that both boys and girls of mothers with high educational levels were less likely to be classified as overweight or obese youth.
... Bold values indicate P<0.05. 4 Alternate Healthy Eating Index-2010 score ranged from 10 to 100 and included 10 components: fruits, vegetables, whole grains, nuts and legumes, long-chain n-3 fatty acids, polyunsaturated fatty acids (PUFAs), red and processed meats, sugar-sweetened beverages and fruit juices, trans fatty acids, sodium Table 3 Multivariable-adjusted odds ratio for metabolic unhealthy status across energy-adjusted tertiles of ultra-processed foods intake (n = 527) 1 higher risk of MU. A review of studies with different designs also suggested adverse effects of UPFs on metabolic health, particularly among adults [35]. The plausible mechanism behind the relationship of UPFs with MU status or its components might be related to exposition to cosmetic additives during preparing and processing of these foods such as preservatives, emulsifiers, thickeners, stabilizers, artificial sweeteners, coloring and flavoring agents that might be associated with elevated risk of cardiometabolic disorders [36]. ...
Background:
In recent years, there has been a lot of discussion over the impact of ultra-processed foods (UPFs) intake on overall health of subjects. However, the association between UPFs intake and metabolic unhealthy (MU) status is still in a state of ambiguity. The current study assessed the relationship between UPFs intake and MU status with regard to brain-derived neurotrophic factor (BDNF) and adropin levels.
Methods:
A sample of Iranian adults (aged 20-65 years) was selected to participate in this cross-sectional study using a multistage cluster random-sampling method. UPFs intake was assessed by a validated food frequency questionnaire and NOVA classification. Concentrations of metabolic parameters, BDNF and adropin were determined through fasting blood samples. MU status was assessed according to the criteria proposed by Wildman.
Results:
The overall prevalence of MU phenotype among study participants (n = 527) was 42.5%. Higher intake of UPFs was associated with elevated odds of MU status in multivariable-adjusted model (ORT3 vs. T1=1.88; 95%CI: 1.02-3.45). Moreover, a positive association was observed between UPFs intake and hypertriglyceridemia after controlling all confounders (ORT3 vs. T1=2.07; 95%CI: 1.15-3.73). However, each tertile increase in UPFs intake was not significantly associated with serum BDNF ([Formula: see text]=0.15; 95%CI: -0.05, 0.34; P = 0.14) and adropin ([Formula: see text]=-1.37; 95%CI: -6.16, 3.42; P = 0.58) levels in multivariable-adjusted linear regression models.
Conclusion:
Our findings suggested that higher consumption of UPFs was related to increased likelihood of MU status among a sample of Iranian adults. Further longitudinal studies are needed to verify the directionality and generalizability of the results to all adult populations.
... In several European countries, between 14% and 44% of adults' daily energy intake comes from UPFs, and in countries where adults consume a higher proportion of energy from UPFs, the burden of overweight and obesity is higher (Mertens et al., 2022). In addition, there is evidence in the available literature that the consumption of UPFs may be positively associated with the prevalence of cardiovascular disease and other non-communicable and metabolic diseases (Monteiro et al., 2019;Elizabeth et al., 2020;de Miranda et al., 2021b). Moreover, higher consumption of UPFs may reduce diversity and affect the composition of the gut microbiota (Cuevas-Sierra et al., 2021;Fernandes et al., 2022), as they often contain large amounts of added sugars, fat, and salt, and they lack fibre and other plant-based nutrients. ...
To enhance recovery, athletes often consume ready-to-eat foods, specialized sports foods and/or supplements that belong to the group of ultra-processed foods (UPFs), which may affect their health. The aim of this study was to estimate consumption of UPFs in basketball players and to determine whether there is a difference in anthropometric characteristics, neuromuscular and cardiovascular fitness and microbiota composition between players in relation to the proportion of daily energy from processed foods. The study involved 17 elite male basketball players (>18 years) from Croatia during the competitive season. After cluster analysis of daily energy contribution from NOVA food groups, 35% of players were clustered into higher UPFs consumption group. No differences in anthropometric characteristics, neuromuscular and cardiovascular fitness were observed between players who consumed more UPFs and those who consumed less UPFs. Players with higher consumption of UPFs had lower abundance of the order Veillonellales-Selenomonadales in their respective microbiotas, more precisely, of family Veillonellaceae (p = 0.040) and the genus Agathobacter (p = 0.025). These results suggest that the consumption of UPFs did not affect athletes’ performance but does impact their gut microbiota. Further studies on this issue are warranted to establish nutritional guidelines for athletes regarding the consumption of UPFs.
... The Nova food classification has been applied to observational studies (8,9), cohort studies (10)(11)(12), and randomized trials (13) to assess the link between UPF consumption and health outcomes. Today, there is plenty of evidence on the association of UPF with health outcomes such as weight gain (14), type 2 diabetes (15), cardiometabolic diseases (16), cerebrovascular disease (16), cancer (17), premature deaths (18), all-cause mortality (16), among others (9,19) including a recent umbrella reviewing showing association with more than 30 health parameters (20). ...
Background
Growing interest in the Nova food classification system surged among various stakeholders, driven primarily by compelling evidence linking the consumption of ultra-processed foods (UPF) to negative health outcomes. However, the conventional classification process often leaves room for uncertainty and operational challenges.
Objective
This study aimed to develop and test a replicable method to identify UPF based on discriminative food composition ingredients using the 2017 Brazilian Food Labels Database and evaluate the sensitivity of this method in comparison with the identification of UPF by food name and food category.
Methods
We created six scenarios to identify UPF using food additives and food substances used in the definition of UPF and compare them with the classic methodology of Nova classification based on product name and food categories. We estimated the proportion of foods and beverages identified as UPF according to the different scenarios based on the presence of these discriminative ingredients, total and per food category. Using a diagnostic test and a receiver operating characteristic (ROC) curve, we compared the UPF identified through each of the six scenarios with the ones identified through the classic method.
Results
We found variations in UPF prevalence from 55% to 72% across scenarios, compared to 70% using the classic method in Brazilian packaged foods. Despite its cautious approach, the scenario using food additives with exclusively cosmetic functions and food substances effectively identified a significant portion of UPF, while maintaining satisfactory sensitivity and specificity, and a better performance on the ROC curve.
Conclusion
This methodological study emphasizes the importance of detailed criteria to identify UPF, offering researchers alternative and standardized methods for safe decision-making.
... There is increased awareness among consumers (Fardet et al. 2015;Verhoeckx et al. 2015;Monteiro et al. 2017) and evidence (Costa et al. 2018;Costa de Miranda et al. 2021;Srour and Touvier 2021) showing that intensively processed food has an impact on human health. By choosing organic-or Demeter-labelled products (according to EU Regulation 2018/848 2018Demeter 2020), consumers expect to obtain products that have been processed in ways that preserve the nutritional and sensory quality of the raw material, 'keeping the product as natural as possible' (Zander et al. 2020;Hüppe and Zander 2021). ...
... Overall, individuals with a higher food processing score exhibit higher blood pressure, trunk fat, and subscapular skinfold, measures of obesity, blood insulin, and triglyceride levels; and lower "good" HDL cholesterol. Further novel findings indicate a higher prevalence of type 2 diabetes (C-peptide), inflammation (C-Reactive Protein), vitamin deficiency (homocysteine, methylmalonic acid), and inflammatory arthritis [65][66][67][68][69][70] . We also find an inverse association between iFPro and telomere length, which can be affected by diet through inflammation and oxidation 71 , suggesting a higher biological age for individuals with higher reliance on more ultra-processed foods (Section S4, Figure S21). ...
Despite the accumulating evidence that increased consumption of ultra-processed food has adverse health implications, it remains difficult to decide what constitutes processed food. Indeed, the current processing-based classification of food has limited coverage and does not differentiate between degrees of processing, hindering consumer choices and slowing research on the health implications of processed food. Here we introduce a machine learning algorithm that accurately predicts the degree of processing for any food, indicating that over 73% of the US food supply is ultra-processed. We show that the increased reliance of an individual’s diet on ultra-processed food correlates with higher risk of metabolic syndrome, diabetes, angina, elevated blood pressure and biological age, and reduces the bio-availability of vitamins. Finally, we find that replacing foods with less processed alternatives can significantly reduce the health implications of ultra-processed food, suggesting that access to information on the degree of processing, currently unavailable to consumers, could improve population health.
... (He et al., 2020;McClements & Grossmann, 2021). There is also accruing evidence to show that consuming ultra-processed foods can have deleterious health effects (de Miranda et al., 2021) and the degree of processing of PBAPs is poorly understood. Therefore, despite the promotion of PBAPs as being more nutritious and healthier alternatives (Hemler & Hu, 2019), the exclusion of animal ingredients per se may not necessarily mean that the respective PBAPs are healthy (Alcorta et al., 2021). ...
Background:
Plant-Based Alternative Products (PBAPs) to meat and dairy are increasingly available. Their relative nutritional quality in comparison to animal-based homologs is poorly documented.
Objective:
To characterize and evaluate the plant-based alternatives available on the market in Spain in comparison to animal products in terms of their nutritional composition and profile, and degree of processing.
Methods:
Nutritional information for PBAPs and homologs were obtained from the Spanish 'Veggie base', branded food composition database. Five PBAPs categories (cheese, dairy products, eggs, meat, and fish, n = 922) were compared to animal-based processed (n = 922) and unprocessed (n = 381) homologs, using the modified version of the Food Standard Agency Nutrient Profiling System (FSAm-NPS score) and NOVA classification criteria.
Results:
Compared to processed or unprocessed animal food, PBAPs contain significantly higher sugar, salt, and fiber. PBAPs for fish, seafood, and meat were lower in protein and saturated fatty acids. Overall, 68% of PBAPs, 43% of processed and 75% of unprocessed animal-homologs had Nutri-Score ratings of A or B (most healthy). About 17% of PBAPs, 35% of processed and 13% of unprocessed animal-based food were in Nutri-Score categories D or E (least healthy). Dairy, fish, and meat alternatives had lower FSAm-NPS scores (most healthy), while cheese alternatives scored higher (least healthy) than animal-based homologs. Unprocessed fish and meat were healthier than similar PBAPs based on FSAm-NPS criteria. Approximately 37% of PBAPs and 72% of processed animal-based products were ultra-processed food (NOVA group 4). Within the ultra-processed food group, Nutri-Score varied widely.
Conclusions:
Most PBAPs had better nutrient profile than animal-based homologs. However, cheese, fish and meats PBAPs had poorer nutrient profile and were more processed. Given the high degree of processing and variable nutritional profile, PBAPs require a multi-dimensional evaluation of their health impact.
... 18 Consumption of UPFs has been linked to an increased risk of cardiovascular disease, metabolic syndrome, and obesity. 19,20 However, few studies have investigated the association between UPF and cognitive decline in samples from high-income countries. [21][22][23] Therefore, we aimed to prospectively investigate the association between UPF consumption at baseline and cognitive decline in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). ...
Importance:
Although consumption of ultraprocessed food has been linked to higher risk of cardiovascular disease, metabolic syndrome, and obesity, little is known about the association of consumption of ultraprocessed foods with cognitive decline.
Objective:
To investigate the association between ultraprocessed food consumption and cognitive decline in the Brazilian Longitudinal Study of Adult Health.
Design, setting, and participants:
This was a multicenter, prospective cohort study with 3 waves, approximately 4 years apart, from 2008 to 2017. Data were analyzed from December 2021 to May 2022. Participants were public servants aged 35 to 74 years old recruited in 6 Brazilian cities. Participants who, at baseline, had incomplete food frequency questionnaire, cognitive, or covariate data were excluded. Participants who reported extreme calorie intake (<600 kcal/day or >6000 kcal/day) and those taking medication that could negatively interfere with cognitive performance were also excluded.
Exposures:
Daily ultraprocessed food consumption as a percentage of total energy divided into quartiles.
Main outcomes and measures:
Changes in cognitive performance over time evaluated by the immediate and delayed word recall, word recognition, phonemic and semantic verbal fluency tests, and Trail-Making Test B version.
Results:
A total of 15 105 individuals were recruited and 4330 were excluded, leaving 10 775 participants whose data were analyzed. The mean (SD) age at the baseline was 51.6 (8.9) years, 5880 participants (54.6%) were women, 5723 (53.1%) were White, and 6106 (56.6%) had at least a college degree. During a median (range) follow-up of 8 (6-10) years, individuals with ultraprocessed food consumption above the first quartile showed a 28% faster rate of global cognitive decline (β = -0.004; 95% CI, -0.006 to -0.001; P = .003) and a 25% faster rate of executive function decline (β = -0.003, 95% CI, -0.005 to 0.000; P = .01) compared with those in the first quartile.
Conclusions and relevance:
A higher percentage of daily energy consumption of ultraprocessed foods was associated with cognitive decline among adults from an ethnically diverse sample. These findings support current public health recommendations on limiting ultraprocessed food consumption because of their potential harm to cognitive function.
