Ultra-processed food consumption and cancer risk: A systematic review and meta-analysis

The Association Between Ultra-Processed Foods Consumption and Disorders of Gut-Brain Interaction: The Isfahan Functional Disorders (ISFUN) Study

BACKGROUND

Ultra-processed foods (UPFs) may lead to dysbiosis of gut microbiota, which significantly contributes to the development of disorders of gut-brain interaction (DGBI). However, knowledge regarding the association of UPFs with DGBI is scarce. Therefore, we aimed to evaluate the association of UPFs with DGBI and its common subtypes in Iranian adults.

METHODS

In this cross-sectional study, a total of 1892 adults were included. Dietary intake of participants was evaluated using a validated version of a dish-based food frequency questionnaire, and UPFs were defined using the NOVA system classification. DGBI, including heartburn, functional dyspepsia (FD), and irritable bowel syndrome (IBS), were examined using the ROME IV questionnaire. The odds of suffering from any DGBI and its subtypes across the tertiles of UPFs were assessed using logistic regression.

RESULTS

After controlling for potential confounders, being in the highest versus lowest tertile of UPFs consumption was associated with increased risk of DGBI (OR = 1.62; 95% CI: 1.20, 2.17) and IBS (OR = 1.89; 95% CI: 1.01, 3.55). However, UPFs consumption was not significantly associated with odds of FD and heartburn in the fully adjusted model. In stratified analysis by sex, females in the highest tertile of UPFs consumption had higher risks of DGBI, IBS, and FD than those in the lowest tertile. In males, in the fully adjusted model, no significant association was found between UPFs consumption and risk of DGBI and its subtypes.

CONCLUSION

Higher consumption of UPFs was significantly associated with an increased risk of total DGBI and IBS in Iranian adults. However, considering the limitations of the available evidence regarding processed foods and DGBI, further large-scale prospective studies are needed to provide more data.

Mortality of Gastrointestinal Cancers Attributable to Smoking, Alcohol, and Metabolic Risk Factors, and its Association With Socioeconomic Development Status 2000-2021

OBJECTIVE

Gastrointestinal (GI) cancers account for one-third of global cancer mortality, with nearly half being preventable. This study updates the global burden of GI cancers attributed to major risk factors.

METHODS

We utilized data from the Global Burden of Disease Study 2021 to examine trends in death and age-standardized death rates related to GI cancers caused by smoking, alcohol, high body mass index (BMI), and high fasting blood glucose (FBG) from 2000 to 2021. Trends were analyzed based on countries' developmental status using a sociodemographic index (SDI).

RESULTS

In 2021, there were 1.12 million GI cancer deaths related to smoking, alcohol, high BMI, and high FBG, which was 53.6% higher than in 2000. The largest proportion of GI cancer mortality was attributed to smoking (43.3%), followed by alcohol (20.6%), high FBG (20.5%), and high BMI (15.6%). The increases in GI cancer deaths between 2000 and 2021 were related to high BMI (+102.54%) and FBG (+107.69%), particularly in liver and pancreatic cancer. In 2021, GI cancer mortality in low, low-middle, and middle SDI countries represented 44.3% of the global GI cancer mortality attributed to smoking, 41.9% for alcohol, 34.3% for high BMI, and 31.6% for high FBG. Since 2000, these proportions have increased by +4.5% for smoking, +7.6% for alcohol, + 12.3% for high BMI, and +6.4% for high FBG.

CONCLUSION

From 2000 to 2021, GI cancer mortality increased substantially, driven primarily by obesity and alcohol. Lower SDI countries are increasingly contributing to the global GI cancer burden.

Association between red and processed meat consumption and colorectal cancer risk: a comprehensive meta-analysis of prospective studies

Increasing evidence suggests that red and processed meat consumption may elevate the risk of colorectal cancer (CRC), yet the magnitude and consistency of this association remain debated. This meta-analysis aims to quantify the relationship between red and processed meat intake and the risk of CRC, colon cancer, and rectal cancer using the most comprehensive set of prospective studies to date. We conducted a comprehensive search in PubMed, Web of Science, Cochrane Library, Embase, and Google Scholar databases from 1990 to November 2024, to identify relevant prospective studies examining red, processed, and total meat consumption in relation to colorectal, colon, and rectal cancer risk. Hazard ratios (HR) and 95% confidence intervals (CI) were extracted for each study and pooled using a random-effects model to account for variability among studies. Statistical evaluation was executed using the online platform MetaAnalysisOnline.com. A total of 60 prospective studies were included. Red meat consumption was associated with a significantly increased risk of colon cancer (HR = 1.22, 95% CI 1.15-1.30), colorectal cancer (HR = 1.15, 95% CI 1.10-1.21), and rectal cancer (HR = 1.22, 95% CI 1.07-1.39). Processed meat consumption showed similar associations with increased risk for colon cancer (HR = 1.13, 95% CI 1.07-1.20), colorectal cancer (HR = 1.21, 95% CI 1.14-1.28), and rectal cancer (HR = 1.17, 95% CI 1.05-1.30). Total meat consumption also correlated with an elevated risk of colon cancer (HR = 1.22, 95% CI 1.11-1.35), colorectal cancer (HR = 1.17, 95% CI 1.12-1.22), and rectal cancer (HR = 1.28, 95% CI 1.10-1.48). This meta-analysis provides robust evidence that high consumption of red and processed meats is significantly associated with an increased risk of colorectal, colon, and rectal cancers. These findings reinforce current dietary recommendations advocating for the limitation of red and processed meat intake as part of cancer prevention strategies.

A global perspective of epidemiological trends in oncological emergencies

PURPOSE OF REVIEW

Oncologic emergencies are a critical interface between oncology and acute-care medicine. As global cancer trends evolve and healthcare disparities persist, this review seeks to address the pressing need to understand the epidemiology, predictors of outcomes, and care strategies for oncological emergencies across diverse healthcare contexts. The limited data available in this field underscores the vast knowledge gaps and the potential for significant scientific discovery.

RECENT FINDINGS

North American research networks have highlighted the variability in emergency department admissions and identified key determinants of outcomes, including functional status and disease staging. European studies have revealed that emergency presentations are frequently linked to advanced disease, whereas data from Asia and Oceania suggest that tumor burden and ethnicity significantly influence emergency care. In resource-limited regions, infection-related malignancies and inadequate healthcare infrastructure exacerbate challenges in managing oncologic emergencies. Despite these regional differences, consistent predictors of clinical outcomes, such as performance status and disease stage, have emerged as universal themes.

SUMMARY

This review highlights the need for targeted research and innovative interventions to bridge gaps in knowledge and care delivery. Region-specific strategies based on local epidemiological insights can improve patient outcomes and promote equity in oncological emergency management worldwide.

From Processed Foods to Ultraprocessed Foods: Evolution of an Industry Model and Impact on Dietary Quality, Health, and Society

The impact of food technology and product development on the nutritional quality of foods is discussed in the context of food classification schemes, clinical research, and sociocultural studies. Food processing operations are analyzed in terms of their beneficial and detrimental consequences for the nutritional value of foods and ingredients. Several classification schemes are discussed, including dietary guidelines, nutrition information panels, and nutritional scores. The health impact of processed and ultraprocessed foods is discussed in connection with the processing-formulation scheme previously developed by the authors. The importance of product development as a driver for the food industry is highlighted, and formulation-based approaches to improve the healthfulness of industrially produced foods are discussed. Finally, the public perception of processed foods and its impact on the industry are discussed, and the need for a broad engagement among stakeholders to ensure the sustainability of our food system and healthy diets for individuals is emphasized.

Beneath the Surface: The Emerging Role of Ultra-Processed Foods in Obesity-Related Cancer

PURPOSEOF REVIEW

Ultra-processed foods (UPFs) are becoming more and more important in daily diets around the world; in some cases, they can account for as much as 60% of daily energy intake. Epidemiological evidence suggests that this shift toward high levels of food processing may be partially responsible for the global obesity epidemic and the rise in the prevalence of chronic diseases.

