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Mendoza K, Smith-Warner SA, Rossato SL, Khandpur N, Manson JE, Qi L, Rimm EB, Mukamal KJ, Willett WC, Wang M, Hu FB, Mattei J, Sun Q. Ultra-processed foods and cardiovascular disease: analysis of three large US prospective cohorts and a systematic review and meta-analysis of prospective cohort studies. LANCET REGIONAL HEALTH. AMERICAS 2024; 37:100859. [PMID: 39286398 PMCID: PMC11403639 DOI: 10.1016/j.lana.2024.100859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 07/24/2024] [Accepted: 07/29/2024] [Indexed: 09/19/2024]
Abstract
Background Prospective associations between total and groups of ultra-processed foods (UPF) and cardiovascular disease (CVD) remained to be characterised. Our aim was to assess the association of total and group-specific UPF intakes with CVD, coronary heart disease (CHD), and stroke in three large prospective cohorts of US adults. Additionally, we conducted a systematic review and meta-analyses on the existing evidence on the associations of total UPF intake with these outcomes. Methods UPF intake was assessed through food frequency questionnaires in the Nurses' Health Study (NHS; n = 75,735), Nurses' Health Study II (NHSII; n = 90,813), and Health Professionals Follow-Up Study (HPFS; n = 40,409). Cox regression estimated cohort-specific associations of total and group-specific UPF intake with risk of CVD (cases = 16,800), CHD (cases = 10,401), and stroke (cases = 6758), subsequently pooled through fixed-effect models. Random-effects meta-analyses pooled existing prospective findings on the UPF-CVD association identified on Medline and Embase up to April 5, 2024, without language restrictions. Risk of bias was assessed with the Newcastle-Ottawa Scale, funnel plots, and Egger's tests, and meta-evidence was evaluated using NutriGrade. Findings The baseline mean (SD) age was 50.8 years (7.2) for the NHS, 36.7 years (4.6) for the NHSII, and 53.4 years (9.6) for the HPFS. The proportion of participants of White race was 97.7% in the NHS, 96.4% in the NHSII, and 94.9% in the HPFS. Among the three cohorts, multivariable-adjusted hazard ratios [HRs (95% CIs)] for CVD, CHD, and stroke for the highest (vs. lowest) total UPF intake quintile were 1.11 (1.06-1.16), 1.16 (1.09-1.24), and 1.04 (0.96-1.12), respectively. UPF groups demonstrated divergent associations. Sugar-/artificially-sweetened drinks and processed meats were associated with higher CVD risk, whereas inverse associations were observed for bread/cold cereals, yoghurt/dairy desserts, and savoury snacks. Meta-analysing 22 prospective studies showed that total UPF intake at the highest category (vs. lowest) was associated with 17% (11%-24%), 23% (12%-34%), and 9% (3%-15%) higher CVD, CHD, and stroke risk. Meta-evidence quality was high for CHD, moderate for CVD, and low for stroke. Interpretation Total UPF intake was adversely associated with CVD and CHD risk in US adults, corroborated by prospective studies from multiple countries, also suggesting a small excess stroke risk. Nutritional advice for cardiovascular health should consider differential consequences of group-specific UPF. Replication is needed in racially/ethnically-diverse populations. Funding National Institutes of Health (NIH) grants supported the NHS, NHSII, and HPFS.