... The types and quantities of UPF are progressively increasing, showing that a transition to a more processed diet continues to happen quickly all over the world [9]. Several studies have shown the association between the consumption of UPF, the occurrence of overweight and obesity [10][11][12], and several chronic diseases [13][14][15][16]. ...
Purpose
This study aims to describe micronutrient intake according to food processing degree and to investigate the association between the dietary share of ultra-processed foods and micronutrient inadequacies in a representative sample of Portuguese adult and elderly individuals.
Methods
Cross-sectional data from the National Food, Nutrition and Physical Activity Survey (2015/2016) were used. Food consumption data were collected through two 24-h food recalls, and food items were classified according to the NOVA system. Linear regression models were used to assess the association between the micronutrient density and the quintiles of ultra-processed food consumption—crude and adjusted. Negative Binomial regressions were performed to measure the prevalence ratio of micronutrient inadequacy according to ultra-processed food quintiles.
Results
For adults, all evaluated vitamins had significantly lower content in the fraction of ultra-processed foods compared to unprocessed or minimally processed foods, except vitamin B2. For the elderly, out of ten evaluated vitamins, seven presented significantly less content in ultra-processed foods compared to non-processed ones. The higher energy contribution of ultra-processed foods in adults was associated with a lower density of vitamins and minerals. This association was not observed in the elderly. For adults, compared with the first quintile of ultra-processed food consumption, the fifth quintile was positively associated with inadequate intakes of vitamin B6 (PR 1.51), vitamin C (PR 1.32), folate (PR 1.14), magnesium (PR 1.21), zinc (PR 1.33), and potassium (PR 1.19).
Conclusion
Our results corroborate the importance of public health actions that promote a reduction in the consumption of ultra-processed foods.
... The consumption of UPFs has increased rapidly among children and adults (10,11). Epidemiological studies indicate that a high intake of UPFs is correlated with the development of several chronic diseases such as obesity (12,13), insulin resistance (14), metabolic syndrome (15), dyslipidemia (16), hypertension (17), and cardiovascular disease (18). As one of the proxies for a low-quality diet, UPFs have gradually become an important concept in modern and western diets (19). ...
Design
There is a strong correlation between dietary intake and allergic diseases. Ultra-processed foods (UPFs) are gradually becoming dominant worldwide and causing health problems for children and adults. We hope to determine whether links exist between UPFs and allergic symptoms.
Methods
We investigated data from 2,736 children (16–19 years) and 4,256 adults (≥20 years) from the National Health and Nutritional Examination Survey (NHANES) 2005–2006. The associations between the mean UPFs contribution to total energy intake and all allergic symptoms (IgE, current asthma, allergy, rash, sneeze, wheeze, eczema, and hay fever) were estimated by weighted multivariate logistic regression.
Results
Logistic regression analysis showed UFPs were negatively associated with IgE levels in children. Those with higher quartiles had a reduced risk from 16% (OR, 0.84, 95%CI, 0.55 to 1.28) to 34% (OR, 0.66, 95%CI, 0.49 to 0.89), p for trend = 0.006. UPFs were also positively related to current asthma in children with an increased risk of 11% (OR, 1.11, 95%CI, 0.79 to 1.56) to 76% (OR, 1.76, 95%CI, 1.10 to 2.82), p for trend = 0.0393. UPFs were also associated with eczema in girls. But there was no association observed between UPFs and allergic symptoms in adults.
Conclusion
Our results suggested that UPFs assessed by the NOVA system were associated with IgE, current asthma in children, and eczema in girls. These results further support the need to test the association of modern dietary patterns with allergic symptoms.
... Accumulating evidence have indicated an adverse impact of high UPF intake on metabolic health, including cardiovascular diseases and mortality [8,9]. The evidence from the animal experiment indicates that UPF is a significant risk factor hyperinsulinemia and glucose intolerance [10], and certain types of UPF (e.g., soda and processed meats) were correlated with diabetes [11,12]. ...
Aims:
We aimed to assess the association between ultra-processed food (UPF) consumption with diabetes in Chinese adults.
Methods:
This study included 12,849 eligible adults aged 20 years and over attending at least two surveys in the China Nutrition and Health Survey during 1997-2011. Food intake at each survey was assessed by a 3-day 24-h dietary recall method. UPF was defined based on the NOVA classification. Diabetes was obtained from questionnaires and/or ascertained by fasting blood tests. The association of diabetes with UPF was examined using mix effect logistic regression adjusting for potential confounding factors.
Results:
The mean age of the participants was 43.3 (SD 14.8) years. The age and gender adjusted mean UPF intake increased four times and the prevalence of diabetes increased eight times in 1997-2011. Compared with non-consumers, the odds ratios (95% CI) of diabetes for those with mean UPF consumption of 1-19 g/day, 20-49 g/day, and ≥50 g/day were 1.21 (0.98, 1.48), 1.49 (1.19, 1.86), and 1.40 (1.08, 1.80), respectively (p trend < 0.001) after adjusted for the measured covariates including lifestyle factors (smoking, alcohol drinking, and physical activity), BMI and hypertension.
Conclusions:
both UPF consumption and prevalence of diabetes increased among adults in China during 1997-2011. Higher UPF consumption was positively associated with diabetes.
... Results showed that ad libitum energy intake was significantly higher with the UPF diet, during which participants gained body weight compared to the unprocessed food diet, where participants lost body weight. In 2020, at least six systematic reviews and meta-analyses of current evidence concluded that diets high in HPF or UPF increase the risk of a range of diet-related health outcomes including obesity and cardiometabolic outcomes (Askari et al. 2020;Chen et al. 2020;Santos et al. 2020;Silva Meneguelli et al. 2020;Costa de Miranda et al. 2021;Pagliai et al. 2021) demonstrating the negative impact of shifting from less processed foods to diets high in HPF or UPF. ...
Guidance from Health Canada to limit highly processed foods (HPF) seeks to ensure that Canadians remain within intake recommendations for nutrients of concern. However, HPF can contribute to dietary requirements of specific populations. The Canadian Nutrition Society and Institute for the Advancement of Food and Nutritional Sciences convened speakers for a Food for Health workshop in 2021 to provide evidence and perspectives from government, industry, and healthcare on reasons for advocating limits and potential unintended consequences of limiting HPF, and implications and necessity of HPF in clinical settings. This paper discusses advantages and disadvantages of HPF explored at this workshop.
... High UPF consumption in children is associated with poorer dietary quality [7,8], but negative effects of UPF consumption have also been shown to be possibly independent of diet quality [9,10]. In children, UPF is associated with an increased risk of being overweight or obese in later life [11,12]. In adults, high levels of UPF consumption are associated with obesity, type 2 diabetes [13], cancer [14], cardiovascular disease [15], and premature death [16]. ...
British children have the highest levels of ultra-processed food (UPF) consumption in Europe. Schools are posited as a positive setting for impacting dietary intake, but the level of UPFs consumed in schools is currently unknown. This study determined the UPF content of school food in the UK. We conducted a pooled cross-sectional analysis of primary (4–11 years, n = 1895) and secondary schoolchildren (11–18 years, n = 1408) from the UK’s National Diet and Nutrition Survey (2008–2017). Multivariable quantile regression models determined the association between meal-type (school meal or packed lunch) and lunchtime UPF intake (NOVA food classification system). We showed that on average, UPF intake was high in both primary (72.6% total lunch Kcal) and secondary schoolchildren (77.8% total lunch Kcal). Higher UPF intakes were observed in packed lunch consumers, secondary schoolchildren, and those in lower income households. This study highlights the need for a renewed focus on school food. Better guidance and policies that consider levels of industrial processing in food served in schools are needed to ensure the dual benefit of encouraging school meal uptake and equitably improving children’s diets.
... Screener questions were informed by the diet component of the WHO and PAHO STEPS survey [22,23], and the regional dietary guidelines from Fiji and SVG [24,25]. Questions were aimed to capture frequency and quantity of consumption of specific food and drink items for which there is prior evidence of association with NCDs-for example, fruits and vegetables, salt, red meat, sugar-sweetened beverages (SSB) and ultra-processed foods [8,[26][27][28][29]. ...
Small Island Developing States (SIDS) have high burdens of nutrition-related chronic diseases. This has been associated with lack of access to adequate and affordable nutritious foods and increasing reliance on imported foods. Our aim in this study was to investigate dietary patterns and food insecurity and assess their associations with socio-demographic characteristics and food sources. We recruited individuals aged 15 years and above from rural and urban areas in Fiji (n = 186) and St. Vincent and the Grenadines (SVG) (n = 147). Data collection included a 24 h diet recall, food source questionnaire and the Food Insecurity Experience Scale. We conducted latent class analysis to identify dietary patterns, and multivariable regression to investigate independent associations with dietary patterns. Three dietary patterns were identified: (1) low pulses, and milk and milk products, (2) intermediate pulses, and milk and milk products and (3) most diverse. In both SIDS, dietary pattern 3 was associated with older age, regularly sourcing food from supermarkets and borrowing, exchanging, bartering or gifting (BEB). Prevalence of food insecurity was not statistically different across dietary patterns. In both SIDS, food insecurity was higher in those regularly sourcing food from small shops, and in SVG, lower in those regularly using BEB. These results complement previous findings and provide a basis for further investigation into the determinants of dietary patterns, dietary diversity and food insecurity in these settings.
... Eat more unrefined foods (13,23,24). Consumption of ultra-processed (refined) foods can lead to overweight, obesity, cardiometabolic disorders (type 2 diabetes, CV disease) (25)(26)(27). ...
... However, a primary important point to emphasize is that an individual can become chronically ill, especially diabetic and/or obese, while fully meeting their nutritional needs. For example, the consumption of many micronutrient/fibre-enriched ultraprocessed foods and/or "empty calories" along with nutritional supplements is not a guarantee to stay healthy since excess ultra-processed food consumption is associated with many chronic diseases [3,4,29,120,121]. In addition, as discussed above, food composition says nothing about chewing and satiety, nutrient bioaccessibility/bioavailability, and the synergistic effects of bioactive compounds. ...
Purpose
For decades, it has been customary to relate human health to the nutritional composition of foods, and from there was born food composition databases, composition labelling scores and the recommendation to eat varied foods. However, individuals can fully address their nutritional needs and become chronically ill. The nutrient balance of a food is only a small part of its overall health potential. In this paper, we discussed the proof of concept that the increased risk of chronic diseases worldwide is primarily associated with the degradation and artificialization of food matrices, rather than only their nutrient contents, based on the assumption that “food matrices govern the metabolic fate of nutrients”.
Methods
An empirico-inductive proof of concept research design has been used, based on scientific data linking the degree of food processing, food matrices and human health, notably on the glycaemic index, nutrient bioavailability, satiety potential, and synergistic effects.
Results
We postulate that if the nutrient content is insufficient to fully characterize the diet-global health relationship, one other dimensions is necessary, i.e., the food matrix through the degree of processing. Both matrix and nutrient composition dimensions have been included under the new concept of the 3V index for Real (Vrai), Vegetal (Végétal), and Varied (Varié) foods. The Real metric, reflecting the integrity of the initial food matrix, is the most important, followed by the Vegetal (nutrient origin) and the Varied (“composition” effect) metrics.
Conclusion
Concerning their effects on health, food matrix comes first, and then nutrient composition, and calorie quality matters more than calorie quantity.
... 43 Consumption of many ultra-processed foods is of concern because of their association with adverse health outcomes, including overweight and obesity, cardiometabolic disorders (type 2 diabetes, cardiovascular disease), and all-cause mortality. [77][78][79] In a 4-week, randomized controlled trial of ad libitum food intake, greater intake of ultra-processed food was associated with excess energy intake and short-term weight gain. 80 Recent prospective studies have also found that high compared with low intake of ultra-processed foods is associated with greater risk of type 2 diabetes, 81 incident CVD, 82,83 and all-cause mortality. ...
Poor diet quality is strongly associated with elevated risk of cardiovascular disease morbidity and mortality. This scientific statement emphasizes the importance of dietary patterns beyond individual foods or nutrients, underscores the critical role of nutrition early in life, presents elements of heart-healthy dietary patterns, and highlights structural challenges that impede adherence to heart-healthy dietary patterns. Evidence-based dietary pattern guidance to promote cardiometabolic health includes the following: (1) adjust energy intake and expenditure to achieve and maintain a healthy body weight; (2) eat plenty and a variety of fruits and vegetables; (3) choose whole grain foods and products; (4) choose healthy sources of protein (mostly plants; regular intake of fish and seafood; low-fat or fat-free dairy products; and if meat or poultry is desired, choose lean cuts and unprocessed forms); (5) use liquid plant oils rather than tropical oils and partially hydrogenated fats; (6) choose minimally processed foods instead of ultra-processed foods; (7) minimize the intake of beverages and foods with added sugars; (8) choose and prepare foods with little or no salt; (9) if you do not drink alcohol, do not start; if you choose to drink alcohol, limit intake; and (10) adhere to this guidance regardless of where food is prepared or consumed. Challenges that impede adherence to heart-healthy dietary patterns include targeted marketing of unhealthy foods, neighborhood segregation, food and nutrition insecurity, and structural racism. Creating an environment that facilitates, rather than impedes, adherence to heart-healthy dietary patterns among all individuals is a public health imperative.