RECENT FINDINGS

Few prospective studies have examined the relationship between UPF consumption and cancer outcomes. According to currently available information, UPFs may increase the risk of cancer due to their obesogenic properties and exposure to substances that can cause cancer, such as certain food additives and pollution from product processing. The complex relationship between obesity and cancer involves factors such as immune dysregulation, altered adipokine and sex hormone levels, abnormal fatty acid metabolism, extracellular matrix remodeling, and chronic inflammation. Addressing cancer risk associated with UPF consumption could involve a multifaceted approach, including consumer behavior modification programs and robust public health regulations aimed at enhancing food environments. Improved knowledge of the potential dual negative impacts of UPFs on the environment and cancer risk is one of the priority areas we identify for future research and policy implications. Various approaches could be used to prevent cancers associated with UPF consumption, such as consumer behavior change programs and stricter public health regulations needed to improve the food environment. This review examines for the first time the potential role of UPFs in cancer risk associated with obesity, exploring underlying biological mechanisms and identifying key areas for future research and policy action, including the dual environmental and health impact of UPFs.

Ultra-Processed Food and Its Impact on Bone Health and Joint Diseases: A Scoping Review

Background/Objectives: This scoping review explores the relationship between ultra-processed food (UPF), bone health, and joint diseases, focusing on its potential impact on bone mineral density (BMD), osteoporosis, osteoarthritis, and inflammatory arthritis, including rheumatoid arthritis (RA), gout, and spondyloarthritis. Methods: A search strategy was developed using key terms such as "ultra-processed food" and related terms like "fast food," alongside various definitions of bone health impairment, chronic degenerative joint diseases, and inflammatory arthritis. Results: A total of 19 studies were included: 12 on bone health, 3 on osteoarthritis, and 4 on inflammatory arthritis. Preclinical studies showed that UPF consumption negatively affects bone structure and strength. In studies on children and adults, four investigations (2013-2017) found no association between fast food intake and BMD. However, more recent large-scale cross-sectional studies linked higher UPF consumption to lower BMD, increased osteoporosis risk, and greater prevalence of osteopenia, particularly in postmenopausal women. UPF intake was associated with knee osteoarthritis risk, with evidence suggesting an interaction with cartilage thickness, though no association was found for hip osteoarthritis. In inflammatory arthritis, UK Biobank data indicated a higher risk of RA and gout in UPF consumers, while a Brazilian study reported worse metabolic profiles in RA patients. No significant differences in UPF intake were found in spondyloarthritis. Conclusions: This review highlights relevant considerations about the deleterious role of UPF on bone health and joint diseases, providing additional evidence to suggest healthier dietary patterns to patients and to the general population.

Low Self-Perceived Cooking Skills Are Linked to Greater Ultra-Processed Food Consumption Among Adolescents: The EHDLA Study

Introduction: Ultra-processed foods (UPFs) are widely consumed despite their established associations with obesity, cardiovascular diseases, and other metabolic disorders. One potential factor contributing to high UPF consumption is the decline in cooking skills, particularly among younger generations. This study aimed to describe the cooking skill perceptions of a sample of Spanish adolescents to examine the relationship between perceived cooking skills and UPF consumption, and to identify the specific UPF subcategories most associated with perceived cooking skills. Methods: This study is a secondary cross-sectional analysis using data from the Eating Healthy and Daily Life Activities (EHDLA) study, which was conducted among 847 Spanish adolescents (12-17 years) from three secondary schools in Valle de Ricote (Region of Murcia, Spain). The participants' perceptions of their cooking skills were assessed through the following question: "How would you rate your cooking skills?". The response options included (a) very adequate, (b) adequate, (c) inadequate, and (d) very inadequate. UPF consumption was evaluated via a self-administered food frequency questionnaire (FFQ) previously validated for the Spanish population. UPFs were classified according to the NOVA system, which distinguishes four groups: (1) unprocessed or minimally processed foods; (2) processed culinary ingredients, such as salt, sugar, and oils, used to enhance the preparation of fresh foods; (3) processed foods; and (4) UPF and drink products. To examine the associations between perceived cooking skills and UPF consumption, marginal means and 95% confidence intervals for servings of individual UPF groups were calculated via generalized linear models. These models were adjusted for age, sex, socioeconomic status, physical activity, sedentary behavior, sleep duration, and body mass index to control for potential confounders. Post hoc comparisons between cooking skill categories were conducted via false discovery rate correction following the Benjamini-Hochberg procedure, with significance set at p < 0.05. Results: Most participants (47%) rated their cooking skills as adequate (47%) or very adequate (18%). Overall UPF intake showed a decreasing trend across skill levels, with the "very adequate" group consuming significantly fewer servings than the "very inadequate" group did (p = 0.015). Among the specific UPF categories, adolescents in the "very adequate" category consumed significantly fewer sweets than those in the "very inadequate" and "inadequate" categories did (p < 0.05 for all). Conclusions: This study revealed evidence of a relationship between cooking skills and overall UPF intake. These results support the importance of interventions that promote cooking competencies among adolescents. School-based culinary programs and community initiatives that teach adolescents simple, time-efficient, and cost-effective cooking techniques could help reduce the overall intake of UPFs.

Impact of unhealthy food/drink marketing exposure to children in New Zealand: a systematic narrative review

Unhealthy food and drink marketing exposure to children is known to influence children's dietary choices and the World Health Organization recommends governments protect children from the marketing of unhealthy commodities. This study aims to explore and synthesize children's unhealthy food and drink marketing exposure in New Zealand. A systematic search strategy was undertaken following the PRISMA guidelines. Eight databases were searched for studies from inception to January 2024 on marketing exposure of unhealthy food and drink to children aged 2-17 years. A deductive coding analysis was used, with codes sourced from a modified coding framework developed using a diagram sourced from the ASEAN and UNICEF (2023) report. The diagram demonstrates the pathway from marketing exposure to unhealthy food- and drink-related diseases. A total of 1019 studies were screened for eligibility. Forty-five studies met the inclusion criteria-five qualitative, 34 quantitative and four mixed-method studies. The results are presented in a narrative review format. Findings demonstrated children's exposure to unhealthy food/drink marketing is ubiquitous with clear links to dietary preference and consumption. To improve child health now and over the life course, unhealthy food/drink marketing needs to be subjected to greater restriction with enforceable legislation to protect children from exposure to unhealthy marketing, breaking the chain from exposure to ill health.

Ultraprocessed foods and cancer risk: the importance of distinguishing ultraprocessed food groups

Several case-control, cohort studies, and meta-analyses found a moderate association between ultraprocessed food consumption and the risk of colorectal and a few other cancers. The evidence is, however, not consistent. A reason for such inconsistence is that the NOVA classification of ultraprocessed foods may include unfavorable but also favorable dietary components, and it may vary across different populations.

Determinants of Adherence to World Cancer Research Fund/American Institute for Cancer Research Recommendations in Women with Breast Cancer

BACKGROUND/OBJECTIVES

The 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations benefit primary prevention and survivor outcomes. This study evaluated the adherence to these recommendations during the year prior to breast cancer diagnosis and identified related clinical and sociodemographic factors.

METHODS

A total of 915 patients with breast cancer were recruited from eight hospitals in four regions of Spain. The participants completed an epidemiologic questionnaire and a food frequency questionnaire. The compliance with the WCRF/AICR recommendations was assessed using a standardized score based on seven recommendations. Standardized prevalences and standardized prevalence ratios (SPRs) for moderate and high adherence were calculated based on participant characteristics using binary and multinomial logistic regression models.