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Affiliation(s)
- Kenny Mendoza
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Stephanie A Smith-Warner
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sinara Laurini Rossato
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Federal University of Uberlândia, Uberlândia, State of Minas Gerais, Brazil
| | | | - JoAnn E Manson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Lu Qi
- Tulane University Obesity Research Center, Tulane University, New Orleans, LA, USA
| | - Eric B Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Molin Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Qi Sun
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Lemke S, de Andrade DF, de Fragas Hinnig P, da Silva SA, Vincenzi SL, Roberto DMT, Lobo AS, Vieira FGK, Di Pietro PF, de Assis MAA. Development and application of the Meal and Snack Assessment (MESA) quality scale for children and adolescents using item response theory. Nutr J 2024; 23:50. [PMID: 38745270 PMCID: PMC11092231 DOI: 10.1186/s12937-024-00948-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/10/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Meals differ in terms of food items and nutritional quality. The aim of the present study was to propose a scale to measure the meals quality of schoolchildren according to food processing degree, perform a preliminary evaluation of the scale's validity and reliability and apply the scale to a representative sample of schoolchildren in a city in southern Brazil. METHODS A methodological study based on the generalized graded unfolding model (GGUM) of item response theory (IRT) with analysis of secondary data was carried out in 6,399 schoolchildren of 6-15y-old attending 2nd to 5th grades of public elementary schools in Florianópolis, Brazil, in 2013-2015 who answered the validated Food Intake and Physical Activities of Schoolchildren (WebCAAFE) questionnaire. Meal quality was the latent trait. The steps for the development of the scale included: latent trait definition; item generation; dimensionality analysis; estimation of item parameters; scale levels definition; assessment of validity and reliability; and assessment of the meal quality of a subsample of schoolchildren aged 7 to 12 years (n = 6,372). RESULTS Eleven out of eighteen items had adequate parameters, without differential item functioning for sex or age. Meal quality was categorized into three levels: healthy, mixed, and unhealthy. Higher scores indicate a greater prevalence of ultra-processed foods in daily meals. Most schoolchildren had mixed (40.6%) and unhealthy (41%) meal patterns. CONCLUSIONS IRT analysis allowed the development of the scale, which measures the quality of meals and snacks based on the degree of food processing. At all snack times, there was a higher frequency of ultra-processed foods consumption, therefore foods consumed as snacks are a potential focus for nutritional interventions.
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Affiliation(s)
- Stella Lemke
- Nutrition Postgraduate Program, Department of Nutrition, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Dalton Francisco de Andrade
- Informatics and Statistics Department, Technological Center, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Patrícia de Fragas Hinnig
- Nutrition Postgraduate Program, Department of Nutrition, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Silvio Aparecido da Silva
- Knowledge Management Department, Federal Institute of Education, Science and Technology of Santa Catarina, Florianópolis, Brazil
| | - Silvana Ligia Vincenzi
- Informatics and Statistics Department, Technological Center, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Denise Miguel Teixeira Roberto
- Nutrition Postgraduate Program, Department of Nutrition, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Adriana Soares Lobo
- Nutrition Postgraduate Program, Department of Nutrition, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Francilene Gracieli Kunradi Vieira
- Nutrition Postgraduate Program, Department of Nutrition, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Patricia Faria Di Pietro
- Nutrition Postgraduate Program, Department of Nutrition, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Brazil.
- Federal University of Santa Catarina, Campus Trindade, Florianópolis, Santa Catarina, 88040-370, Brazil.
| | - Maria Alice Altenburg de Assis
- Nutrition Postgraduate Program, Department of Nutrition, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Brazil
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Dicken SJ, Batterham RL. Ultra-processed Food and Obesity: What Is the Evidence? Curr Nutr Rep 2024; 13:23-38. [PMID: 38294671 PMCID: PMC10924027 DOI: 10.1007/s13668-024-00517-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 02/01/2024]
Abstract
PURPOSE OF REVIEW Obesity is a growing global healthcare concern. A proposed driver is the recent increase in ultra-processed food (UPF) intake. However, disagreement surrounds the concept of UPF, the strength of evidence, and suggested mechanisms. Therefore, this review aimed to critically appraise the evidence on UPF and obesity. RECENT FINDINGS Observational studies demonstrate positive associations between UPF intake, weight gain, and overweight/obesity, more clearly in adults than children/adolescents. This is supported by high-quality clinical data. Several mechanisms are proposed, but current understanding is inconclusive. Greater UPF consumption has been a key driver of obesity. There is a need to change the obesogenic environment to support individuals to reduce their UPF intake. The UPF concept is a novel approach that is not explained with existing nutrient- and food-based frameworks. Critical analysis of methodologies provides confidence, but future observational and experimental research outputs with greater methodological rigor will strengthen findings, which are outlined.
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Affiliation(s)
- Samuel J Dicken
- Centre for Obesity Research, Department of Medicine, University College London (UCL), London, WC1E 6JF, UK
| | - Rachel L Batterham
- Centre for Obesity Research, Department of Medicine, University College London (UCL), London, WC1E 6JF, UK.
- Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital (UCLH), London, NW1 2BU, UK.
- National Institute for Health Research, Biomedical Research Centre, University College London Hospital (UCLH), London, W1T 7DN, UK.