... and lower "good" HDL cholesterol. Further novel findings indicate a higher prevalence of type 2 diabetes (C-peptide), inflammation (C-Reactive Protein), vitamin deficiency (homocysteine, methylmalonic acid), and inflammatory arthritis [47][48][49][50][51][52]. We also find an inverse association between iF P ro and telomere length, which can be affected by diet through inflammation and oxidation [53], suggesting a higher biological age for individuals with higher reliance on more ultra-processed foods (SI Section 4). ...
Despite the accumulating evidence that increased consumption of ultra-processed food has adverse health implications, it remains difficult to decide what constitutes processed food. Indeed, the current processing-based classification of food has limited coverage and does not differentiate between degrees of processing, hindering consumer choices and slowing research on the health implications of processed food. Here we introduce a machine learning algorithm that accurately predicts the degree of processing for any food, indicating that over 73% of the U.S. food supply is ultra-processed. We show that the increased reliance of an individual's diet on ultra-processed food correlates with higher risk of metabolic syndrome, diabetes, angina, elevated blood pressure and biological age, and reduces the bio-availability of vitamins. Finally, we find that replacing foods with less processed alternatives can significantly reduce the health implications of ultra-processed food, suggesting that access to information on the degree of processing, currently unavailable to consumers, could improve population health.
... Growing evidence has accumulated that the consumption of ultra-processed foods has positive associations with metabolic health [7,13,[53][54][55][56][57][58][59] such as obesity, hypertension, dyslipidemia, and diabetes, cardiovascular diseases [12,14], cancer [60,61], and mortality [9,62,63]. The adverse impacts of ultra-processed foods on human health have been explained by the poor nutrient profile of these foods [3,17], the low dietary quality [3,4,11,33] associated with the consumption of these foods, and the addictive eating behaviors induced by these foods, which may lead to overconsumption [7,64]. ...
There is growing evidence for a global transition to a more highly processed diet. While the dietary share of ultra-processed foods depends on a country’s economic status, food choice and consumption are also influenced by the socioeconomic situation of individuals. This study investigated whether ultra-processed food consumption differed across socioeconomic subgroups and over time (2010–2018) in Korea. Cross-sectional data from the Korea National Health and Nutrition Examination Survey 2010–2018 were analyzed. Food and beverages reported in a one-day 24 h recall were classified according to the NOVA food classification criteria. The dietary energy contribution of ultra-processed foods was high among men and urban residents, and increased with education and income level; additionally, it reached its peak in adolescents and thereafter decreased with increasing age. After adjusting the socioeconomic variables, such associations remained significant, except for income level. The overall contribution of ultra-processed foods increased from 23.1% (2010–2012) to 26.1% (2016–2018), and the same trend over time was observed in all age groups and socioeconomic strata. In the Korean population, ultra-processed food consumption differed by individual socioeconomic characteristics, but gradually increased over time, and this trend was consistently found in all socioeconomic subgroups. Future strategies to promote healthy food choices are needed for the Korean population.
Background
Ultra-processed food (UPF) consumption has been linked to adverse metabolic outcomes, potentially mediated by alterations in gut microbiota and metabolite production.
Objective
This study aims to explore the cross-sectional and longitudinal associations between NOVA-classified UPF consumption, fecal microbiota, and fecal metabolome in a population of Mediterranean older adults at high cardiovascular risk.
Methods
A total of 385 individuals, aged between 55 and 75 years, were included in the study. Dietary and lifestyle information, anthropometric measurements, and stool samples were collected at baseline and after 1-year follow-up. Fecal microbiota and metabolome were assessed using 16 S rRNA sequencing and liquid chromatography-tandem mass spectrometry, respectively.
Results
At baseline, higher UPF consumption was associated with lower abundance of Ruminococcaceae incertae sedis (β = − 0.275, P = 0.047) and lower concentrations of the metabolites propionylcarnitine (β = − 0.0003, P = 0.013) and pipecolic acid (β = − 0.0003, P = 0.040) in feces. Longitudinally, increased UPF consumption was linked to reduced abundance of Parabacteroides spp. after a 1-year follow-up (β = − 0.278, P = 0.002).
Conclusions
High UPF consumption was associated with less favorable gut microbiota and metabolite profiles, suggesting a possible link to reduced short-chain fatty acid (SCFA) production, altered mitochondrial energy metabolism, and impaired amino acid metabolism. These findings support the reduction of UPF consumption and the promotion of dietary patterns rich in fiber for better gut health. Further research is needed to confirm these associations and clarify the underlying mechanisms.
Trial registration
: ISRCTN89898870 (https://doi.org/10.1186/ISRCTN89898870).
Highlights
•Asian Indians with Type 2 Diabetes should undergo mandatory screening for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) using non-invasive tools like Fibrosis-4 Index (FIB-4) or vibration-controlled transient elastography for disease assessment and progression monitoring.
•Lifestyle modifications through culturally appropriate dietary changes and structured physical activity (both aerobic and resistance exercises) remain the cornerstone of therapy, targeting 5-10% weight loss.
•Glucagon-Like Peptide-1 receptor agonists and Sodium-Glucose Cotransporter-2 inhibitors demonstrate significant benefits for both glycemic control and MASLD-related outcomes while addressing both conditions simultaneously.
Cardiovascular diseases (CVDs) are a group of heart and blood vessel disorder. It is a persistent global health challenge, being the number one cause of death worldwide. These diseases exert a substantial burden on healthcare systems and economies, with their impact shaped by socioeconomic disparities and access to medical care. Natural resources are increasingly recognized as valuable assets in cardiovascular treatment, and it is important to examine the promising potential of natural resources in preventing and treating cardiovascular diseases by reviewing the potential benefits of bioactive compounds present in plants, herbs, and dietary components on cardiovascular health. The prominent bioactive agents include hawthorn, garlic, ginkgo, danshen, turmeric, and dietary interventions like the Mediterranean diet, omega-3 fatty acids, coenzyme Q10, and fiber-rich foods. These natural sources act through diverse mechanisms, including antioxidant and anti-inflammatory effects, vasodilation, lipid modulation, and cardio protection. This chapter will provide a thorough understanding of the role of natural resources in cardiovascular therapy, serving as a valuable resource for researchers, medical professionals, and individuals interested in promoting cardiovascular health and managing cardiovascular diseases using natural approaches.
Ultraprocessed foods (UPF) consumption plays a critical role in the development of chronic diseases, but evidence of their effect on children's health is limited. We hypothesized that the consumption of UPF can influence blood pressure levels in 6-year-old children. This study is a secondary analysis of a randomized field trial in Brazil that is registered at clinicaltrial.gov (NCT00635453). Dietary intake was obtained using 2 multiple-pass 24-hour recalls when 305 children were 3 and 6 years old. We classified foods according to the NOVA system and determined the percentage of total energy intake derived from ultraprocessed foods. We collected anthropometric measures from and evaluated systolic and diastolic blood pressures of 6-year-old children. Linear regression analysis was used to assess the association between UPF consumption and blood pressure levels. UPF represented 40.3% (interquartile range, 34.1-48.5) of the total energy intake at 3 years and 45.2% (interquartile range, 41.5-53.2) at 6 years. The adjusted linear regression analyses showed that systolic blood pressure was associated with UPF consumption at 6 years (P = .05), birth weight (P = .02), waist circumference (P < .01), and physical activity (P = .04), whereas diastolic blood pressure was associated with UPF consumption at 3 and 6 years (P = .01 and P < .01, respectively), birth weight (P = .05), and waist circumference (P < .01). Our data suggest that UPF consumption played a role in increasing 6-year-old children's blood pressure. These results reinforce the importance of effective strategies to prevent the excessive consumption of UPF in childhood.
Com a leitura dos 21 capítulos desta obra, preparada e revisada por professores e alunos do Grupo PESQSAÚDE – Grupo de Pesquisa em Avaliação e Análise Estatística em Saúde Coletiva da Universidade Estadual do Ceará – UECE que possuem reconhecida competência e qualificação na área de avaliação e análise estatística em saúde coletiva. O grupo é composto por professores e alunos (graduandos, mestrandos e doutorandos) envolvidos no processo de aprendizagem, tem compromisso ético na realização de pesquisa envolvendo saúde coletiva. Os temas abordados nesta obra acadêmica apresentam temas relacionados covid e suas estratégias de enfretamento; violência doméstica, gênero e atenção primária; ortorexia nervosa, acesso aos sistemas de saúde e as articulações da rede de atuação a saúde no serviço de urgência e emergência; evidências científicas acerca do clareamento dental, atrofia muscular esquelética. A produção de conhecimentos pela academia alcança a tão buscada e difícil articulação da pesquisa científica com os serviços de saúde. O Grupo PESQSAÚDE, da Universidade Estadual do Ceará – UECE constitui fomento de seara neste panorama. Esta obra foi elaborada com o conhecimento teórico prático dos professores e alunos que atuam na pesquisa contribuindo com a formação estudantes, profissionais de saúde, professores, pesquisadores. E que todos possam desfrutar de uma excelente leitura.
Com a leitura dos 21 capítulos desta obra, preparada e revisada por professores e alunos do Grupo PESQSAÚDE – Grupo de Pesquisa em Avaliação e Análise Estatística em Saúde Coletiva da Universidade Estadual do Ceará – UECE que possuem reconhecida competência e qualificação na área de avaliação e análise estatística em saúde coletiva. O grupo é composto por professores e alunos (graduandos, mestrandos e doutorandos) envolvidos no processo de aprendizagem, tem compromisso ético na realização de pesquisa envolvendo saúde coletiva. Os temas abordados nesta obra acadêmica apresentam temas relacionados covid e suas estratégias de enfretamento; violência doméstica, gênero e atenção primária; ortorexia nervosa, acesso aos sistemas de saúde e as articulações da rede de atuação a saúde no serviço de urgência e emergência; evidências científicas acerca do clareamento dental, atrofia muscular esquelética. A produção de conhecimentos pela academia alcança a tão buscada e difícil articulação da pesquisa científica com os serviços de saúde. O Grupo PESQSAÚDE, da Universidade Estadual do Ceará – UECE constitui fomento de seara neste panorama. Esta obra foi elaborada com o conhecimento teórico prático dos professores e alunos que atuam na pesquisa contribuindo com a formação estudantes, profissionais de saúde, professores, pesquisadores. E que todos possam desfrutar de uma excelente leitura.
Objective:
Ultraprocessed food (UPF) intake is associated with BMI, but effects on regional adipose depots or related to minimally processed food (MPF) intake are unknown.
Methods:
Data included 12,297 adults in the National Health and Nutrition Examination Survey (NHANES), 2011 to 2016. This study analyzed associations between usual percentage of kilocalories from UPFs and MPFs and three adiposity indicators: supine sagittal abdominal diameter to height ratio (SADHtR, estimates visceral adiposity); waist circumference to height ratio (WHtR, estimates abdominal adiposity); and BMI, using linear and multinomial logistic regression.
Results:
Standardized β coefficients per 10% increase in UPF intake were 0.0926, 0.0846, and 0.0791 for SADHtR, WHtR, and BMI, respectively (all p < 0.001; p > 0.26 for pairwise differences). For MPF intake, the β coefficients were -0.0901, -0.0806, and -0.0688 (all p < 0.001; p > 0.18 pairwise). Adjusted odds ratios (95% CI) for adiposity tertile 3 versus tertile 1 (comparing UPF intake quartiles 2, 3, and 4 to quartile 1) were 1.33 (1.22-1.45), 1.67 (1.43-1.95), and 2.24 (1.76-2.86), respectively, for SADHtR; 1.31 (1.19-1.44), 1.62 (1.37-1.91), and 2.13 (1.63-2.78), respectively, for WHtR; and 1.27 (1.16-1.39), 1.53 (1.31-1.79), and 1.96 (1.53-2.51), respectively, for BMI. MPF intake showed inverse associations with similar trends in association strength.
Conclusions:
Among US adults, abdominal and visceral adiposity indictors were positively associated with UPFs and inversely associated with MPFs.
