Excluding whole grain-containing foods from the Nova ultraprocessed food category: a cross-sectional analysis of the impact on associations with cardiometabolic risk measures

Ultra-processed food intake, diet quality, and risk of gestational diabetes mellitus: a cross-sectional analysis from the Mutaba'ah study

BACKGROUND

High intake of Ultra-Processed Foods (UPF) has raised concerns about how they might impact maternal diet and potentially increase the risk of Gestational Diabetes Mellitus (GDM). This study aimed to evaluate the associations between UPF intake or adherence to the Mediterranean Diet and GDM among pregnant women in the United Arab Emirates.

METHODS

Pregnant women (n = 1054) from the dietary subcohort within the prospective Mutaba'ah Study cohort were included. Diet was assessed through a semi-quantitative food frequency questionnaire, and UPF intake in servings/day was classified according to the NOVA system. The alternate Mediterranean Diet (aMED) score specific for pregnancy defined adherence to the Mediterranean Diet. GDM diagnosis was based on the National Institute for Health and Clinical Excellence criteria. Logistic regression models adjusted for maternal age, first trimester body mass index, parity, gestational age, education level, employment status, physical activity, and husband's smoking status were used to assess associations between UPF intake or aMED score and GDM.

RESULTS

Mean ± SD UPF intake was 9.4 ± 3.4 servings/day and mean aMED score was 4.0 ± 1.5. Women in the highest tertile of UPF intake had lower aMED score than those in the lowest tertile (4.3 ± 1.4 vs. 3.6 ± 1.4, P < 0.001). Women in the highest tertile of UPF intake had higher intakes of carbohydrates, saturated fatty acids, sodium, and selenium than those in the lowest tertile, while intakes of protein, total fat, monounsaturated fatty acids, and most micronutrients were lower (P < 0.05). Neither tertiles of UPF intake (third tertile compared to the lowest OR = 0.85, 95% CI: 0.54-1.34) nor continuous UPF intake (OR = 0.97, 95% CI: 0.92-1.03) was associated with GDM. Similarly, aMED score was not associated with GDM in either tertile of the score (third tertile compared to the lowest OR = 0.94, 95% CI: 0.54-1.64) or as a continuous variable (OR = 0.99, 95% CI: 0.87-1.11).

CONCLUSIONS

Higher intake of UPF was associated with a lower adherence to the Mediterranean Diet. However, neither UPF intake nor aMED score was associated with GDM.

Existing food processing classifications overlook the phytochemical composition of processed plant-based protein-rich foods

According to existing food processing classification systems, plant-based protein-rich (PBPR) foods are often considered 'ultra-processed'-and therefore perceived as unhealthy-despite their ability to provide various bioactive compounds beneficial for human health. Here we used a non-targeted metabolomics approach to analyse the impact of processing on the biochemical composition of PBPR foods. Our results show that existing food classification systems may provide questionable categories for PBPR foods without considering their overall biochemical composition, including phytochemicals. An analysis focusing specifically on biochemical compounds of soy-based products manufactured using various technologies showed no clear distinctions between processing groups in the principal component analysis based on the NOVA and Poti classification. However, clear differences were found between soy-based products based on their phytochemical profile. Although food processing classification systems are welcome in their attempt to guide consumers towards healthy choices, they should be improved to more accurately reflect the biochemical composition of PBPR foods.

Ultra-processed foods consumption and health-related outcomes: a systematic review of randomized controlled trials

Introduction

The increase in ultra-processed foods (UPFs) intake has raised concerns about its impact on public health. Prospective observational studies have reported significant associations between higher intake of UPFs and adverse health outcomes. The aim of this study is to determine whether these associations could be confirmed in randomized controlled trials (RCTs).

Methods

We conducted a systematic review to analyze the evidence on the effects of UPFs intake on health. A systematic search was conducted in Medline, Embase, Web of Science, Scopus, LILACS, and CENTRAL up to April 22, 2024. RCTs in English, Spanish, and Portuguese evaluating the health effects of interventions to modify UPFs intake were included. The certainty of evidence was determined using the GRADE methodology.

Results

Three educational intervention studies and one controlled feeding trial were included, evaluating the effect of reducing the consumption of UPFs (455 participants, median follow-up, 12 weeks). No significant effects were observed in 30 out of the 42 outcomes evaluated. The controlled feeding trial in adults with stable weight showed a reduction in energy intake, carbohydrates, and fat (low certainty of evidence), as well as in body weight, total cholesterol, and HDL cholesterol (moderate certainty of evidence). In the educational intervention studies, a reduction in body weight and waist circumference was observed (low certainty of evidence) in women with obesity, as well as improvement in some dimensions of quality of life (very low certainty of evidence). No significant changes were observed in children and adolescents with obesity, while in overweight pregnant women, the consumption of UPFs was not reduced, so the observed benefits could be attributed to other components of the intervention.

Conclusion

Interventions aimed at reducing the consumption of UPFs showed benefits on some anthropometric and dietary intake outcomes, although significant effects were not observed for most of the evaluated outcomes. The limited number and significant methodological limitations of the studies prevent definitive conclusions. Further well-designed and conducted RCTs are needed to understand the effects of UPF consumption on health.Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023469984.

Ultra-Processed Foods: A Narrative Review of the Impact on the Human Gut Microbiome and Variations in Classification Methods

Ultra-processed foods (UPFs) are foods that are industrially processed and are often pre-packaged, convenient, energy-dense, and nutrient-poor. UPFs are widespread in the current Western diet and their proposed contribution to non-communicable diseases such as obesity and cardiovascular disease is supported by numerous studies. UPFs are hypothesized to affect the body in multiple ways, including by inducing changes in the gut microbiome. This review summarizes the available research on the effect of UPFs on the gut microbiome. We also review current usage of the NOVA food classification system in randomized controlled trials and observational studies and how its implementation effects UPF research. Despite some differences in methodology between studies, results often associate UPF consumption with a number of negative health consequences. There are attempts to standardize a UPF classification system; however, reaching and implementing a consensus is difficult. Future studies focusing on the mechanisms by which UPFs effect the body, including through the microbiome and metabolome, will be essential to refine our understanding of the effects of UPFs on human health.