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Okada E, Nakade M, Hanzawa F, Murakami K, Matsumoto M, Sasaki S, Takimoto H. National Nutrition Surveys Applying Dietary Records or 24-h Dietary Recalls with Questionnaires: A Scoping Review. Nutrients 2023; 15:4739. [PMID: 38004132 PMCID: PMC10674720 DOI: 10.3390/nu15224739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
Development of an accurate and efficient dietary method is required for national nutrition surveys. Some countries conduct dietary surveys and combine 24-h dietary records or 24-h dietary recalls with dietary questionnaires. This scoping review aimed to summarize studies that used results from national surveys that combined detailed dietary surveys (dietary records or 24-h dietary recall) and dietary questionnaires and identify the purpose of combining the two methods. The PubMed database and manual searches were used for the literature review. We extracted 58 articles from 16 national nutrition surveys from 14 countries. Most studies used 24-h dietary recall for detailed dietary surveys and the food frequency questionnaire (FFQ) or food propensity questionnaire (FPQ) for questionnaire surveys. Among 37 studies from eight countries, the purpose of combining the two dietary survey methods was to estimate energy and nutrient intakes from detailed dietary surveys and habitual food intake from questionnaires. These findings are useful as a reference when introducing new dietary survey methods in future national nutrition surveys.
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Affiliation(s)
- Emiko Okada
- The Health Care Science Institute, 3-2-12 Akasaka, Minato-ku, Tokyo 107-0052, Japan
- Department of Nutritional Epidemiology and Shokuiku, National Institute of Biomedical Innovation, Health and Nutrition, Kento Innovation Park, NK Building, 3-17 Senrioka Shinmachi, Settsu-shi 566-0002, Japan
| | - Makiko Nakade
- Department of Food Science and Nutrition, University of Hyogo, 1-1-12 Shinzaike-Honcho, Himeji-shi 670-0092, Japan
- Research Institute for Food and Nutritional Sciences, 1-1-12 Shinzaike-Honcho, Himeji-shi 670-0092, Japan
| | - Fumiaki Hanzawa
- Department of Food Science and Nutrition, University of Hyogo, 1-1-12 Shinzaike-Honcho, Himeji-shi 670-0092, Japan
- Research Institute for Food and Nutritional Sciences, 1-1-12 Shinzaike-Honcho, Himeji-shi 670-0092, Japan
| | - Kentaro Murakami
- Department of Social and Preventive Epidemiology, School of Public Health, University of Tokyo, Tokyo 113-0033, Japan
| | - Mai Matsumoto
- Department of Nutritional Epidemiology and Shokuiku, National Institute of Biomedical Innovation, Health and Nutrition, Kento Innovation Park, NK Building, 3-17 Senrioka Shinmachi, Settsu-shi 566-0002, Japan
| | - Satoshi Sasaki
- Department of Social and Preventive Epidemiology, School of Public Health, University of Tokyo, Tokyo 113-0033, Japan
| | - Hidemi Takimoto
- Department of Nutritional Epidemiology and Shokuiku, National Institute of Biomedical Innovation, Health and Nutrition, Kento Innovation Park, NK Building, 3-17 Senrioka Shinmachi, Settsu-shi 566-0002, Japan
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Rossato SL, Khandpur N, Lo CH, Jezus Castro SM, Drouin-Chartier JP, Sampson L, Yuan C, Murta-Nascimento C, Carvalhaes MA, Monteiro CA, Sun Q, Fung TT, Willett WC. Intakes of Unprocessed and Minimally Processed and Ultraprocessed Food Are Associated with Diet Quality in Female and Male Health Professionals in the United States: A Prospective Analysis. J Acad Nutr Diet 2023; 123:1140-1151.e2. [PMID: 36965524 DOI: 10.1016/j.jand.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/08/2023] [Accepted: 03/20/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND High unprocessed and minimally processed food (UMP) intake has been associated with high-quality diets, whereas the opposite has been shown for ultraprocessed food (UPF). Nevertheless, the association between UMP and UPF consumption and diet quality over the long-term warrants further examination. OBJECTIVE This study aimed to assess whether UMP and UPF intake are associated with three diet-quality metrics in female and male health professionals from two US cohorts over 3 decades of follow-up. DESIGN This was a cohort study, including data from the Nurses' Health Study (NHS), from 1986 to 2010 (N = 51,956) and the Health Professionals Follow-up Study (HPFS) from 1986 to 2006 (n = 31,307). PARTICIPANTS AND SETTING Participants were invited in 1976 (NHS) and 1986 (HPFS) to respond to mailed questionnaires every 2 to 4 years and diet was assessed with a semi-quantitative food frequency questionnaire every 4 years. MAIN EXPOSURE MEASURES UMP and UPF intake were calculated using the NOVA classification. STATISTICAL ANALYSES Generalized estimating equations for marginal means and repeated cross-sectional associations between diet-quality metrics and quintiles of UMP and UPF. Diets were assessed every 4 years from 1986 to 2010. RESULTS With increasing quintiles of UMP intakes, the Alternate Healthy Eating Index-2010 increased 7.1% (3.80 points, 95% CI 3.66 to 3.93) in