Longitudinal studies evaluating the relationship between UPF consumption and the incidence of Metabolic Syndrome (MetS) and its components are still scarce. This study aimed to evaluate the effect of UPF consumption on the incidence of MetS and its components in adults. A prospective study was conducted with 896 participants from the 1978/79 Ribeirão Preto cohort, São Paulo, Brazil. UPF consumption was evaluated in %kcal and %g at ages 23–25 years. Incidence of MetS and its components were estimated at ages 37–39 years, according to the Joint Interim Statement criteria. Poisson regression was used to assess associations, and interactions with sex were investigated. UPF consumption had no association with MetS (%kcal Adjusted PR: 1.00; 95% CI: 0.99–1.01; %g Adjusted PR: 1.00; 95% CI: 0.99–1.01). However, women with higher UPF consumption, in %kcal and %g, had a higher risk of abdominal obesity (%kcal: p = 0.030; %g: p = 0.003); and women with higher UPF consumption, in %g, had a higher risk of low HDL-cholesterol (p = 0.041). For the other components of MetS, no significant associations were observed in either sex. These findings suggest evidence of no association between UPF consumption and MetS; however, consumption of UPF was associated with increased WC and low HDL-c, but only in women.
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.
Introduction: Bacterial vaginosis is the most common vaginal infection in women of childbearing age. Identifying nutritional risk factors as a potential therapeutic target can be important. The aim of this study was to determine the relationship between the consumption of processed foods and bacterial vaginosis.
Methods: This case-control study was performed in 2020 among women of ages between 15-45 years that were referrerd to the gynecology clinic of Imam Hossein Hospital in Tehran, Iran. Bacterial vaginosis was diagnosed using the Amsel criteria and based on this, participants were divided into case and control groups. Food intake of participants were collected using a valid semi-quantitative food frequency questionnaire with 168 food nutrients.. Processed foods were classified according to the NOVA classification system.
Results: After adjusting for confounding variables, it was seen that participants in the upper tertile of intakes of the ultra-processed foods (OR=2.13, CI: 1.19-3.8, P=0.004), processed meats and fast foods (OR=2.27, CI: 1.23-4.2, P=0.004), oil and sauces (OR=2.47, CI: 1.34-4.54, P=0.008) and sweets (OR=2.82, CI: 1.5-5.3 P=0.001) were significantly more likely to be suffering from bacterial vaginosis.
Conclusion: There was a direct relationship between the intake of processed foods, processed meats and fast foods, oil and sauces and sweets with bacterial vaginosis.
Background and Aims
There is a lack of knowledge on the association of dietary factors and Lumbar Spinal Stenosis (LSS). We evaluated the association of a Mediterranean diet (MD), its major food components and ultra-processed food (UPF) with the risk of LSS.
Methods and Results
Participants were recruited from the Neurosurgery Department of the IRCCS Neuromed, Italy. The study sample consisted of 156 cases of LSS, and 312 controls matched 1:2 for sex, age (±6 months) and physical activity, without a history or clinical evidence of LSS who were identified from the general population. Adherence to MD was assessed by the Mediterranean Diet Score based on 9 food groups. UPF was defined according to NOVA classification and calculated as the ratio (%) of UPF (g/d) on total food consumed (g/d). In multivariable-adjusted analysis, a 2-point increase in the MD score was not associated with LSS risk (OR: 1.02, 95% CI: 0.72-1.46). An increment of 10 g/d of fruits and nuts, cereals or fish led to lower odds of LSS (OR: 0.97, 95% CI: 0.95-0.99; OR: 0.88, 95% CI: 0.82-0.94; OR: 0.87, 95% CI: 0.76-0.99, respectively). Additionally, 1% increment in the consumption of UPF in the diet was independently associated with higher LSS risk (OR: 1.09, 95% CI: 1.04 -1.14).
Conclusion
A diet rich in fruits, cereals, fish is associated with lower risk of LSS while a large dietary share of UPF increases the risk of this disease. Further studies with a prospective design and larger sample sizes are warranted.
Objective
To examine the relationship between the dietary quality of Canadian children and adults and household food insecurity status.
Design
Dietary intake was assessed with one 24-h recall. Households were classified as food secure or marginally, moderately or severely food insecure based on their responses to the Household Food Security Survey Module. We applied multivariable analyses of variance to determine whether % energy from ultra-processed foods, fruit and vegetable intake, Healthy Eating Index (HEI) scores, macronutrient composition, and micronutrient intakes per 1000 kcal differed by food insecurity status after accounting for income, education and region. Analyses were run separately for children 1-8 years and 9-18 years and men and women 19-64 years of age.
Setting
10 provinces in Canada
Participants
Respondents to the 2015 Canadian Community Health Survey-Nutrition, aged 1-64 years, with complete food insecurity data and non-zero energy intakes. N=15909
Results
Among adults and children, % energy from ultra-processed foods was strongly related to severity of food insecurity, but no significant trend was observed for fruit and vegetable intake or HEI score. Carbohydrate, total sugar, fat, and saturated fat intake/1000 kcal did not differ by food insecurity status, but there was a significant negative trend in protein/1000 kcal among older children, a positive trend in sodium/1000 kcal among younger children, and inverse associations between food insecurity severity and several micronutrients/1000 kcal among adults and older children.
Conclusions
With more severe household food insecurity, ultra-processed food consumption was higher and diet quality was generally lower among both adults and children.
Citrate is widely used as a food additive being part of virtually all processed foods. Although considered inert by most of the regulatory agencies in the world, plasma citrate has been proposed to play immunometabolic functions in multiple tissues through altering a plethora of cellular pathways. Here, we used a short-term alimentary intervention (24 hours) with standard chow supplemented with citrate in amount corresponding to that found in processed foods to evaluate its effects on glucose homeostasis and liver physiology in C57BL/6J mice. Animals supplemented with dietary citrate showed glucose intolerance and insulin resistance as revealed by glucose and insulin tolerance tests. Moreover, animals supplemented with citrate in their food displayed fed and fasted hyperinsulinemia and enhanced insulin secretion during an oral glucose tolerance test. Citrate treatment also amplified glucose-induced insulin secretion in vitro in INS1-E cells. Citrate supplemented animals had increased liver PKCα activity and altered phosphorylation at serine or threonine residues of components of insulin signaling including IRS-1, Akt, GSK-3 and FoxO1. Furthermore, citrate supplementation enhanced the hepatic expression of lipogenic genes suggesting increased de novo lipogenesis, a finding that was reproduced after citrate treatment of hepatic FAO cells. Finally, liver inflammation markers were higher in citrate supplemented animals. Overall, the results demonstrate that dietary citrate supplementation in mice causes hyperinsulinemia and insulin resistance both in vivo and in vitro, and therefore call for a note of caution on the use of citrate as a food additive given its potential role in metabolic dysregulation.
Background
Rapid simultaneous increases in ultra-processed food sales and obesity prevalence have been observed worldwide, including in Australia. Consumption of ultra-processed foods by the Australian population was previously shown to be systematically associated with increased risk of intakes of nutrients outside levels recommended for the prevention of obesity. This study aims to explore the association between ultra-processed food consumption and obesity among the Australian adult population and stratifying by age group, sex and physical activity level.
Methods
A cross-sectional analysis of anthropometric and dietary data from 7411 Australians aged ≥20 years from the National Nutrition and Physical Activity Survey 2011–2012 was performed. Food consumption was evaluated through 24-h recall. The NOVA system was used to identify ultra-processed foods, i.e. industrial formulations manufactured from substances derived from foods and typically added of flavours, colours and other cosmetic additives, such as soft drinks, confectionery, sweet or savoury packaged snacks, microwaveable frozen meals and fast food dishes. Measured weight, height and waist circumference (WC) data were used to calculate the body mass index (BMI) and diagnosis of obesity and abdominal obesity. Regression models were used to evaluate the association of dietary share of ultra-processed foods (quintiles) and obesity indicators, adjusting for socio-demographic variables, physical activity and smoking.
Results
Significant (P-trend ≤ 0.001) direct dose–response associations between the dietary share of ultra-processed foods and indicators of obesity were found after adjustment. In the multivariable regression analysis, those in the highest quintile of ultra-processed food consumption had significantly higher BMI (0.97 kg/m²; 95% CI 0.42, 1.51) and WC (1.92 cm; 95% CI 0.57, 3.27) and higher odds of having obesity (OR = 1.61; 95% CI 1.27, 2.04) and abdominal obesity (OR = 1.38; 95% CI 1.10, 1.72) compared with those in the lowest quintile of consumption. Subgroup analyses showed that the trend towards positive associations for all obesity indicators remained in all age groups, sex and physical activity level.
Conclusion
The findings add to the growing evidence that ultra-processed food consumption is associated with obesity and support the potential role of ultra-processed foods in contributing to obesity in Australia.
Objective
The objective of this study was to examine the associations between ultra-processed food consumption and risk of obesity among UK adults.
Methods
Participants aged 40–69 years at recruitment in the UK Biobank (2006–2019) with dietary intakes collected using 24-h recall and repeated measures of adiposity––body mass index (BMI), waist circumference (WC) and percentage of body fat (% BF)––were included (N = 22,659; median follow-up: 5 years). Ultra-processed foods were identified using the NOVA classification and their consumption was expressed as a percentage of total energy intake. Multivariable Cox proportional hazards regression models were used to estimate hazard ratios (HR) of several indicators of obesity according to ultra-processed food consumption. Models were adjusted for sociodemographic and lifestyle characteristics.
Results
947 incident cases of overall obesity (BMI ≥ 30 kg/m²) and 1900 incident cases of abdominal obesity (men: WC ≥ 102 cm, women: WC ≥ 88 cm) were identified during follow-up. Participants in the highest quartile of ultra-processed food consumption had significantly higher risk of developing overall obesity (HR 1.79; 95% CI 1.06─3.03) and abdominal obesity (HR 1.30; 95% CI 1.14─1.48). They had higher risk of experiencing a ≥ 5% increase in BMI (HR 1.31; 95% CI 1.20─1.43), WC (HR 1.35; 95% CI 1.25─1.45) and %BF (HR 1.14; 95% CI 1.03─1.25), than those in the lowest quartile of consumption.
Conclusions
Our findings provide evidence that higher consumption of ultra-processed food is strongly associated with a higher risk of multiple indicators of obesity in the UK adult population. Policy makers should consider actions that promote consumption of fresh or minimally processed foods and reduce consumption of ultra-processed foods.
Consumption of ultra-processed food (UPF) replaces the intake of freshly prepared unprocessed/minimally processed food (MPF) and is positively associated with hypertension and cardiovascular disease (CVD). The objective of this observational study was to investigate the relation between (1) UPF and (2) MPF with peripheral and central blood pressure (BP), wave reflection, and arterial stiffness. Habitual dietary intake, ambulatory BP, augmentation index (AIx), and pulse wave velocity (PWV) were assessed in 40 normotensive young adults (15 M/25 W; 27 ± 1 y; body mass index 23.6 ± 0.5 kg/m 2). UPF consumption was positively associated with overall and daytime peripheral systolic BP (B = 0.25, 95% confidence interval (CI) 0.03, 0.46, p = 0.029; B = 0.32, 95% CI 0.09, 0.56, p = 0.008, respectively), daytime diastolic BP (B = 0.18, 95% CI 0.01, 0.36, p = 0.049) and daytime peripheral pulse pressure (PP; B = 0.22, 95% CI 0.03, 0.41, p = 0.027). MPF consumption was inversely associated with daytime peripheral PP (B = −0.27, 95% CI −0.47, −0.07, p = 0.011), overall and daytime central systolic BP (B = −0.27, 95% CI −0.51, −0.02, p = 0.035; B = −0.31, 95% CI −0.58, −0.04, p = 0.024, respectively), and nighttime central PP (B = −0.10, 95% CI −0.19, −0.01, p = 0.042). Both UPF and MPF were not associated with AIx nor PWV. These data suggest avoidance of UPF and consumption of more MPF may reduce CVD risk factors.
This study aimed to investigate the association of ultra-processed food consumption at 4 and 7 years of age with appetitive traits at 7 years, and body mass index (BMI) at 10 years of age. Participants were 1175 children of the population-based birth cohort Generation XXI, who provided food diaries and complete data on socio-demographic variables, anthropometric measures, and the Portuguese Children's Eating Behaviour Questionnaire (P-CEBQ). Foods were grouped according to NOVA classification into: "unprocessed, minimally or moderately processed, and culinary preparations"; "processed"; "ultra-processed". To assess tracking of groups' consumption, Pearson's Correlation Coefficient (r) and the Intraclass Correlation Coefficient (ICC) were calculated. Generalized linear models were fitted to test main associations, mediators, and interactions among the variables. Ultra-processed consumption exhibited a fair level of stability between ages 4 and 7 (r=0.34; ICC=0.32; 95%CI: 0.25; 0.39), corresponding respectively to 27.3% (449.8 kcal per day; SD=217.2) and 29.3% (526.9 kcal per day; SD=229.7) of total energy intake. After adjusting for maternal and child characteristics, higher ultra-processed consumption at 4 years was associated directly with 'Food Responsiveness' (β̂ = 0.019; 95%CI: 0.007; 0.037), and indirectly through energy intake with avoidant traits: 'Food Fussiness' (β̂ = -0.007; 95% CI: 0.002; 0.012) and 'Satiety Responsiveness' (β̂ = -0.007; 95% CI: 0.003; 0.012). Ultra-processed consumption at 4 years old was associated with BMI at 10 years old, but appetitive behaviours were not powerful mediators of this association. The results suggest a path by which ultra-processed products may impact on later appetitive traits and higher BMI in children.