RESULTS

The mean adherence was 3.5 points out of 7. The recommendations with the best and worst adherence were avoiding sugar-sweetened drinks (54.4% adherence) and maintaining a fiber-rich diet (4.4% consumed ≥30 g/day). The overall adherence was better in women aged ≥60 years (SPR = 1.55; 95% CI = 1.09-2.22), and worse in those with a caloric intake ≥2000 kcal/day (SPR = 0.48; 95% CI = 0.37-0.62) or ≥2 comorbidities (SPR = 0.66; 95% CI = 0.49-0.89). The adherence to maintaining a healthy weight was worse in those with ≥2 comorbidities and stage III-IV tumors. The physical activity adherence was worse in working women and those with ≥2 comorbidities. The alcohol restriction adherence was worse in smokers. Younger women, smokers and those with a low calorie intake were less adherent to the fruit/vegetable recommendation. The consumption of fiber and limited consumption of red/processed meat adherence was poor in all the subgroups. The adherence to a limited consumption of fast food and sugary drinks was worse in younger women and high-calorie-diet consumers.

CONCLUSIONS

The differences in the adherence to recommendations according to patient characteristics justify the design of personalized interventions for breast cancer patients.

Physicochemical, microbiology, and sensory characteristics of kombucha prepared with Tommy mango peel flour

Fermented foods are a good option due to the beneficial compounds generated in the fermentation process and the low pH that allows conservation without additives. The objective of the study was to produce and include Tommy mango peel flour in the production of kombucha and evaluate its effects on the physicochemical and sensory properties, antioxidant capacity, and microbiological profile. The kombucha was developed with green tea and the addition of Tommy mango peel flour (10% and 20%). The kombuchas were evaluated in the first fermentation (aerobic) and at the end of the second fermentation (anaerobic), the granulometry and colorimetry of the flour and the antioxidant profile were evaluated. Microbiome analysis was performed by 16S DNA extraction. For sensory analysis, an affective test was performed for global evaluation, flavor, texture, and oral perception. The results showed that the total phenolic content was 4.86 mg EAG/mL in F1, 8.79 mg EAG/mL in F2 with 10% mango peel flour, and 8.83 ± 0.54 mg EAG/mL in F2 with 20% mango peel flour, evidencing a significant increase in the second fermentation with the addition of the flour. In addition, the antioxidant activity was also higher in the second fermentation. The values obtained were F1 = 15.27 µmol TE/mL; F2 with 10% FCMT = 18.80 µmol TE/mL; and F2 with 20% FCMT = 26.76 µmol TE/mL. These findings indicate that the antioxidant capacity increases significantly during the second fermentation, directly correlating with the amount of mango peel flour added. The most abundant bacterial genera were Liquorilactobacillus nagelii (72%), Acetobacter (13%), and Komagataeibacter (12%) and for fungi (90%) Brettanomyces/Dekkera bruxellensis. The beverage obtained different levels of acceptance among consumers and non-consumers only in terms of flavor, proving to be a good alternative for the food industry for applying a mango byproduct to drinks.

Impact of ultra-processed meat products on human health: Review and outlook

Modern diets are increasingly dominated by ultra-processed foods, a shift driven by urbanization and lifestyle changes. Among these, ultra-processed meat products (UPMPs) are particularly popular due to their appealing flavor and texture. However, emerging evidence highlights potential health risks associated with UPMPs. Although meat products are rich in high-quality proteins, the processing methods used in UPMPs can affect protein digestibility. Moderate processing techniques, such as sous-vide cooking, fermentation, and enzymatic tenderization, can enhance digestion and nutrient absorption, whereas excessive processing may lead to protein aggregation and cross-linking, reducing protein digestibility. Additionally, the overuse of additives and excessive thermal processing are key concerns in UPMP production, leading to the formation of potentially harmful substances, including acrylamide, heterocyclic amines, polycyclic aromatic hydrocarbons, and advanced glycation end products. This review examines how different processing techniques influence protein digestibility in UPMPs, elucidates the pathways through which harmful substances are generated, and assesses the impact of UPMPs on gut health, with a focus on gut microbiota and the colon. Our synthesis of current research indicates that excessive consumption of UPMPs contributes to gut microbiota dysbiosis, compromises the gut barrier, and increases the risk of colorectal cancer, though the dose-dependent effects require further clarification. Future research should focus on key parameters of moderate processing, explore natural alternatives to harmful additives, examine the dose-response relationship between UPMP consumption and health risks, and evaluate how individual factors, such as genetics and metabolism, influence the health impacts of UPMPs.

Ultra-Processed Food Intakes and Health Outcomes in Adults Older Than 60 Years: A Systematic Review

CONTEXT

Relationships between ultraprocessed food (UPF) intakes and health have been well described in adults, but evidence of these relationships in older adults is rather limited. Demographic shifts in aging emphasize the importance of understanding the role of diet in maintaining health during later life.

OBJECTIVE

The aim of this systematic review was to identify health outcomes associated with UPF consumption in those aged ≥60 years.

DATA SOURCES

The Medline, Web of Science, Scopus, and Embase databases were searched from inception until June 2023, using search terms representing UPF and any health outcome. Observational studies restricted to individuals aged ≥60 years using the Nova food classification were included. Articles were screened independently by 2 researchers using PECOS inclusion criteria.

DATA EXTRACTION

Two-thirds of the studies in the present review were prospective cohort studies (n = 4) and the rest were cross-sectional (n = 2). The number of participants ranged from 652 to 2713 across the 6 studies. The mean age of participants ranged between 67 and 73 years.

DATA ANALYSIS

In the prospective cohort studies, the highest consumption of UPF was associated with incident frailty, incident dyslipidemia, renal function decline, and abdominal obesity. For cross-sectional studies, the highest intake of UPF was associated with negative outcomes similar to young and middle-aged cohorts, with the addition of nutritional frailty and worse cognitive performance.

CONCLUSIONS

Currently, the limited understanding of how high UPF intakes could be associated with negative health outcomes for older adults influences the ability to inform policy and practice recommendations. More research is required owing to the very limited number of studies, specifically in older adults.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023442783.

Burden of diet-related chronic diseases in Chinese and Japanese adults attributable to dietary risk factors from 1990 to 2021: a systematic analysis of the Global Burden of Disease Study 2021

Background

Chronic diseases are a major cause of death, contributing significantly to the global disease burden. The growing aging population and chronic disease burden in China and Japan have a substantial impact on health outcomes. Dietary factors, as key modifiable elements, are particularly important. Therefore, we aimed to analyze and compare the impact of dietary factors on the burden of chronic diseases in China and Japan and to develop measures to reduce this burden.

Methods

According to the WHO classification of chronic diseases, we selected cardiovascular diseases, neoplasms, and diabetes for analysis. We collected relevant data from the GBD database, described and analyzed the disease burden by age, gender, and year, and created bar and trend charts. We conducted a comparative analysis of the dietary factors influencing these three chronic diseases by generating heatmaps. The joinpoint model was used to analyze the time trends of these three diseases from 1990 to 2021.

Results

From 1990 to 2021, the burden of neoplasms and cardiovascular diseases in China and Japan declined to varying degrees, while the burden of diabetes continued to increase. The main dietary risk factor for neoplasms is a high red meat diet, while for cardiovascular diseases, a high-sodium diet, especially in China. In addition, high meat consumption appears to serve as a protective factor for both Chinese and Japanese populations. Regarding dietary risk factors for diabetes, China is associated with a high red meat diet, whereas Japan is characterized by a high-processed meat diet.

Conclusion

By comparing the burden of chronic diseases related to dietary factors in China and Japan, this study proposes strategies for national healthy diets, such as reducing sodium, processed meat, and red meat intake and increasing whole grains, vegetables, and fruit intake. In addition, attention should be given to the dietary status of the elderly, along with targeted health education initiatives.