the NHS and 10.1% (5.75 points, 95% CI 5.52 to 5.98) in the HPFS; the Mediterranean diet index increased 11.7% (0.50 points, 95% CI 0.47 to 0.52) in the NHS and 14.0% (0.64 points, 95% CI 0.60 to 0.68) in the HPFS; and the Dietary Approaches To Stop Hypertension diet score increased 7.5% (1.81 points, 95% CI 1.76 to 1.87) in the NHS and 10.6% (2.66 points, 95% CI 2.57 to 2.76) in the HPFS. In the fifth quintile of UPF intake compared with the first, the Alternate Healthy Eating Index-2010 was -9.3% (-4.60 points, 95% CI -4.73 to -4.47) lower in the NHS and -13.7% (-6.89 points, 95% CI -7.12 to -6.66) lower in the HPFS; the Mediterranean diet index was -14.7% (-0.55 points, 95% CI -0.57 to -0.53) lower in the NHS, and -19.0% (-0.74 points, 95% CI -0.78 to -0.70) lower in the HPFS; and the Dietary Approaches To Stop Hypertension diet score was -8.1% (-1.81 points, 95% CI -1.86 to -1.76) lower in the NHS and -12.8% (-2.84 points, 95% CI -2.93 to -2.74) lower in the HPFS. CONCLUSIONS Consumption of UMP was associated with better dietary quality, whereas consumption of UPF was associated with poorer dietary quality.
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Affiliation(s)
- Sinara Laurini Rossato
- Institute of Geography, Graduation Course of Collective Health, Universidade Federal de Uberlândia. Uberlândia, Minas Gerais, Brazil; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Neha Khandpur
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Chun-Han Lo
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Stela Maris Jezus Castro
- Department of Statistics, Institute of Math and Statistics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Jean Philippe Drouin-Chartier
- Centre Nutrition, Santé et Société, Institut sur la Nutrition et les Aliments Fonctionnels, Université Laval, Québec, Québec, Canada; Faculté de Pharmacie, Université Laval, Ferdinand Vandry Pavillon, Québec City, Québec, Canada
| | - Laura Sampson
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Changzheng Yuan
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Big Data and Health Science, School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Cristiane Murta-Nascimento
- Department of Public Health, School of Medicine, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Maria Antonieta Carvalhaes
- Department of Public Health, School of Medicine, São Paulo State University, Botucatu, São Paulo, Brazil; Postgraduate Program in Nursing, Master and Doctorate Courses, School of Medicine, São Paulo State University, São Paulo, Brazil
| | - Carlos Augusto Monteiro
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Qi Sun
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Teresa T Fung
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Nutrition, Simmons College, Boston, Massachusetts
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Chen Z, Khandpur N, Desjardins C, Wang L, Monteiro CA, Rossato SL, Fung TT, Manson JE, Willett WC, Rimm EB, Hu FB, Sun Q, Drouin-Chartier JP. Ultra-Processed Food Consumption and Risk of Type 2 Diabetes: Three Large Prospective U.S. Cohort Studies. Diabetes Care 2023; 46:1335-1344. [PMID: 36854188 PMCID: PMC10300524 DOI: 10.2337/dc22-1993] [Citation(s) in RCA: 51] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/01/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE We examined the relationship between ultra-processed food (UPF) intake and type 2 diabetes (T2D) risk among 3 large U.S. cohorts, conducted a meta-analysis of prospective cohort studies, and assessed meta-evidence quality. RESEARCH DESIGN AND METHODS We included 71,871 women from the Nurses' Health Study, 87,918 women from the Nurses' Health Study II, and 38,847 men from the Health Professional Follow-Up Study. Diet was assessed using food frequency questionnaires and UPF was categorized per the NOVA classification. Associations of total and subgroups of UPF with T2D were assessed using Cox proportional hazards models. We subsequently conducted a meta-analysis of prospective cohort studies on total UPF and T2D risk, and assessed meta-evidence quality using the NutriGrade scoring system. RESULTS Among the U.S. cohorts (5,187,678 person-years; n = 19,503 T2D cases), the hazard ratio for T2D comparing extreme quintiles of total UPF intake (percentage of grams per day) was 1.46 (95% CI 1.39-1.54). Among subgroups, refined breads; sauces, spreads, and condiments; artificially and sugar-sweetened beverages; animal-based products; and ready-to-eat mixed dishes were associated with higher T2D risk. Cereals; dark and whole-grain breads; packaged sweet and savory snacks; fruit-based products; and yogurt and dairy-based desserts were associated with lower T2D risk. In the meta-analysis (n = 415,554 participants; n = 21,932 T2D cases), each 10% increment in total UPF was associated with a 12% (95% CI 10%-13%) higher risk. Per NutriGrade, high-quality evidence supports this relationship. CONCLUSIONS High-quality meta-evidence shows that total UPF consumption is associated with higher T2D risk. However, some UPF subgroups were associated with lower risk in the U.S. cohorts.