Background
Ultra-processed food (UPF) consumption has increased drastically worldwide and already represents 50%–60% of total daily energy intake in several high-income countries. In the meantime, the prevalence of overweight and obesity has risen continuously during the last century. The objective of this study was to investigate the associations between UPF consumption and the risk of overweight and obesity, as well as change in body mass index (BMI), in a large French cohort.
Methods and findings
A total of 110,260 adult participants (≥18 years old, mean baseline age = 43.1 [SD 14.6] years; 78.2% women) from the French prospective population-based NutriNet-Santé cohort (2009–2019) were included. Dietary intakes were collected at baseline using repeated and validated 24-hour dietary records linked to a food composition database that included >3,500 different food items, each categorized according to their degree of processing by the NOVA classification. Associations between the proportion of UPF in the diet and BMI change during follow-up were assessed using linear mixed models. Associations with risk of overweight and obesity were assessed using Cox proportional hazard models. After adjusting for age, sex, educational level, marital status, physical activity, smoking status, alcohol intake, number of 24-hour dietary records, and energy intake, we observed a positive association between UPF intake and gain in BMI (β Time × UPF = 0.02 for an absolute increment of 10 in the percentage of UPF in the diet, P < 0.001). UPF intake was associated with a higher risk of overweight (n = 7,063 overweight participants; hazard ratio (HR) for an absolute increase of 10% of UPFs in the diet = 1.11, 95% CI: 1.08–1.14; P < 0.001) and obesity (n = 3,066 incident obese participants; HR10% = 1.09 (1.05–1.13); P < 0.001). These results remained statistically significant after adjustment for the nutritional quality of the diet and energy intake. Study limitations include possible selection bias, potential residual confounding due to the observational design, and a possible item misclassification according to the level of processing. Nonetheless, robustness was tested and verified using a large panel of sensitivity analyses.
Conclusions
In this large observational prospective study, higher consumption of UPF was associated with gain in BMI and higher risks of overweight and obesity. Public health authorities in several countries recently started to recommend privileging unprocessed/minimally processed foods and limiting UPF consumption.
Trial registration
ClinicalTrials.gov NCT03335644 (https://clinicaltrials.gov/ct2/show/NCT03335644)
Background:
Ultra-processed food (UPF) consumption, which is increasing worldwide, has recently been associated with an increased risk of death and cardiovascular disease. We aimed to assess whether consumption of UPF is directly associated with subclinical coronary atherosclerosis in middle-aged men.
Methods:
A computed tomography scan was performed on 1876 men from the Aragon Workers' Health Study, recruited from January 2011 to December 2014, to assess coronary calcium. All participants were free of coronary heart disease. Dietary intake was collected by a validated 136-item semi-quantitative food frequency questionnaire. UPF was defined according to the NOVA classification. Associations between consumption of total energy-adjusted UPF and Coronary Calcium Agatston Score (CACS)-categorized into CACS of 0, > 0 and < 100, and ≥ 100-were cross-sectionally assessed by generalized ordered logistic regression adjusted for main confounders.
Results:
No coronary calcium was detected in 60.2% of the participants, whereas 10.2% had a CACS ≥ 100. A significant dose-response association was observed between energy-adjusted UPF consumption and the risk of having a CACS ≥ 100, when compared with those in the lowest CACS categories (CACS of 0 together with CACS > 0 and < 100). The fully adjusted ORs (95% CI) of having a CACS ≥ 100 across quartiles of energy-adjusted UPF consumption (approximately 100 g/day in the lowest quartile (ref.) and 500 g/day in the highest) were 1.00 (ref.), 1.50 (0.93, 2.42), 1.56 (0.96, 2.52), and 2.00 (1.26, 3.16), p trend .005.
Conclusion:
In this middle-aged worker's sample, approximately 500 g/day of UPF consumption was associated with a 2-fold greater prevalence of subclinical coronary atherosclerosis than consuming only 100 g/day, independently of total energy intake and other well-established cardiovascular risk factors.
Introduction and objectives. Ultra-processed food (UPF) consumption has been associated with increased incidence of cardiovascular disease and its risk factors. The aim of this study was to assess, for the first time in the literature, the prospective association between UPF consumption and the incidence of abdominal obesity (AO) in older adults. Methods. The study sample consists of 652 participants in the Seniors Study on Nutrition and Cardiovascular Risk in Spain: Seniors-ENRICA-1 study, (mean age 67, 44% women). At baseline, standardized anthropometric measurements were collected (including abdominal circumference). After a median follow-up of six years, the abdominal circumference was measured again, and the incidence of abdominal obesity (AO) was calculated, defined as an abdominal perimeter ≥102 cm in men and ≥88 cm in women. At baseline, dietary information was collected using a computerized and validated dietary history. Information was obtained on the usual diet in the previous year. A total number of 880 foods were classified according to their degree of processing following the NOVA classification. Foods or drinks formulated mostly or entirely from substances derived from foods, with little or no presence of the unaltered original food were classified as UPF. For each participant, the percentage of energy from UPF was derived and sex-specific tertiles were calculated. Logistic regression models were built and adjusted for sociodemographic, lifestyle, morbidity, and drug treatment variables.
Understanding the drivers and dynamics of global ultra‐processed food (UPF) consumption is essential, given the evidence linking these foods with adverse health outcomes. In this synthesis review, we take two steps. First, we quantify per capita volumes and trends in UPF sales, and ingredients (sweeteners, fats, sodium and cosmetic additives) supplied by these foods, in countries classified by income and region. Second, we review the literature on food systems and political economy factors that likely explain the observed changes. We find evidence for a substantial expansion in the types and quantities of UPFs sold worldwide, representing a transition towards a more processed global diet but with wide variations between regions and countries. As countries grow richer, higher volumes and a wider variety of UPFs are sold. Sales are highest in Australasia, North America, Europe and Latin America but growing rapidly in Asia, the Middle East and Africa. These developments are closely linked with the industrialization of food systems, technological change and globalization, including growth in the market and political activities of transnational food corporations and inadequate policies to protect nutrition in these new contexts. The scale of dietary change underway, especially in highly populated middle‐income countries, raises serious concern for global health.
Ultra-processed food consumption has been associated with several health outcomes such as obesity, hypertension, cardiovascular disease and cancer. The deleterious nutrient profile of these products, and the presence of food additives, neoformed contaminants and contact materials such as phthalates and bisphenol may be some of the potential pathways through which ultra-processed food influences disease outcomes. The aim of this study was to examine the association between dietary contribution of ultra-processed foods and urinary biomarker concentrations of parent compounds or their metabolites including Di(2-ethylhexyl) phthalate (ΣDEHP), Di-isononyl phthalate (ΣDiNP), Monocarboxynonyl phthalate (mCNP), Mono (3-carboxypropyl) phthalate (mCPP), Monobenzyl phthalate (mBzP), Bisphenol A (BPA), Bisphenol F (BPF) and Bisphenol S (BPS), in the US. Participants from the cross-sectional 2009–2016 National Health and Nutrition Examination Survey, aged 6+ years, with urinary measures and with one 24-hour dietary recall were included in the study. Ultra-processed foods were identified based on the NOVA classification system, a four-group food classification based on the extent and purpose of industrial food processing. Linear regression was used to compare average urinary creatinine-standardized concentrations across quintiles of energy contribution of ultra-processed foods. Models incorporated survey sample weights and were adjusted for different sociodemographic and life-style variables. Adjusted geometric means of ΣDiNP, mCNP, mCPP, mBzP and BPF increased monotonically from the lowest to the highest quintile of ultra-processed food consumption. As both phthalates/bisphenol and ultra-processed foods have been previously associated with insulin resistance, diabetes, general/abdominal obesity and hypertension, our results suggest the possibility of contact materials in ultra-processed foods as one link between ultra-processed food and these health outcomes. Future studies could confirm findings and further explore these mechanisms of action.
We examined the association between the consumption of ultra-processed foods and adiposity in a nationally representative sample of the UK adult population. We studied 6,143 participants (19 to 96 years, 51.6% female) sampled by the UK National Diet and Nutrition Survey (2008–16). Food items reported in four-day food diary were classified according to the NOVA system. Multiple linear and logistic regressions were used to evaluate associations between the dietary contribution of ultra-processed foods (sex-specific quartile and continuous) and Body Mass Index (BMI), Waist Circumference (WC) and obesity (BMI>30kg/m²) and abdominal obesity (men: WC≥102cm, women: WC≥88cm) status. Models were adjusted for sociodemographic and lifestyle characteristics. In multivariable analyses, the highest consumption of ultra-processed food was associated with 1.66 kg/m² higher BMI (95%CI 0.96–2.36), 3.56 cm greater WC (95%CI 1.79–5.33) and 90% higher odds for being obese (OR = 1.90, 95%CI 1.39–2.61), compared with the lowest consumption. A 10% increase in the consumption of ultra-processed foods was associated with an increase of 0.38 kg/m² in BMI (95%CI 0.20–0.55), 0.87 cm in WC (95%CI 0.40–1.33) and 18% higher odds of being obese (OR = 1.18, 95%CI 1.08–1.28). The consumption of ultra-processed food was associated with an increase in BMI, WC and prevalence of obesity in both sexes. A dose response relationship was observed in both sexes, with a 10% increase in the consumption of ultra-processed foods being associated with a 18% increase in the prevalence of obesity in men and a 17% increase in women. Higher consumption of ultra-processed food is associated with greater adiposity in the UK adult population. Policy makers should consider actions that promote consumption of unprocessed or minimally processed foods and reduce consumption of ultra-processed foods.
Emerging evidence suggests that the consumption of ultra-processed foods (UPF) plays a role in the development of chronic diseases, but evidence of their influence in children is limited. Our objective was to study longitudinal trends of UPF intake and determine their impact on blood lipids in young children. The present study was a follow-up of a randomized field trial of children (n=308) from Porto Alegre, Brazil. Dietary intake was collected using two 24-h recalls at 3 and 6 years of age and consumption of UPF was classified according to the NOVA system. At age 6 years, blood tests were performed to measure lipid profile. Contribution of UPF to total energy intake increased by 10% during the follow-up period, from 43.4% at 3 years to 47.7% at 6 years of age. Linear regression models showed that children in the highest tertile of UPF consumption at age 3 years had higher levels of total cholesterol (β 8.51 mg/dL;95%CI 1.65 to 15.37) and triglycerides at age 6 years (β 9.69 mg/dL;95%CI 0.97 to 18.42) compared to those in the lowest tertile. A positive dose-response was observed for an absolute increment of 10% of UPF on total cholesterol (β 2.76 mg/dL;95%CI 0.04 to 5.44) and triglycerides (β 3.44 mg/dL;95%CI 0.46 to 6.42). Based on our data, consumption of UPF increased significantly over time and was associated with higher blood lipids levels in children from a low-income community. Our findings highlight the need for effective strategies to minimizing the consumption of UPF in early life.
Background
Identifying modifiable lifestyle behaviors linked to childhood obesity is necessary to develop preventive strategies.
Objective
To estimate the association of five lifestyle behaviors in children aged 4 years on obesity and cardiometabolic risk factors at age 4 years and on obesity and blood pressure at age 7 years.
Methods
We used child lifestyle data from the INMA project at age 4 years (n = 1480). We constructed a child lifestyle score by summing five behaviors (physical activity, sleep time, television time, plant based foods and intake of ultra‐processed foods) and we categorized it into tertiles. At ages 4 and 7 years, we calculated age‐ and sex‐specific z‐scores for BMI, waist circumference (WC), and blood pressure. At age 4, we also calculated age‐, and sex‐, specific z‐scores for triglycerides and HDL. We used linear and logistic regression analyses.
Results
The lifestyle score was not associated with the outcomes at 4 years, but it was negatively associated with BMI and WC z‐scores at age 7 years. Children at age 4 years in the highest tertile of the score had lower risk of overweight or obesity at age 7 years (OR = 0.61; 95% CI 0.39; 0.96) and abdominal obesity (OR = 0.48; 95% CI 0.24; 0.96).
Conclusions
Higher adherence to a healthy lifestyle at age 4 years decreased risk of overweight, obesity and abdominal obesity at 7 years.
Objective
To evaluate the association of ultra-processed food (UPF) consumption with gains in weight and waist circumference, and incident overweight/obesity, in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort.
Design
We applied FFQ at baseline and categorized energy intake by degree of processing using the NOVA classification. Height, weight and waist circumference were measured at baseline and after a mean 3·8-year follow-up. We assessed associations, through Poisson regression with robust variance, of UPF consumption with large weight gain (1·68 kg/year) and large waist gain (2·42 cm/year), both being defined as ≥90th percentile in the cohort, and with incident overweight/obesity.