Atherosclerosis and the Bidirectional Relationship Between Cancer and Cardiovascular Disease: From Bench to Bedside, Part 2 Management

The first part of this review highlighted the evolving landscape of atherosclerosis, noting emerging cardiometabolic risk factors, the growing impact of exposomes, and social determinants of health. The prominent role of atherosclerosis in the bidirectional relationship between cardiovascular disease and cancer was also discussed. In this second part, we examine the complex interplay between multimorbid cardio-oncologic patients, cardiometabolic risk factors, and the harmful environments that lend a "syndemic" nature to these chronic diseases. We summarize management strategies targeting disordered cardiometabolic factors to mitigate cardiovascular disease and explore molecular mechanisms enabling more tailored therapies. Importantly, we emphasize the early interception of atherosclerosis through multifactorial interventions that detect subclinical signs (via biomarkers and imaging) to treat modifiable risk factors and prevent clinical events. A concerted preventive effort-referred to by some as a "preventome"-is essential to reduce the burden of atherosclerosis-driven chronic diseases, shifting from mere chronic disease management to the proactive promotion of "chronic health".

Beneficial microbiome and diet interplay in early-onset colorectal cancer

Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the second leading cause of cancer-related deaths worldwide. Although the risk of developing CRC increases with age, approximately 10% of newly diagnosed cases occur in individuals under the age of 50. Significant changes in dietary habits in young adults since industrialization create a favorable microenvironment for colorectal carcinogenesis. We aim here to shed light on the complex interplay between diet and gut microbiome in the pathogenesis and prevention of early-onset CRC (EO-CRC). We provide an overview of dietary risk factors associated with EO-CRC and contrast them with the general trends for CRC. We delve into gut bacteria, fungi, and phages with potential benefits against CRC and discuss the underlying molecular mechanisms. Furthermore, based on recent findings from human studies, we offer insights into how dietary modifications could potentially enhance gut microbiome composition to mitigate CRC risk. All together, we outline the current research landscape in this area and propose directions for future investigations that could pave the way for novel preventive and therapeutic strategies.

Ultra-processed Food Intake During Pregnancy and its Impact on Maternal Diet Quality and Weight Change: A Systematic Review of Observational Studies

PURPOSE OF REVIEW

Adequate and balanced nutrition during pregnancy is essential for both the mother's and fetus's health. The increased dietary intake of ultra-processed foods (UPFs) and their significant share in the diet negatively affects diet quality and gestational weight gain during pregnancy. The aim of this systematic review was to examine the association of UPFs consumption with diet quality and gestational weight change among healthy pregnant women, using data from observational studies (PROSPERO Identifier: CRD42023468269) from the last 10 years.

RECENT FINDINGS

A search was performed in Pubmed, Wiley, Scopus, and Web of Science, and studies published in english language were selected. Study selection and data extraction were made by determining the exclusion and eligible inclusion criterias according to the PECOS framework. Of the 12 studies included, 5 were longitudinal cohort studies and 7 were cross-sectional studies. On average, half of the energy in the participants' daily diets came from UPFs in 3 studies, but the energy share of UPFs was about 20-30% in the remainder studies. UPFs-enriched maternal diet was associated with less dietary intake of legumes, vegetables, fruits and protein sources (seafood and plant protein, total protein) and greater consumption of refined grains compared to those who consume less UPFs. In parallel, UPFs consumption was negatively associated with Healthy Eating Index. UPF intake during pregnancy has a negative impact on diet quality and gestational weight gain. Increasing awareness of UPFs during this period may reduce potential complications during pregnancy and fetal growth.

Consumption of Ultra-Processed Foods and Semen Quality in Healthy Young Men Living in Italy

BACKGROUND/OBJECTIVES

The study aim was to evaluate the association between UPF consumption and semen quality in a sample of healthy young men in Italy.

METHODS

A cross-sectional analysis was carried out using data from 126 participants (mean age ± SD 20.0 ± 1.2 years) enrolled in the FASt randomized controlled trial. Food intake was assessed through the European Prospective Investigation into Cancer and Nutrition (EPIC) FFQ. Food items were categorized according to the Nova classification based on their purpose and extent of processing as follows: (1) unprocessed/minimally processed foods; (2) processed culinary ingredients; (3) processed foods; and (4) UPFs. The weight ratio (%) between each Nova group (g/d) and total food (g/d) was then calculated. For semen analyses, sperm volume, concentration, motility and morphology were measured. The associations between UPF consumption (quarters of) and semen quality parameters were estimated using multivariable-adjusted linear regression models.

RESULTS

Participants consuming high UPFs (Q4), compared to those in the bottom category of intake (Q1), had a lower sperm concentration (β = -54.16 × 106 cell/mL; 95%CI: -92.91 to -15.40; p for trend = 0.0020 across fourths) and progressive motility (β = -14.17%; 95%CI: -28.25 to -0.09; p for trend = 0.036). The percentage of normal morphology cells had a tendency to decrease amongst subjects consuming more UPFs compared to those with the lowest intake.

CONCLUSIONS

A large dietary intake of UPFs was inversely associated with sperm concentration and progressive motility in reproductive-age men. These findings suggest that dietary recommendations for improving male fertility and sperm health should also recommend limiting UPFs.

Ultra-Processed Food and Prostate Cancer Risk: A Systemic Review and Meta-Analysis

Background/Objectives: Prostate cancer is the second leading cause of cancer death among American men, following lung cancer. While diet and exercise have been extensively studied in relation to prostate cancer prevention, the evidence remains inconclusive. Methods: A comprehensive literature search was performed to identify observational studies investigating the association between ultra-processed food (UPF) consumption and prostate cancer risk and mortality, determined by the NOVA classification system. In addition, we conducted subgroup analyses to assess the association based on study design, age, and data collection methods. Results: Six studies were identified, including four cohort studies and two case-control studies. No significant association was found between high UPF consumption and increased risk of prostate cancer [RR = 1.02, 95% confidence interval (CI) = 0.96-1.08, n = 5]. However, there was a slight increase in mortality (RR = 1.15, 95% CI = 0.99-1.35, n = 2). A subgroup analysis by the dietary assessment method revealed an RR of 1.01 (95% CI = 0.93-1.09) for studies using the food frequency questionnaire (FFQ) and 1.04 (95% CI = 0.93-1.16) for studies using 24-h recalls. There was no significant heterogeneity among the studies (I2 = 0, p = 0.82). Conclusions: This meta-analysis suggests no significant association between high UPF consumption and prostate cancer risk. Given the known associations with other chronic diseases, the potential public health implications of reducing UPF consumption remain important. Further research with the use of more robust food assignment systems and more precise dietary assessments is needed to clarify the role of UPF in prostate cancer development.

Positive serial dependence in ratings of food images for appeal and calories

Food is fundamental to survival, and our brains are highly attuned to rapidly process food stimuli. Neural signals show that foods can be discriminated as edible or inedible as early as 85 ms after stimulus onset,1 distinguished as processed or unprocessed beginning at 130 ms,2 and as high or low density from 165 ms.3 Recent evidence revealed specialized processing of food stimuli in the ventral visual pathway,4,5,6 an area that underlies perception of faces and other important objects. For many visual objects, perception can be biased toward recent perceptual history (known as serial dependence7,8). We examined serial dependence for food in two large samples (n > 300) who rated sequences of food images for either "appeal" or "calories." Ratings for calories were highly correlated between participants and were similar for males and females. Appeal ratings varied considerably between participants, consistent with the idiosyncratic nature of food preferences, and tended to be higher for males than females. High-calorie ratings were associated with high appeal, especially in males. Importantly, response biases showed clear positive serial dependences: higher stimulus values in the previous trials led to positive biases, and vice versa. The effects were similar for males and females and for calories and appeal ratings and were remarkably consistent across participants. These findings square with recently found food selectively in the visual temporal cortex, reveal a new mechanism influencing food decision-making, and suggest a new sensory-level component that could complement cognitive strategies in diet intervention.

An unbiased, sustainable, evidence-informed Universal Food Guide: a timely template for national food guides

BACKGROUND

Although national food guides are designed, ostensibly, to translate scientific evidence with respect to food, dietary patterns, and health, their development has increasingly become a corporate/political process as well as scientific one; often with corporate/political influences overriding science. Our aim was to construct an unbiased, sustainable, evidence-informed Universal Food Guide to serve as a template for countries to develop their unique guides, thereby, provide a valid resource for health professionals, health authorities, and the public.