Setting
Brazil.
Participants
Civil servants of Brazilian public academic institutions in six cities ( n 11 827), aged 35–74 years at baseline (2008–2010).
Results
UPF provided a mean 24·6 ( sd 9·6) % of ingested energy. After adjustment for smoking, physical activity, adiposity and other factors, fourth (>30·8 %) v . first (<17·8 %) quartile of UPF consumption was associated (relative risk (95 % CI)) with 27 and 33 % greater risk of large weight and waist gains (1·27 (1·07, 1·50) and 1·33 (1·12, 1·58)), respectively. Similarly, those in the fourth consumption quartile presented 20 % greater risk (1·20 (1·03, 1·40)) of incident overweight/obesity and 2 % greater risk (1·02; (0·85, 1·21)) of incident obesity. Approximately 15 % of cases of large weight and waist gains and of incident overweight/obesity could be attributed to consumption of >17·8 % of energy as UPF.
Conclusions
Greater UPF consumption predicts large gains in overall and central adiposity and may contribute to the inexorable rise in obesity seen worldwide.
Objectives:
to investigate the relationship between the Diet Quality Index Adapted for Pregnant Women (IQDAG) and excess maternal body weight.
Methods:
a cross-sectional study was conducted with 754 adult pregnant women, in Ribeirão Preto, São Paulo, between 2011 and 2012. The criteria proposed by Atalah were used to classify the body mass index (BMI). Adjusted multinomial logistic regression models were employed to investigate the relationship between the IQDAG and being overweight and obese, estimating the odds ratio (OR) and the 95% confidence interval (CI95%).
Results:
the mean (SD) age of women was 28 (5) years, 33.4% were overweight and 25.6% obese. The pregnant women with higher scores in the IQDAG were less likely to be overweight [OR= 0.56 (CI95% = 0.37-0.85)] or obese [0.43 (0.26-0.71)]; those with higher scores in the "Fiber" [0.51 (0.33; 0.78)] and "Iron" [0.62 (0.40-0.96)] components were less likely to be overweight. However, women with higher scores in the percentage of energy from ultra-processed foods were more likely to be overweight [1.72 (1.10-2.94)] or obese [5.24 (2.80-9.80)], when compared to women with lower scores.
Conclusions:
poorer quality maternal diets were observed among the women who were overweight and obese during pregnancy.
Background:
There may be a direct association between consumption of ultra-processed foods and C-reactive protein (CRP) levels, under the assumption that the high glycemic index of these food products could stimulate the entire chronic inflammation cascade, along with an indirect association mediated by obesity. The types of food consumed, including ultra-processed products, strongly influence obesity, and are also associated with higher serum CRP levels.
Objective:
Our aim was to investigate whether the caloric contribution of ultra-processed foods to diet is associated with CRP levels, independent of body mass index (BMI).
Design and setting:
Cross-sectional analysis on the Longitudinal Study of Adult Health (ELSA-Brasil) baseline cohort (2008-2010).
Methods:
Dietary information, obtained through a food frequency questionnaire, was used to estimate the percentage of energy contribution from ultra-processed food to individuals' total caloric intake. CRP levels were the response variable. Sex-specific associations were estimated using generalized linear models with gamma distribution and log-link function.
Results:
Ultra-processed food accounted for 20% of total energy intake. Among men, after adjustments for sociodemographic characteristics, there was no association between ultra-processed food intake and CRP levels. Among women, after adjustment for sociodemographic characteristics, smoking and physical activity, the highest tercile of ultra-processed food intake was associated with mean CRP levels that were 14% higher (95% confidence interval: 1.04-1.24) than those of the lowest tercile. However, after considering BMI, this association lost statistical significance.
Conclusion:
Our findings suggest that the positive association of ultra-processed food consumption with CRP levels among women seems to be mediated by the presence of adiposity.
Objective
To estimate the consumption of ultra-processed foods and determine its association with dietary quality among middle-aged Japanese adults.
Design
Cross-sectional study using data from the Saitama Prefecture Health and Nutrition Survey 2011. Dietary intake was assessed using one- or two-day dietary records. Sociodemographic and lifestyle factors were obtained via self-administered questionnaire. Food items were classified according to the NOVA system into four groups: unprocessed or minimally processed foods; processed culinary ingredients; processed foods; and ultra-processed foods. The dietary share of each NOVA food group and their subgroups was calculated in relation to total energy intake, and the average dietary content of key nutrients was determined across tertiles of the dietary energy share of ultra-processed foods (low, middle and high intake).
Setting
Saitama Prefecture in Japan.
Participants
Community-dwelling adults aged 30–59 years (256 men, 361 women).
Results
Consumption of unprocessed or minimally processed foods, processed culinary ingredients, processed foods and ultra-processed foods contributed 44·9 ( se 0·8) %, 5·5 ( se 0·2) %, 11·3 ( se 0·4) % and 38·2 ( se 0·9) % of total daily energy intake, respectively. A positive and statistically significant linear trend was found between the dietary share of ultra-processed foods (tertiles) and the dietary content of total and saturated fat, while an inverse relationship was observed for protein, vitamin K, vitamin B 6 , dietary fibre, magnesium, phosphorus and iron.
Conclusions
Our findings show that higher consumption of ultra-processed foods was associated with decreased dietary quality among Japanese adults.
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 relationship between ultra-processed food consumption and obesity indicators in adolescents. Methods Cross-sectional study with a convenience sample of 200 10- to 18-year-old adolescents from Campinas, São Paulo (SP). Usual dietary intake was determined through a semiquantitative food frequency questionnaire. Daily intake of each food was obtained from the intake frequency. Subsequently, foods were classified as raw and minimally processed, cooking ingredients or ultra-processed foods, and their caloric contribution to the total energy value was calculated. Sociodemographic and anthropometric variables were also investigated. Overweight was defined as Z-score>+1 and obesity was defined as Z-score>+2 according to the Body Mass Index per age group. The associations were tested by chi-square test and linear trend. Results The frequency of obesity was 47.0%, and 21.5% presented increased waist circumference. The average energy intake was 4,176kcal/day, of which 50.6% was derived from ultra-processed foods. The categories with the highest caloric contributions among ultra-processed foods were industrial loaves/cakes (16.2%), sweets and candy (6.2%), pastas (6.0%) and sweetened drinks (5.1%). No association was found between ultra-processed food consumption and anthropometric indicators. Conclusion The significant contribution of ultra-processed foods to daily calories is evidence of a poor diet of this population of young people, although this has not been shown as a factor associated with excess weight. Therefore, there is an urgent need for public policies that discourage the consumption of these products and encourage the return to a traditional diet.
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.
This study aimed to investigate the relationship between food intake (considering the nature, extent, and purpose of food processing) during pregnancy and overweight, obesity, and gestational diabetes mellitus conditions. This is a cross-sectional study conducted among 785 adult women in singleton pregnancies (between 24th and 39th weeks of gestation) in Brazil. Usual food intake was estimated by the Multiple Source Method, using two 24-hour dietary recalls. The food groups of interest in this study were the unprocessed or minimally processed foods and ultra-processed foods. The World Health Organization criteria for the diagnosis of gestational diabetes mellitus and the Atalah criteria for excess weight were used. Adjusted multinomial logistic regression models were used to assess the relationship between energy contribution (%E) from foods with overweight and obesity conditions and, adjusted logistic regression models for gestational diabetes mellitus. In total, 32.1% participants were overweight, 24.6% were obese, and 17.7% of women were diagnosed with gestational diabetes mellitus . After adjustments, an inverse association between the highest tertile of %E from the intake of unprocessed or minimally processed foods and obesity was found [0.49 (0.30-0.79)]. Moreover, a positive association between the highest tertile of %E from ultra-processed food intake [3.06 (1.27-3.37)] and obesity was observed. No association between food intake (considering the nature, extent, and purpose of food processing) during pregnancy and overweight or gestational diabetes mellitus was found. The findings suggest a role of food processing in obesity but not in gestational diabetes mellitus. Further research is warranted to provide robust evidence on the relationship between the role of processed foods in obesity and gestational diabetes mellitus.
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).
Background and aims:
Obesity and insulin resistance development are related to known risk factors (such as diet) that begin in childhood. Among dietary factors, the consumption of ultra-processed foods has received attention. The present study investigated the association between ultra-processed foods consumption at preschool age and changes in anthropometric measurements from preschool to school age and glucose profile at school age.
Methods and results:
The present study was a follow-up of a randomized controlled trial, conducted with 307 children of low socioeconomic status from São Leopoldo, Brazil. At ages 4 and 8 years, children's anthropometric assessments were collected from preschool to school age including body-mass index (BMI) for-age, waist circumference (WC), waist-to-height ratio (WHtR) and skinfold. At the age 8 years, blood tests were performed to measure glucose profile. Dietary data were collected through 24-h recalls and the children's ultra-processed food intake was assessed. Linear regression analysis was used to assess the relationship between ultra-processed food consumption and the outcomes. The percentage of daily energy provided by ultra-processed foods was 41.8 ± 8.7 (753.8 ± 191.0 kcal) at preschool age and 47.8 ± 8.9 (753.8 ± 191.0 kcal) at school age, on average. The adjusted linear regression analyses showed that ultra-processed food consumption at preschool age was a predictor of an increase in delta WC from preschool to school age (β = 0.07; 95%CI 0.01-0.14; P = 0.030), but not for glucose metabolism.
Conclusion:
Our data suggest that early ultra-processed food consumption played a role in increasing abdominal obesity in children. These results reinforce the importance of effective strategies to prevent the excessive consumption of ultra-processed foods, especially in early ages.
Background:
This meta-analytic study explored the relationship between the risk of type 2 diabetes mellitus (T2DM) and bisphenol A concentrations.
Methods:
The Embase and Medline (PubMed) databases were searched, using relevant keywords, for studies published between 1980 and 2018. A total of 16 studies, twelve cross-sectional, two case-control and one prospective, were included in the meta-analysis. The odds ratio (OR) and its 95% confidence interval (CI) were determined across the sixteen studies. The OR and its 95% CI of diabetes associated with bisphenol A were estimated using both fixed-effects and random-effects models.
Results:
A total of 41,320 subjects were included. Fourteen of the sixteen studies included in the analysis provided measurements of urine bisphenol A levels and two study provided serum bisphenol A levels. Bisphenol A concentrations in human bio-specimens showed positive associations with T2DM risk (OR 1.28, 95% CI 1.14, 1.44). A sensitivity analysis indicated that urine bisphenol A concentrations were positively associated with T2DM risk (OR 1.20, 95% CI 1.09, 1.31).
Conclusions:
This meta-analysis indicated that Bisphenol A exposure is positively associated with T2DM risk in humans.
Objectives
To assess the association between consumption of ultra-processed foods and obesity in the Canadian population.
Methods
Cross-sectional study including 19,363 adults aged 18 years or more from the 2004 Canadian Community Health Survey, cycle 2.2. Ultra-processed food intake was estimated using daily relative energy intake of ultra-processed food (% of total energy intake) from data obtained by 24-h food recalls. Obesity was assessed using body mass index (BMI ≥ 30 kg/m²). Univariate and multivariate linear regressions were performed to describe ultra-processed food consumption according to socio-economic and demographic variables, and multivariate logistic regression was performed to verify the association between ultra-processed food consumption and obesity, adjusting for potential confounders, including socio-demographic factors, physical activity, smoking, immigrant status, residential location, and measured vs self-reported weight and height.
Results
Ultra-processed foods make up almost half (45%) of the daily calories consumed by Canadian adults. Consumption of these foods is higher among men, younger adults, those with fewer years of formal education, smokers, those physically inactive, and Canadian-born individuals. Ultra-processed food consumption is positively associated with obesity. After adjusting for confounding factors, individuals in the highest quintile of ultra-processed food consumption were 32% more likely of having obesity compared to individuals in the first quintile (predicted OR = e0.005 × 56 = 1.32; 95% CI = 1.05–1.57).
Conclusion
Canadians would benefit from reducing consumption of ultra-processed foods and beverages and increasing consumption of freshly prepared dishes made from unprocessed or minimally processed foods.
Objectives
The current study investigates which foods may be most implicated in addictive-like eating by examining how nutritionally diverse foods relate to loss of control consumption and various subjective effect reports. Subjective effect reports assess the abuse liabilities of substances and may similarly provide insight into which foods may be reinforcing in a manner that triggers an addictive-like response for some individuals.
Design
Cross-sectional.
Setting
Online community.
Participants
507 participants (n = 501 used in analyses) recruited through Amazon MTurk.
Measurements
Participants (n = 501) self-reported how likely they were to experience a loss of control over their consumption of 30 nutritionally diverse foods and rated each food on five subjective effect report questions that assess the abuse liability of substances (liking, pleasure, craving, averseness, intensity). Hierarchical cluster analytic techniques were used to examine how foods grouped together based on each question.
Results
Highly processed foods, with added fats and/or refined carbohydrates, clustered together and were associated with greater loss of control, liking, pleasure, and craving. The clusters yielded from the subjective effect reports assessing liking, pleasure, and craving were most similar to clusters formed based on loss of control over consumption, whereas the clusters yielded from averseness and intensity did not meaningfully differentiate food items.
Conclusion
The present work applies methodology used to assess the abuse liability of substances to understand whether foods may vary in their potential to be associated with addictive-like consumption. Highly processed foods (e.g., pizza, chocolate) appear to be most related to an indicator of addictive-like eating (loss of control) and several subjective effect reports (liking, pleasure, craving). Thus, these foods may be particularly reinforcing and capable of triggering an addictive-like response in some individuals. Future research is warranted to understand whether highly processed foods are related to these indicators of abuse liability at a similar magnitude as addictive substances.
Background:
Nonnutritive sweeteners, such as aspartame, sucralose and stevioside, are widely consumed, yet their long-term health impact is uncertain. We synthesized evidence from prospective studies to determine whether routine consumption of non-nutritive sweeteners was associated with long-term adverse cardiometabolic effects.
Methods:
We searched MEDLINE, Embase and Cochrane Library (inception to January 2016) for randomized controlled trials (RCTs) that evaluated interventions for nonnutritive sweeteners and prospective cohort studies that reported on consumption of non-nutritive sweeteners among adults and adolescents. The primary outcome was body mass index (BMI). Secondary outcomes included weight, obesity and other cardiometabolic end points.
Results:
From 11 774 citations, we included 7 trials (1003 participants; median follow-up 6 mo) and 30 cohort studies (405 907 participants; median follow-up 10 yr). In the included RCTs, nonnutritive sweeteners had no significant effect on BMI (mean difference -0.37 kg/m(2); 95% confidence interval [CI] -1.10 to 0.36; I(2) 9%; 242 participants). In the included cohort studies, consumption of nonnutritive sweeteners was associated with a modest increase in BMI (mean correlation 0.05, 95% CI 0.03 to 0.06; I(2) 0%; 21 256 participants). Data from RCTs showed no consistent effects of nonnutritive sweeteners on other measures of body composition and reported no further secondary outcomes. In the cohort studies, consumption of nonnutritive sweeteners was associated with increases in weight and waist circumference, and higher incidence of obesity, hypertension, metabolic syndrome, type 2 diabetes and cardiovascular events. Publication bias was indicated for studies with diabetes as an outcome.
Interpretation:
Evidence from RCTs does not clearly support the intended benefits of nonnutritive sweeteners for weight management, and observational data suggest that routine intake of nonnutritive sweeteners may be associated with increased BMI and cardiometabolic risk. Further research is needed to fully characterize the long-term risks and benefits of nonnutritive sweeteners. Protocol registration: PROSPERO-CRD42015019749.
Introduction:
Metabolic syndrome is associated with increased risk for both type 2 diabetes and cardiovascular disease. Development of these pathologies is associated with the disorders of lipid and lipoprotein metabolism. Dyslipidemia leads to the overproduction of potentially atherogenic lipid and lipoproteins. Furthermore, there is a decrease in the levels of high-density lipoproteins and an increase in the levels of remnant and small dense LDL particles.
Conclusion:
In the current review, we have discussed the pathophysiology of lipoprotein biosynthesis and metabolism in the metabolic syndrome. Finally, we describe regulation of lipoprotein metabolism which may be used as a potential target for treating dyslipidemia in metabolic syndrome.
Gut bacteria play an important role in several metabolic processes and human diseases, such as obesity and accompanying co-morbidities, such as fatty liver disease, insulin resistance/diabetes, and cardiovascular events. Among other factors, dietary patterns, probiotics, prebiotics, synbiotics, antibiotics, and non-dietary factors, such as stress, age, exercise, and climatic conditions, can dramatically impact the human gut microbiota equilibrium and diversity. However, the effect of minor food constituents, including food additives and trace contaminants, on human gut microbiota has received less attention. Consequently, the present review aimed to provide an objective perspective of the current knowledge regarding the impacts of minor food constituents on human gut microbiota and consequently, on human health.
Metabolic syndrome (MetS) is a leading public health and clinical challenge worldwide. MetS represents a group of interelated risk factors that predict cardiovascular diseases (CVD) and diabetes mellitus (DM). Its prevalence ranges between 10 and 84%, depending of the geographic region, urban or rural environment, individual demographic characteristics of the population studied (sex, age, racial and ethnic origin), as well as the criteria used to define MetS. Persons with MetS have higher mortality rate when compared with people without MetS, primarily caused by progressive atherosclerosis, accelerated by pro-inflammatory and pro-coagulation components of MetS. Considering the high prevalence of metabolic disorders (a glucose metabolism disorder, hypertension, dyslipidaemia, obesity etc.), preventive healthcare should focus on changing lifestyle in order to reduce obesity and increase physical activity. In this narrative review we consider the available evidence from clinical and experimental studies dealing with MetS and current treatment options for patients with insulin resistance and MetS.
Background:
The consumption of advanced glycation end products (AGEs) has increased because of modern food processing and has been linked to the development of type 2 diabetes in rodents.
Objective:
We determined whether changing dietary AGE intake could modulate insulin sensitivity and secretion in healthy, overweight individuals.
Design:
We performed a double-blind, randomized, crossover trial of diets in 20 participants [6 women and 14 men; mean ± SD body mass index (in kg/m(2)): 29.8 ± 3.7]. Isoenergetic- and macronutrient-matched diets that were high or low in AGE content were alternately consumed for 2 wk and separated by a 4-wk washout period. At the beginning and end of each dietary period, a hyperinsulinemic-euglycemic clamp and an intravenous glucose tolerance test were performed. Dietary, plasma and urinary AGEsN(€)-(carboxymethyl)lysine (CML),N(€)-(carboxyethyl)lysin (CEL), and methylglyoxal-derived hydroimadazolidine (MG-H1) were measured with the use of mass spectrometry.
Results:
Participants consumed less CML, CEL, and MG-H1 during the low-AGE dietary period than during the high-AGE period (allP< 0.05), which was confirmed by changes in urinary AGE excretion. There was an overall difference in insulin sensitivity of -2.1 mg · kg(-1)· min(-1)between diets (P= 0.001). Insulin sensitivity increased by 1.3 mg · kg(-1)· min(-1)after the low-AGE diet (P= 0.004), whereas it showed a tendency to decrease by 0.8 mg · kg(-1)· min(-1)after the high-AGE diet (P= 0.086). There was no difference in body weight or insulin secretion between diets (P= NS).
Conclusions:
A diet that is low in AGEs may reduce the risk of type 2 diabetes by increasing insulin sensitivity. Hence, a restriction in dietary AGE content may be an effective strategy to decrease diabetes and cardiovascular disease risks in overweight individuals. This trial was registered atclinicaltrials.govasNCT00422253.
Background
Higher intake of ultraprocessed foods (UPFs) might be associated with increased risk of cardiovascular disease.
Objectives
Our objective was to examine the association between usual percentage of calories (%kcal) from UPFs and the American Heart Association's “Life's Simple 7” cardiovascular health (CVH) metrics in US adults.
Methods
We analyzed data from 11,246 adults aged ≥20 y from the NHANES 2011–2016 (a cross-sectional, nationally representative survey). UPF designation was assigned on the basis of the NOVA classification system, according to the extent and purpose of food processing. Each CVH metric was given a score of 0, 1, or 2 representing poor, intermediate, or ideal health, respectively. Scores of the 6 metrics (excluding diet) were summed, and CVH was categorized as inadequate (0–4), average (5–8), or optimum (9–12). We used the National Cancer Institute's methods to estimate the usual %kcal from UPFs, and multivariable linear and multinomial logistic regression to assess the association between UPFs and CVH, adjusted for age, sex, race and Hispanic origin, education, and poverty.
Results
The weighted prevalence of inadequate, average, and optimum CVH was 8.0%, 51.7%, and 40.3%, respectively. The mean usual %kcal from UPFs was 55.4%, and midpoint of quartiles of intake ranged from 40.4% (quartile 1) to 70.5% (quartile 4). Every 5% increase in calories from UPFs was associated with 0.14 points lower CVH score (P < 0.001). The adjusted ORs for inadequate CVH were 1.40 (95% CI: 1.23, 1.60), 1.82 (1.45, 2.29), and 2.57 (1.79, 3.70), respectively, comparing quartiles 2, 3, and 4 with quartile 1 of UPF intake. The pattern of association was largely consistent across subgroups.
Conclusions
Usual %kcal from UPFs represented more than half of total calorie intake in US adults. A graded inverse association between %kcal from UPFs and CVH was observed.
Background:
Ultra-processed food consumption and obesity have been highlighted as an important relationship to public health. We aimed to evaluate the association between ultra-processed food consumption and body fat from 6 to 11 years of age.
Methods:
We assessed the association between ultra-processed food consumption (from food frequency questionnaires) and body fat (measured by air displacement plethysmography) between 6 and 11 years of age among participants of the Pelotas-Brazil 2004 Birth Cohort. The NOVA classification was used to classify foods according to the processing degree. Body fat was evaluated relative to the height using fat mass index (FMI). Generalized estimating equations were used to answer the main research question and mediation analyses were run to assess the direct and indirect effect of ultra-processed food in body fat.
Results:
At fully adjusted analysis, an increase of 100 g in contribution from ultra-processed food to daily food intake at between 6 and 11 years of age was associated with a gain of 0.14 kg/m² in FMI in the same period; 58% of the total effect of ultra-processed food intake at 6 years (in grams) over the change in FMI from 6 to 11 years was mediated by its calorie content.
Conclusions:
Ultra-processed food consumption was associated with an increase in body fat from childhood to early adolescence, and this association was not just due to the effect of ultra-processed food on calorie content.
This study aims to investigate the dietary share of ultra-processed foods and its association with non-communicable diseases (NCDs)-related nutrient profile of adult and elderly population in Portugal. Cross-sectional data from the National Food, Nutrition and Physical Activity Survey (2015–2016) of the Portuguese population has been analyzed. Dietary intake was assessed by two non-consecutive 24-h recalls and food items were classified according to the NOVA system. We estimated the percentage of dietary energy provided by each of the NOVA food groups and assessed the NCD-related nutrient profile of the overall diet across quintiles of ultra-processed foods consumption. Weighted t-test, besides crude and adjusted linear and Poisson regressions have been performed. Ultra-processed foods contributed with around 24% and 16% of daily energy intake for adults and elderly, respectively. In both groups, as the consumption of ultra-processed foods increased, the dietary content of free sugars, total fats and saturated fats increased, while the dietary content of protein decreased. In adults, the total energy intake, the dietary energy density, and content of carbohydrates also increased as the consumption of ultra-processed foods increased, while the dietary content of fibre, sodium and potassium decreased. The prevalence of those exceeding the upper limits recommended for free sugars and saturated fats increased by 544% and 153% in adults, and 619% and 60% in elderly, when comparing the lowest to the highest quintile of ultra-processed consumption. Such a scenario demands for effective strategies addressing food processing in Portuguese population to improve their diet quality and prevention against diet-related NCDs.
Objective
To investigate the association between percent contribution of ultra-processed foods to total dietary energy intake and measurements of body composition obtained using high validity methods.
Research Methods & Procedures
Cross-sectional study with 1525 adolescents aged 18-19 years old from the second follow-up of the 1997/98 São Luís birth cohort, Brazil. To evaluate nutritional status and body composition, the Body Mass Index (BMI)-for-age was used, along with waist circumference, total and android body fat percentage, muscle mass, and Lean Mass Index (LMI). Food consumption was evaluated by a Food Frequency Questionnaire. Food items were grouped according to the level of processing according to the NOVA classification. Through semi-structured questionnaires, sociodemographic and lifestyle data were abstracted. Adjusted linear regression models were used to evaluate the associations between consumption of ultra-processed foods and body composition measurements.
Results
Total average energy consumption was 2,919.7 kcal, with 58% (1,634.9 kcal) derived from natural or minimally processed foods and 37% (1,136.5 kcal) from ultra-processed products. In the adjusted analyses, BMI, muscle mass, and LMI were inversely associated with consumption of ultra-processed foods. A 1% increase in the percent contribution of ultra-processed items to total dietary energy intake was associated with a 0.04 kg decrease in muscle mass (b= -0,04; CI95%= -0.06 – -0.02; p-value <0.001) and a 0.01 kg/m² decrease in Lean Body Mass (b= -0.01; CI95%= -0.02 – -0.01; p-value <0.001).
Conclusion
The contribution of ultra-processed foods to total dietary energy intake of Brazilian adolescents was associated with body composition, especially with decreasing lean body mass.
Objective
To analyse the association between food consumption according to the degree of processing and incidence of hypertension in CUME project participants.