METHODS

To address our aim, we conducted an integrative review of multiple evidence-informed sources (e.g., established databases, evidence syntheses, scholarly treatises, and policy documents) related to four areas: 1. Food guides' utility and conflicts of interest; 2. The evidence-based healthiest diet; 3. Constituents of the Universal Food Guide template; and 4. Implications for population health; regulation/governance; environment/climate/planetary health; and ethics.

RESULTS

The eating pattern that is healthiest for humans (i.e., most natural, and associated with maximal health across the life cycle; reduced non-communicable disease (NCD) risk; and minimal end-of-life illness) is whole food, low fat, plant-based, especially vegan, with the absence of ultra-processed food. Disparities in national food guide recommendations can be explained by factors other than science, specifically, corporate/political interests reflected in heavily government-subsidized, animal-sourced products; and trends toward dominance of daily consumption of processed/ultra-processed foods. Both trends have well-documented adverse consequences, i.e., NCDs and endangered environmental/planetary health. Commitment to an evidence-informed plant-based eating pattern, particularly vegan, will reduce risks/manifestations of NCDs; inform healthy food and nutrition policy regulation/governance; support sustainable environment/climate and planetary health; and is ethical with respect to 'best' evidence-based practice, and human and animal welfare.

CONCLUSION

The Universal Food Guide that serves as a template for national food guides is both urgent and timely given the well-documented health-harming influences that corporate stakeholders/politicians and advisory committees with conflicts of interest, exert on national food guides. Such influence contributes to the largely-preventable NCDs and environmental issues. Policy makers, health professionals, and the public need unbiased, scientific evidence as informed by the Universal Food Guide, to inform their recommendations and choices.

Ultra-processed food consumption and renal cell carcinoma incidence and mortality: results from a large prospective cohort

BACKGROUND

Growing evidence shows that ultra-processed food consumption is associated with the risk of cancer. However, prospective evidence is limited on renal cell carcinoma (RCC) incidence and mortality. In this study, we aimed to examine the association of ultra-processed food consumption and RCC incidence and mortality in a large cohort of US adults.

METHODS

A population-based cohort of 101,688 participants were included from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Ultra-processed food items were confirmed by using the NOVA food classification system. The consumption of ultra-processed food was expressed as a percentage of total food intake (g/day). Prospective associations were calculated using Cox regression. Restricted cubic spline regression was used to assess nonlinearity. Subgroup analyses were performed to investigate the potential effect modifiers on the incidence and mortality of RCC.

RESULTS

A total of 410 participants developed RCC during a total of 899,731 person-years of follow-up (median 9.41 years) and 230 RCC deaths during 1,533,930 person-years of follow-up (median 16.85 years). In the fully adjusted model, participants in the highest compared with the lowest quintiles of ultra-processed food consumption had a higher risk of RCC (HR quartile 4 vs 1:1.42; 95% CI: 1.06-1.91; Ptrend = 0.004) and mortality (HR quartile 4 vs. quartile 1: 1.64; 95% CI: 1.10-2.43; Ptrend = 0.027). Linear dose-response associations with RCC incidence and mortality were observed for ultra-processed food consumption (all Pnonlinearity > 0.05). The reliability of these results was supported by sensitivity and subgroup analyses.

CONCLUSION

In conclusion, higher consumption of ultra-processed food is associated with an increased risk of RCC incidence and mortality. Limiting ultra-processed food consumption might be a primary prevention method of RCC.

Allura Red AC is a xenobiotic. Is it also a carcinogen?

Merriam-Webster and Oxford define a xenobiotic as any substance foreign to living systems. Allura Red AC (a.k.a., E129; FD&C Red No. 40), a synthetic food dye extensively used in manufacturing ultra-processed foods and therefore highly prevalent in our food supply, falls under this category. The surge in synthetic food dye consumption during the 70s and 80s was followed by an epidemic of metabolic diseases and the emergence of early-onset colorectal cancer in the 1990s. This temporal association raises significant concerns, particularly given the widespread inclusion of synthetic food dyes in ultra-processed products, notably those marketed toward children. Given its interactions with key contributors to colorectal carcinogenesis such as inflammatory mediators, the microbiome, and DNA damage, there is growing interest in understanding Allura Red AC's potential impact on colon health as a putative carcinogen. This review discusses the history of Allura Red AC, current research on its effects on the colon and rectum, potential mechanisms underlying its impact on colon health, and provides future considerations. Indeed, although no governing agencies classify Allura Red AC as a carcinogen, its interaction with key guardians of carcinogenesis makes it suspect and worthy of further molecular investigation. The goal of this review is to inspire research into the impact of synthetic food dyes on colon health.

24-Hour Urinary Sodium Excretion Is Associated With Increased Risk of Pancreatic Cancer: A Prospective Cohort Study

INTRODUCTION

This study builds on previous research and its limitations, which indicate the need for further investigation in prospective cohorts. Our aim was to explore the association between estimated 24-hour urinary sodium excretion (indicative of daily sodium consumption) and the occurrence of pancreatic cancer in the UK Biobank's large prospective cohort.

METHODS

Using the INTERSALT equation, the study computed estimated 24-hour urinary sodium excretion by analyzing the baseline spot urine sodium measurements of 434,372 individuals enrolled in the UK Biobank. Pancreatic cancer cases were identified through UK cancer registries. Adjusted Cox proportional hazards models were used to evaluate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between estimated 24-hour urinary sodium excretion and the risk of pancreatic cancer.

RESULTS

Over a median follow-up period of 13.8 years, 1,765 cases of pancreatic cancer were detected. The multivariable adjusted Cox model showed that each 1-gram rise in estimated 24-hour urinary sodium excretion corresponded to a 1.12 HR for incident pancreatic cancer (95% CI: 1.03, 1.22). The estimated HR for 24-hour urinary sodium excretion in binary form was 1.23 (95% CI: 1.05, 1.44). Compared with the lowest group, the group with the highest estimated 24-hour urinary sodium excretion exhibited an HR of 1.38 (95% CI: 1.21, 1.58).

DISCUSSION

These results propose an association between elevated sodium consumption and a heightened risk of pancreatic cancer. Further validation and exploration of potential mechanisms are warranted.

Association of ultra-processed food consumption with muscle mass among young and middle-aged US adults

INTRODUCTION

Muscle mass is vital for physical activity and fundamental physiological processes supporting long-term health. While aging is inevitable, certain modifiable factors positively influence muscle preservation and overall well-being. However, the relationship between the consumption of ultra-processed foods (UPF) and muscle mass is not yet clear.

METHODS

This study included 7,173 men and nonpregnant women aged 20-59 years with valid 24-hour dietary recalls and accessible whole-body dual-energy x-ray absorptiometry (DXA) scans from NHANES 2011-2018. UPFs were identified through the NOVA classification system, and the percentage of energy derived from UPF consumption was evaluated in quintiles. Muscle mass measures were derived from DXA scans and quantified by the total and regional muscle mass index (MMI, kg/m²) and appendicular muscle mass index (AMMI, kg/m²). Multivariable-adjusted generalized linear regression models were applied to investigate the association between consumption of UPFs and muscle mass measures overall and by sociodemographic subgroups.