Design
Longitudinal study in which food consumption was evaluated according to the percentage contribution of daily energetic intake (%/d) of each NOVA classification group (unprocessed/minimally processed foods and culinary preparations (U/MPF&CP); processed foods and ultra-processed foods (UPF)). Hypertension was defined according to American College of Cardiology/American Heart Association (ACC/AHA) criteria. Adjusted relative risks (RR) and their 95% confidence intervals (95 % CI) were estimated by Poisson regression models with robust variances.
Setting
Brazil.
Participants
1221 graduates classified as non-hypertensive at baseline and monitored for 2 years.
Results
Daily energetic percentage from each group according to degree of processing was 64·3 ( sd 12) % for U/MPF&CP; 9·9 ( sd 5·8) % for processed foods and 25·8 ( sd 11) % for UPF. Incidence of hypertension was high (152/1000 person-years; n 113, 193/1000 person-years in males and n 257, 138/1000 person-years in females). After adjusting for potential confounders, participants in the upper quintile of daily energetic intake of U/MPF&CP presented a reduced risk of hypertension (RR: 0·72; 95 % CI 0·52, 0·98), while those in the upper quintile of daily energetic intake of UPF presented an increased risk of the outcome (RR: 1·35; 95 % CI 1·01, 1·81).
Conclusions
In this prospective cohort of Brazilian middle-aged adult university graduates, the highest consumptions of U/MPF&CP and UPF were associated with, respectively, reduced and increased risk of hypertension. Additional longitudinal studies are needed to confirm our results.
We aimed to examine the association of weight gain during adulthood with the risk of cardiovascular disease (CVD) in the general population. We performed a systematic search of PubMed and Scopus, from inception to June 2019. Prospective cohort studies investigating the association of weight gain during adulthood with the risk of CVD were included. The relative risks (RRs) were calculated by using random-effects models. Twenty-three prospective cohort studies with 1,093,337 participants were included. The RRs for a 5-kg increment in body weigh were 1.11 (95%CI: 1.04, 1.19; I2 = 80%, n = 11) for CVD mortality, 1.18 (95%CI: 1.04, 1.32; I2 = 90%, n = 8) for coronary heart disease (CHD), 1.08 (95%CI: 1.04, 1.12; I2 = 0%, n = 3) for stroke, 1.18 (95%CI: 1.12, 1.25; I2 = 0%, n = 2) for myocardial infarction, and 1.05 (95%CI: 0.86, 1.23; I2 = 80%, n = 2) for heart failure. A dose-response analysis demonstrated that the risk of CVD mortality was unchanged within weight gain of 0-5 kg, and then increased sharply and linearly (P for nonlinearity <0.001). The analysis of CHD indicated a sharp increase in risk from baseline up to weight gain equal to 25-kg (P for nonlinearity = 0.12). Adult weight gain may be associated with a higher risk of CVD. Measuring weight gain during adulthood may be better than static, cross-sectional assessment of weight because it considers trend over time, and thus, can be used as a supplementary approach to predict CVD.
Introduction: Consumption of ultra-processed food and beverages (UPFB) is gaining growing attention due to its possible relation with increased risk of disease/mortality. To date, the possibility of such an association was only addressed in two European and one US population-based cohorts.
Hypothesis: We assessed the hypothesis of a positive association between UPFB consumption and mortality risk in a large sample of the Italian population and tested whether some known cardiovascular disease (CVD) risk factors and nutrients could be on the pathway of this relation. We also separately analyzed UPFB presumed to be healthy ( e.g. , breakfast cereals, fruit juices) from nutrient-poor foods ( e.g., cakes, snacks).
Methods: Longitudinal analysis on 22,810 men and women (mean age 55±12 y) recruited in the Moli-sani Study cohort between 2005-2010. Food intake was assessed using a semi-quantitative 188-item food frequency questionnaire. UPFB intake was defined by the NOVA classification according to degree of food processing and then categorized as number of servings/d. Hazard ratios with 95% confidence intervals (95% CI) were calculated using multivariable Cox-proportional hazard models.
Results: Over a median follow up of 8.3 y, 1,235 deaths were ascertained. As opposed to lower intake (<2 servings/d), individuals reporting high intake of UPFB (>4 servings/d) experienced an increased risk of CVD mortality (HR=1.50; 95%CI 1.18-1.92) and of death for ischemic heart (IHD)/cerebrovascular disease (1.56; 1.13-2.14). An upward trend was found for all-cause mortality too (1.15; 1.00-1.34). Biomarkers of renal function (cystatin C and creatinine) or of lipid metabolisms were likely to be on the pathway between UPFB and CVD mortality. Among selected macronutrients, high content of sugar and saturated fats possibly drove the relation of UPFB with CVD mortality. High intake of ‘healthy’ UPFB was associated with an increased trend of risk comparable to that associated with ‘unhealthy’ UPFB.
Conclusions: In a large Mediterranean cohort of Italian adults, high consumption of UPFB was associated with increased risk of CVD death and IHD/cerebrovascular mortality. This association was partly explained by established CVD risk factors and a high dietary content of sugar and saturated fats. UPFB presumed to be healthy appeared similarly linked to higher death risk. National dietary guidelines might consider discourage excessive consumption of ultra-processed food while recommending natural or minimally processed foods.
Importance
Ultraprocessed foods (UPF) are widespread in Western diets. Their consumption has been associated in recent prospective studies with increased risks of all-cause mortality and chronic diseases such as cancer, cardiovascular diseases, hypertension, and dyslipidemia; however, data regarding diabetes is lacking.
Objective
To assess the associations between consumption of UPF and risk of type 2 diabetes (T2D).
Design, Setting, and Participants
In this population-based prospective cohort study, 104 707 participants aged 18 years or older from the French NutriNet-Santé cohort (2009-2019) were included. Dietary intake data were collected using repeated 24-hour dietary records (5.7 per participant on average), designed to register participants' usual consumption for more than 3500 different food items. These were categorized according to their degree of processing by the NOVA classification system.
Main Outcomes and Measures
Associations between UPF consumption and risk of T2D were assessed using cause-specific multivariable Cox proportional hazard models adjusted for known risk factors (sociodemographic, anthropometric, lifestyle, medical history, and nutritional factors).
Results
A total of 104 707 participants (21 800 [20.8%] men and 82 907 [79.2%] women) were included. Mean (SD) baseline age of participants was 42.7 (14.5) years. Absolute T2D rates in the lowest and highest UPF consumers were 113 and 166 per 100 000 person-years, respectively. Consumption of UPF was associated with a higher risk of T2D (multi-adjusted hazard ratio [HR] for an absolute increment of 10 in the percentage of UPF in the diet, 1.15; 95% CI, 1.06-1.25; median follow-up, 6.0 years; 582 252 person-years; 821 incident cases). These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet, for other metabolic comorbidities (HR, 1.13; 95% CI, 1.03-1.23), and for weight change (HR, 1.13; 95% CI, 1.01-1.27). The absolute amount of UPF consumption (grams per day) was consistently associated with T2D risk, even when adjusting for unprocessed or minimally processed food intake (HR for a 100 g/d increase, 1.05; 95% CI, 1.02-1.08).
Conclusions and Relevance
In this large observational prospective study, a higher proportion of UPF in the diet was associated with a higher risk of T2D. Even though these results need to be confirmed in other populations and settings, they provide evidence to support efforts by public health authorities to recommend limiting UPF consumption.
Trial Registration
ClinicalTrials.gov Identifier: NCT03335644
The consumption of Western-type calorically rich diets combined with chronic overnutrition and a sedentary lifestyle in Western societies evokes a state of chronic metabolic inflammation, termed metaflammation. Metaflammation contributes to the development of many prevalent non-communicable diseases (NCDs), and these lifestyle-associated pathologies represent a rising public health problem with global epidemic dimensions. A better understanding of how modern lifestyle and Western diet (WD) activate immune cells is essential for the development of efficient preventive and therapeutic strategies for common NCDs. Here, we review the current mechanistic understanding of how the Western lifestyle can induce metaflammation, and we discuss how this knowledge can be translated to protect the public from the health burden associated with their selected lifestyle.
Although obesity is typically associated with metabolic dysfunction and cardiometabolic diseases, some people with obesity are protected from many of the adverse metabolic effects of excess body fat and are considered "metabolically healthy." However, there is no universally accepted definition of metabolically healthy obesity (MHO). Most studies define MHO as having either 0, 1, or 2 metabolic syndrome components, whereas many others define MHO using the homeostasis model assessment of insulin resistance (HOMA-IR). Therefore, numerous people reported as having MHO are not metabolically healthy, but simply have fewer metabolic abnormalities than those with metabolically unhealthy obesity (MUO). Nonetheless, a small subset of people with obesity have a normal HOMA-IR and no metabolic syndrome components. The mechanism(s) responsible for the divergent effects of obesity on metabolic health is not clear, but studies conducted in rodent models suggest that differences in adipose tissue biology in response to weight gain can cause or prevent systemic metabolic dysfunction. In this article, we review the definition, stability over time, and clinical outcomes of MHO, and discuss the potential factors that could explain differences in metabolic health in people with MHO and MUO - specifically, modifiable lifestyle factors and adipose tissue biology. Better understanding of the factors that distinguish people with MHO and MUO can produce new insights into mechanism(s) responsible for obesity-related metabolic dysfunction and disease.
This study evaluated global trends in ultraprocessed food and drink (UPFD) volume sales/capita and associations with adult body mass index (BMI) trajectories. Total food/drink volume sales/capita from Euromonitor for 80 countries (2002-2016) were matched to mean adult BMI from the NCD Risk Factor Collaboration (2002-2014). Products were classified as UPFD/non-UPFD according to the NOVA classification system. Mixed models for repeated measures were used to analyse associations between UPFD volume sales/capita and adult BMI trajectories, controlling for confounding factors. The increase in UPF volume sales was highest for South and Southeast Asia (67.3%) and North Africa and the Middle East (57.6%), while for UPD, the increase was highest for South and Southeast Asia (120.0%) and Africa (70.7%). In 2016, baked goods were the biggest contributor to UPF volume sales (13.1%-44.5%), while carbonated drinks were the biggest contributor to UPD volume sales (40.2%-86.0%). For every standard deviation increase (51 kg/capita, 2002) in UPD volume sales, mean BMI increased by 0.195 kg/m 2 for men (P < .001) and 0.072 kg/ m 2 for women (P = .003). For every standard deviation (40 kg/capita, 2002) increase in UPF volume sales, mean BMI increased by 0.316 kg/m 2 for men (P < .001), while the association was not significant for women. Increases in UPFD volume sales/capita were positively associated with population-level BMI trajectories.
Objective
To evaluate the association between ultra-processed food intake and all-cause mortality and CVD mortality in a nationally representative sample of US adults.
Design
Prospective analyses of reported frequency of ultra-processed food intake in 1988–1994 and all-cause mortality and CVD mortality through 2011.
Setting
The Third National Health and Nutrition Examination Survey (NHANES III, 1988–1994).
Participants
Adults aged ≥20 years ( n 11898).
Results
Over a median follow-up of 19 years, individuals in the highest quartile of frequency of ultra-processed food intake (e.g. sugar-sweetened or artificially sweetened beverages, sweetened milk, sausage or other reconstructed meats, sweetened cereals, confectionery, desserts) had a 31% higher risk of all-cause mortality, after adjusting for demographic and socio-economic confounders and health behaviours (adjusted hazard ratio=1·31; 95% CI 1·09, 1·58; P -trend = 0·001). No association with CVD mortality was observed ( P -trend=0·86).
Conclusions
Higher frequency of ultra-processed food intake was associated with higher risk of all-cause mortality in a representative sample of US adults. More longitudinal studies with dietary data reflecting the modern food supply are needed to confirm our results.
Objective:
To explore the association between polycyclic aromatic hydrocarbons (PAHs) and diabetes and to determine whether effects are heterogeneous when examined by body mass index (BMI).
Methods:
Cross-sectional data from 8664 participants were analyzed from the National Health and Nutrition Examination Survey for years 2005-2014. Multivariable logistic regression was used to explore the association between urinary biomarkers of PAHs and diabetes. All models were adjusted for age, sex, race, poverty-income ratio, and serum cotinine.
Results:
When compared with the lowest quintiles of exposure, the highest quintiles of exposure to 2-hydroxynaphthalene, 2-hydroxyfluorene, 9-hydroxyfluorene, 2-hydroxyphenanthrene, and a summed variable of all low molecular weight PAHs (aOR = 1.73; 95% CI: 1.17-2.55) showed a positive association with diabetes. Stratified analyses by BMI indicated that the positive association between PAHs and diabetes was found among both normal weight and obese participants.
Conclusions:
High levels of exposure to PAHs are positively associated with diabetes in the U.S. general population and these effects are modified by BMI. These findings suggest the importance of strong environmental regulation of PAHs to protect population health.
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.