RESULTS

The multivariable-adjusted differences of total MMI from the lowest to highest quintile of UPF consumption were 0 (reference), -0.03 (95% CI, -0.13, 0.07), -0.13 (95%CI, -0.24, -0.04), -0.12 (95% CI, -0.23, -0.01), and - 0.17 (95% CI, -0.27, -0.08) (P for trend < 0.001). Subtotal MMI followed a similar magnitude of associational pattern as total MMI. For trunk MMI, corresponding values from the lowest to highest quintiles of UPF consumption were 0 (reference), -0.02 (95% CI, -0.07, 0.02), -0.05 (95%CI, -0.11, 0.00), -0.07 (95% CI, -0.13, -0.01), and - 0.07 (95% CI, -0.12, -0.01). For AMMI, corresponding values from the lowest to highest quintiles of UPF consumption were 0 (reference), -0.004 (95% CI, -0.07, 0.06), -0.08 (95%CI, -0.14, -0.02), -0.05 (95% CI, -0.11, 0.02), and - 0.10 (95% CI, -0.16, -0.04) (All P for trend < 0.001). While most subgroups maintained similar overall patterns, heterogeneous findings were also observed. For example, the multivariable-adjusted differences in total MMI between the lowest and highest quantile of UPF consumption were - 0.19 (95% CI, -0.32, -0.06) for non-Hispanic Whites, 0.18 (95% CI, 0.01, 0.36) for non-Hispanic Blacks, -0.25 (95%CI, -0.45, -0.04) for Hispanics, -0.25 (95% CI, -0.51, 0.05) for non-Hispanic Asians and - 0.32 (95% CI, -0.75, 0.12) for others (P for interaction < 0.001).

CONCLUSION

Higher consumption of UPFs was significantly associated with lower values of total and regional muscle mass. Specifically, comparing the highest quantile of UPF consumption to the lowest, total MMI decreased by 0.93%, trunk MMI decreased by 0.76%, and AMMI decreased by 1.25%. The differences in associational patterns between UPF consumption and muscle mass across sociodemographic subgroups require further investigation.

Effects of ketogenic diets on cancer-related variables: A systematic review and meta-analysis of randomised controlled trials

Cancer is a global health concern influenced by genetics, environment and lifestyle choices. Recent research shows that a ketogenic diet (KD) might ease cancer symptoms and reduce tumour size. We hypothesised that the KD could result in improvements in cancer-related variables. Therefore, this study aims to perform a systematic review and meta-analysis to assess the KD's efficacy for patients with cancer. The databases PubMed (MEDLINE), Web of Science, CINAHL and Open Grey were utilised for conducting a systematic review and meta-analysis. The analysis was limited to randomised controlled trials with adult participants aged 18 years and above. Levels of glucose, cholesterol, insulin-like growth factor 1, weight and quality of life were evaluated following the KD. After identifying 596 articles in the initial search, eight studies, lasting between 4 and 16 weeks, were included in the systematic review and seven in the meta-analysis. The KD led to decreased glucose levels in patients with cancer but did not show significant improvements in cholesterol, insulin-like growth factor 1, weight or quality of life. Based on the results of this systematic review and meta-analysis, there is insufficient evidence to establish a definitive link between the KD and cancer-related parameters. While some studies suggest potential benefits in terms of some outcomes and tumour size reduction, further research is required to fully comprehend the effects of this diet.

Exploring the Scientific Literature Between Ultraprocessed Foods and Cancer: A Scientometric Mapping

Objective: The objective of the study is to explore the scientific literature between ultraprocessed foods (UPFs) and cancer using a scientometric mapping. Materials and Methods: A Scopus search was conducted on February 4, 2024, limited to papers published between 2018 and 2023. We found 662 articles, 189 reviews, 68 book chapters, 13 conference papers, and 9 notes. The whole analysis included the evaluation of scholarly output by country/region, the number of scholarly papers produced (scholarly output), the number of views (view count), the field-weighted citation impact (FWCI). Results: In the analysis conducted for the period 2018-2023, a dataset was examined where the annual growth rate was 5.96%, indicating a sustained expansion of the literature. The average number of citations per paper was 18.56, underlining the impact and relevance of the publications. Sixty-six single-authored papers were identified, and international collaborations accounted for 27.23% of the collaborative efforts. The most prominent authors were Inge Huybrechts, Marc J.R. Gunter, and Edward Luciano Giovannucci. In terms of impact and visibility, Harvard University leads with 52 contributions and a field-weighted impact of 3.39. Conclusions: The literature in the field of UPFs and cancer has experienced a sustained expansion. The scientometric indicators reveal a high activity of recent academic contributions with significant impact.

Ultra-Processed Food Consumption as a Risk Factor for Gastrointestinal Cancer and Other Causes of Mortality in Southern Italy: A Competing Risk Approach

BACKGROUND

Ultra-Processed Foods (UPFs) are increasingly consumed worldwide, even in regions with strong dietary traditions like the Mediterranean and can play a crucial role in the development of chronic diseases, including cancer. This population-based prospective cohort study investigates the association between UPF consumption and gastrointestinal cancers and other causes of mortality in Southern Italy.

METHODS

Data were collected from 4870 participants in the MICOL and NUTRIHEP cohorts. The EPIC questionnaire was used to elicit information on food and drink consumption and UPFs were categorized by degree of processing according to the NOVA classification. Cox proportional hazards regression and competing risk models were employed for statistical analysis.

RESULTS

UPF consumption was positively associated with all-cause mortality: participants in the 3rd UFP quartile, as compared to the lowest, had a 27% higher risk of death (SHR 1.27 95% CI, 1.03; 1.57), while in the highest quartile as compared to the lowest, the risk was 34% higher (SHR 1.34 95% CI, 1.00; 1.79). Higher UPFs intake was also correlated with an increased gastrointestinal cancers mortality risk, especially the 2nd (SHR 1.65, 95% CI: 1.01; 2.71) and 4th quartile (SHR 3.14 95% CI: 1.56; 6.32), with a dose-dependent effect. For the other cancers, a SHR 1.61 (95% CI 1.03; 2.54) was observed for the 3rd quartile.

CONCLUSIONS

Our results reinforce the link between UPF consumption and cancer risk, emphasizing the urgent need for interventions targeting dietary patterns.

Stress factors and food purchase prioritization during the pandemic of coronavirus disease 2019

BACKGROUND

The pandemic of coronavirus disease 2019 (COVID-19) pandemic confinement has an impact on stress levels, which causes changes in food purchase and consumption behaviors. The objective of this study is to associate food purchase prioritization with stress level during the COVID-19 pandemic confinement.

METHODS

Multicenter, observational and cross-sectional study, an online questionnaire that included data on sociodemographic variables, stress factors and food purchase prioritization was disseminated through digital platforms and social networks.

RESULTS

A number of 6357 participants were included, of whom 83.6% were female, 56.3% were from the middle socioeconomic level, 71.2% had completed higher education and 78.3% had a job. At greater stress levels it was observed a higher prioritization of canned foods (Odds ratio (OR): 1.91, 95% CI: 1.56; 2.34), sweets (OR: 1.58, 95% CI: 1.06; 2.34) and flours (OR: 1.45, 95% CI: 1.25; 1.68). While lower stress levels are associated with nuts (OR: 0.75, 95% CI: 0.66; 0.85), vegetables (OR: 0.82, 95% CI: 0.72; 0.94), and fruits (OR: 0.90, 95% CI: 0.80; 1.01), after adjusting for confounders.

CONCLUSIONS

There is an association between food purchase prioritization and stress level during the COVID-19 confinement. At greater stress levels, individuals purchase more food, both healthy and unhealthy. The later may have a negative impact on people's health, leading to or further aggravating malnutrition by excess and nutrition-related noncommunicable diseases.

A Perspective Review on Diet Quality, Excess Adiposity, and Chronic Psychosocial Stress and Implications for Early-Onset Colorectal Cancer

Colorectal cancer (CRC) is the third most common cancer worldwide. Although the overall incidence of CRC has been decreasing over the past 40 y, early-onset colorectal cancer (EOCRC), which is defined as a CRC diagnosis in patients aged >50 y has increased. In this Perspective, we highlight and summarize the association between diet quality and excess adiposity, and EOCRC. We also explore chronic psychosocial stress (CPS), a less investigated modifiable risk factor, and EOCRC. We were able to show that a poor-quality diet, characterized by a high intake of sugary beverages and a Western diet pattern (high intake of red and processed meats, refined grains, and foods with added sugars) can promote risk factors associated with EOCRC development, such as an imbalance in the composition and function of the gut microbiome, presence of chronic inflammation, and insulin resistance. Excess adiposity, particularly obesity onset in early adulthood, is a likely contributor of EOCRC. Although the research is sparse examining CPS and CRC/EOCRC, we describe likely pathways linking CPS to tumorigenesis. Although additional research is needed to understand what factors are driving the uptick in EOCRC, managing body weight, improving diet quality, and mitigating psychosocial stress, may play an important role in reducing an individual's risk of EOCRC.

The causal relationship between serum metabolites and the risk of psoriasis: a Mendelian randomization and meta-analysis study

Objective

To explore the influence of serum metabolites on the risk of psoriasis.

Methods

In the initial stage, we applied Mendelian randomization to evaluate the association between 1,400 serum metabolites and the risk of psoriasis. Causal effects were primarily assessed through the Inverse-Variance Weighted method and Wald Ratio's odds ratios, and 95% confidence intervals. False Discovery Rate was used for multiple comparison corrections. Sensitivity analyses were conducted using Cochran's Q Test, MR-PRESSO. MR-Steiger Test was employed to check for reverse causality. In the validation stage, we sought other sources of psoriasis GWAS data to verify the initial results and used meta-analysis to combine the effect sizes to obtain robust causal relationships. In addition, we also conducted metabolic pathway enrichment analysis on known metabolites that have a causal relationship with the risk of psoriasis in both stages.

Results

In the initial stage, we identified 112 metabolites causally associated with psoriasis, including 32 metabolite ratios and 80 metabolites (69 known and 11 unknown). In the validation stage, 24 metabolites (16 known, 1 unknown, and 7 metabolite ratios) were confirmed to have a causal relationship with psoriasis onset. Meta-analysis results showed that the overall effect of combined metabolites was consistent with the main analysis in direction and robust in the causal relationship with psoriasis onset. Of the 16 known metabolites, most were attributed to lipid metabolism, with 5 as risk factors and 8 as protective factors for psoriasis. Peptidic metabolite Gamma-glutamylvaline levels had a negative causal relationship with psoriasis, while exogenous metabolite Catechol sulfate levels and amino acid 3-methylglutaconate levels had a positive causal relationship with the disease onset. The metabolites associated with psoriasis risk in the two stages are mainly enriched in the following metabolic pathways: Glutathione metabolism, Alpha Linolenic Acid and Linoleic Acid Metabolism, Biosynthesis of unsaturated fatty acids, Arachidonic acid metabolism, Glycerophospholipid metabolism.

Conclusion

Circulating metabolites may have a potential causal relationship with psoriasis risk, and targeting specific metabolites may benefit psoriasis diagnosis, disease assessment, and treatment.

UPDATE trial: investigating the effects of ultra-processed versus minimally processed diets following UK dietary guidance on health outcomes: a protocol for an 8-week community-based cross-over randomised controlled trial in people with overweight or obesity, followed by a 6-month behavioural intervention

INTRODUCTION

Obesity increases the risk of morbidity and mortality. A major driver has been the increased availability of ultra-processed food (UPF), now the main UK dietary energy source. The UK Eatwell Guide (EWG) provides public guidance for a healthy balanced diet but offers no UPF guidance. Whether a healthy diet can largely consist of UPFs is unclear. No study has assessed whether the health impact of adhering to dietary guidelines depends on food processing. Furthermore, our study will assess the impact of a 6-month behavioural support programme aimed at reducing UPF intake in people with overweight/obesity and high UPF intakes.

METHODS AND ANALYSIS

UPDATE is a 2×2 cross-over randomised controlled trial with a 6-month behavioural intervention. Fifty-five adults aged ≥18, with overweight/obesity (≥25 to <40 kg/m2), and ≥50% of habitual energy intake from UPFs will receive an 8-week UPF diet and an 8-week minimally processed food (MPF) diet delivered to their home, both following EWG recommendations, in a random order, with a 4-week washout period. All food/drink will be provided. Participants will then receive 6 months of behavioural support to reduce UPF intake. The primary outcome is the difference in weight change between UPF and MPF diets from baseline to week 8. Secondary outcomes include changes in diet, waist circumference, body composition, heart rate, blood pressure, cardiometabolic risk factors, appetite regulation, sleep quality, physical activity levels, physical function/strength, well-being and aspects of behaviour change/eating behaviour at 8 weeks between UPF/MPF diets, and at 6-month follow-up. Quantitative assessment of changes in brain MRI functional resting-state connectivity between UPF/MPF diets, and qualitative analysis of the behavioural intervention for feasibility and acceptability will be undertaken.

ETHICS AND DISSEMINATION

Sheffield Research Ethics Committee approved the trial (22/YH/0281). Peer-reviewed journals, conferences, PhD thesis and lay media will report results.

TRIAL REGISTRATION NUMBER

NCT05627570.

Nutrient profile of packaged foods according to the degree of processing

An increased consumption of ultra-processed foods (UPF) leads to a rising prevalence of chronic noncommunicable diseases. This study aims to characterise the nutrient profile of white-label pre-packaged foods and bakery products available in a market leader Portuguese food retail chain, according to the extent of processing proposed by NOVA classification system. The nutrient profile (energy, sugar, total fat, saturated fat and sodium) according to processing degree was analysed using non-parametric tests. UPF were the most energy dense (278 kcal/100 g, p < .001) and the highest in sugar (15.9 g/100 g, p < .001). Processed foods were the highest in sodium (538 mg/100 g, p < .001). Processed and UPF showed significantly higher total (12.4 and 10.8 g/100 g, respectively) and saturated fat content (6.10 and 4.61 g/100 g, respectively) than unprocessed/minimally processed foods (p < .001). Regarding the variation of the nutritional value across the extent of processing, different results were observed for some categories suggesting the importance of a stratified analysis. The consumption of less processed foods and the manufacture of processed/UPF with better nutrient profile should be promoted.

Complementarity between the updated version of the front-of-pack nutrition label Nutri-Score and the food-processing NOVA classification

OBJECTIVE

To compare the initial and the updated versions of the front-of-pack label Nutri-Score (related to the nutritional content) with the NOVA classification (related to the degree of food processing) at the food level.

DESIGN

Using the OpenFoodFacts database - 129,950 food products - we assessed the complementarity between the Nutri-Score (initial and updated) with the NOVA classification through a correspondence analysis. Contingency tables between the two classification systems were used.

SETTINGS

The food offer in France.

PARTICIPANTS

Not applicable.

RESULTS

With both versions (i.e. initial and updated) of the Nutri-Score, the majority of ultra-processed products received medium to poor Nutri-Score ratings (between 77·9 % and 87·5 % of ultra-processed products depending on the version of the algorithm). Overall, the update of the Nutri-Score algorithm led to a reduction in the number of products rated A and B and an increase in the number of products rated D or E for all NOVA categories, with unprocessed foods being the least impacted (-3·8 percentage points (-5·2 %) rated A or B and +1·3 percentage points (+12·9 %) rated D or E) and ultra-processed foods the most impacted (-9·8 percentage points (-43·4 %) rated A or B and +7·8 percentage points (+14·1 %) rated D or E). Among ultra-processed foods rated favourably with the initial Nutri-Score, artificially sweetened beverages, sweetened plant-based drinks and bread products were the most penalised categories by the revision of Nutri-Score while low-sugar flavoured waters, fruit and legume preparations were the least affected.

CONCLUSION

These results indicate that the update of the Nutri-Score reinforces its coherence with the NOVA classification, even though both systems measure two distinct health dimensions at the food level.

Eating out intensity, ultra-processed foods and BMI among Albanian youth

OBJECTIVE

Ultra-processed foods (UPF) and eating out of home (OH) are changing nutrition, particularly among youth in constrained settings. We aimed to assess the role of eating OH intensity on the associations of UPF and unprocessed or minimally processed foods (UMPF) with BMI among Albanian youth.

DESIGN

Cross-sectional.

SETTING

Albania, a south-eastern European country.

PARTICIPANTS

281 youth, predominantly females.

METHODS

UPF and UMPF were defined based on NOVA, while eating OH intensity based on energy percentage from OH foods. Multivariable models tested associations of UPF and UMPF with BMI stratified by eating OH intensity, controlled for relevant covariates including diet quality, portion size and costs.

RESULTS

The respondents age ranged between 18 and 23 years with a female predominance (87·5 %). Mean energy from UPF and UMPF was 846 (sd: 573·0) and 802·9 (422·5) kcals, respectively. Among substantial at home eaters UPF intake was not associated (β = −0·07, 95 % CI (−0·13, 0·267)) with BMI; however, UMPF negatively associated with BMI (β = −0·24, 95 % CI (−0·43, −0·06)). Among those defined as substantial OH eaters, UPF (β = 0·24, 95 % CI (0·08, 0·40)) and UMPF (β = 0·18, 95 % CI (0·04, 0·33)) were positively associated with BMI.

CONCLUSIONS

Our findings provide evidence for the hypothesis that eating OH plays an important role in the association of UPF and UMPF with BMI in youth. While causality cannot be established due to cross-sectional design, to the best of our knowledge, we provide the first assessment of UPF and UMPF intake in a south-eastern European setting, while highlighting the need for establishing and integrating youth nutrition into national nutritional surveillance systems for key dietary risk factors in Albania.

Emulsifiers in ultra-processed foods in the UK food supply

OBJECTIVE

Ultra-processed foods (UPF), including those containing food additive emulsifiers, have received research attention due to evidence implicating them in the pathogenesis of certain diseases. The aims of this research were to develop a large-scale, brand-level database of UPF in the UK food supply and to characterise the occurrence and co-occurrence of food additive emulsifiers.

DESIGN

A database was compiled sampling all products from the food categories contributing to energy intake from UPF in the UK from the National Diet and Nutrition Survey (2008-2014). Every food in these categories were identified from online supermarket provision from the 'big four' supermarkets that dominate the market share in the UK, comprising Tesco, Sainsbury's, Asda and Morrisons.

SETTING

Major supermarkets in the UK.

RESULTS

A total of 32 719 food products in the UK supermarket food supply were returned in searches. Of these, 12 844 products were eligible and manually reviewed for the presence of emulsifiers. Emulsifiers were present in 6642 (51·7 %) food products. Emulsifiers were contained in 95·0 % of 'Pastries, buns and cakes', 81·9 % of 'Milk-based drinks', 81·0 % of 'Industrial desserts' and 77·5 % of 'Confectionary'. Fifty-one per cent of all emulsifier-containing foods contained multiple emulsifiers. Across emulsifier-containing foods, there were a median of two emulsifiers (IQR 2) per product. The five most common emulsifiers were lecithin (23·4 % of all products), mono- and diglycerides of fatty acids (14·5 %), diphosphates (11·6 %), and xanthan gum and pectin (8·0 %).

CONCLUSIONS

Findings from this study are the first to demonstrate the widespread occurrence and co-occurrence of emulsifiers in UPF in the UK food supply.

Prostate Cancer Severity in Relation to Level of Food Processing

BACKGROUND

The level of food processing has gained interest as a potential determinant of human health. The aim of this study was to assess the relationship between the level of food processing and prostate cancer severity.

METHODS

A sample of 120 consecutive patients were examined for the following: their dietary habits, assessed through validated food frequency questionnaires; their dietary intake of food groups, categorized according to the NOVA classification; and their severity of prostate cancer, categorized into risk groups according to European Association of Urology (EAU) guidelines. Uni- and multivariate logistic regression analyses were performed to test the association between the variables of interest.

RESULTS

Individuals reporting a higher consumption of unprocessed/minimally processed foods were less likely to have greater prostate cancer severity than those who consumed less of them in the energy-adjusted model (odds ratio (OR) = 0.38, 95% confidence interval (CI): 1.17-0.84, p = 0.017 and OR = 0.33, 95% CI: 0.12-0.91, p = 0.032 for medium/high vs. low grade and high vs. medium/low grade prostate cancers, respectively); however, after adjusting for potential confounding factors, the association was not significant anymore. A borderline association was also found between a higher consumption of ultra-processed foods and greater prostate cancer severity in the energy-adjusted model (OR = 2.11, 95% CI: 0.998-4.44; p = 0.051), but again the association was not significant anymore after adjusting for the other covariates.

CONCLUSIONS

The level of food processing seems not to be independently associated with prostate cancer severity, while potentially related to other factors that need further investigation.

Association between ultra-processed food consumption and risk of breast cancer: a systematic review and dose-response meta-analysis of observational studies

Background

Some epidemiological studies have examined the association between consumption of ultra-processed food (UPF) and the risk of breast cancer. However, the results were inconsistent. Therefore, we carried out a systematic review and dose-response meta-analysis to examine whether an association exists between high consumption of UPF and breast cancer risk.

Methods

PubMed/MEDLINE, ISI Web of Science, EBSCO and CNKI databases were systematically searched from inception to May 2023. The summary relative risks (RRs) and 95% confidence intervals (CIs) associated with UPF consumption and breast cancer were calculated using a random-effects model (DerSimonian-Laird method). Heterogeneity between included studies was examined using the Cochran's Q test and I-square (I2) statistics. Publication bias was studied by visual inspection of funnel plot asymmetry and Begg's and Egger's tests.

Results

Overall, six articles involving 462,292 participants, were eligible to be included in this study. Compared to the lowest consumption, highest consumption of UPF was related to a higher risk of breast cancer (RR = 1.10; 95%CI: 1.00-1.22, p = 0.056). Besides, the linear dose-response analysis showed that each 10% increment in UPF consumption was related to a 5% higher risk of breast cancer (RR = 1.05; 95%CI: 1.00-1.10, p = 0.048). Subgroup analyses suggested that UPF consumption was positively associated with breast cancer risk in case-control studies (RR = 1.13; 95%CI: 1.01-1.26, p = 0.028). Additionally, there was also a significant positive association between UPF consumption and breast cancer risk in the subgroup with sample size<5,000(RR = 1.17; 95%CI: 1.02-1.35, p = 0.028).

Conclusion

Our results indicate that higher consumption of UPF is slightly related to a higher risk of breast cancer. Further studies in particular of large prospective cohort studies are warranted to confirm these results.

High Dietary Phosphorus Is Associated with Increased Breast Cancer Risk in a U.S. Cohort of Middle-Aged Women

Research has shown that high amounts of dietary phosphorus that are twice the amount of the U.S. dietary reference intake of 700 mg for adults are associated with all-cause mortality, phosphate toxicity, and tumorigenesis. The present nested case-control study measured the relative risk of self-reported breast cancer associated with dietary phosphate intake over 10 annual visits in a cohort of middle-aged U.S. women from the Study of Women's Health Across the Nation. Analyzing data from food frequency questionnaires, the highest level of daily dietary phosphorus intake, >1800 mg of phosphorus, was approximately equivalent to the dietary phosphorus levels in menus promoted by the United States Department of Agriculture. After adjusting for participants' energy intake, this level of dietary phosphorus was associated with a 2.3-fold increased risk of breast cancer incidence compared to the reference dietary phosphorus level of 800 to 1000 mg, which is based on recommendations from the U.S. National Kidney Foundation, (RR: 2.30, 95% CI: 0.94-5.61, p = 0.07). Despite the lack of statistical significance, likely due to the small sample size of the cohort, the present nested case-control study's clinically significant effect size, dose-response, temporality, specificity, biological plausibility, consistency, coherence, and analogy with other research findings meet the criteria for inferred causality in observational studies, warranting further investigations. Furthermore, these findings suggest that a low-phosphate diet should be tested on patients with breast cancer.