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Affiliation(s)
- Zhangling Chen
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Neha Khandpur
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Studies in Health and Nutrition, Faculty of Public Health, University of São Paulo, São Paulo, Brazil
| | - Clémence Desjardins
- Centre Nutrition, Santé et Société, Institut sur la Nutrition et les Aliments Fonctionnels, Université Laval, Québec, Canada
- Faculté de Pharmacie, Université Laval, Québec, Canada
| | - Lu Wang
- Friedman School of Nutrition Science and Policy, Boston, MA
| | - Carlos A. Monteiro
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Studies in Health and Nutrition, Faculty of Public Health, University of São Paulo, São Paulo, Brazil
| | - Sinara L. Rossato
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Institute of Geography, Universidade Federal de Uberlândia, Minas Gerais, Brazil
| | - Teresa T. Fung
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Nutrition, Simmons University, Boston, MA
| | - JoAnn E. Manson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Walter C. Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Eric B. Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Frank B. Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Qi Sun
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
- Joslin Diabetes Center, Boston, MA
| | - Jean-Philippe Drouin-Chartier
- Centre Nutrition, Santé et Société, Institut sur la Nutrition et les Aliments Fonctionnels, Université Laval, Québec, Canada
- Faculté de Pharmacie, Université Laval, Québec, Canada
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7
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Martinez-Steele E, Khandpur N, Batis C, Bes-Rastrollo M, Bonaccio M, Cediel G, Huybrechts I, Juul F, Levy RB, da Costa Louzada ML, Machado PP, Moubarac JC, Nansel T, Rauber F, Srour B, Touvier M, Monteiro CA. Best practices for applying the Nova food classification system. NATURE FOOD 2023; 4:445-448. [PMID: 37264165 DOI: 10.1038/s43016-023-00779-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Euridice Martinez-Steele
- Department of Nutrition, School of Public Health, University of Sao Paulo, São Paulo, Brazil
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | - Neha Khandpur
- Department of Nutrition, School of Public Health, University of Sao Paulo, São Paulo, Brazil.
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil.
- Department of Human Health and Nutrition, Wageningen University, Wageningen, Netherlands.
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Carolina Batis
- Health and Nutrition Research Center, National Institute of Public Health, Cuernavaca, Mexico
| | - Maira Bes-Rastrollo
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- CIBERobn, Instituto de Salud Carlos III, Madrid, Spain
| | - Marialaura Bonaccio
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| | | | - Inge Huybrechts
- International Agency for Research on Cancer (IARC), Lyon, France
| | - Filippa Juul
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY, USA
| | - Renata B Levy
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
- Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Maria Laura da Costa Louzada
- Department of Nutrition, School of Public Health, University of Sao Paulo, São Paulo, Brazil
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | - Priscila P Machado
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Jean-Claude Moubarac
- Department of Nutrition, Faculty of Medicine, Université de Montréal, Quebec, Canada
| | - Tonja Nansel
- Social and Behavioral Sciences Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Fernanda Rauber
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
- Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Bernard Srour
- Université Sorbonne Paris Nord, Bobigny, France
- Université Paris Cité, Paris, France
- INSERM, Paris, France
- INRAE, Paris, France
- CNAM, Paris, France
- Nutritional Epidemiology Research Team (EREN) of the Center of Research in Epidemiology and StatisticS (CRESS), Bobigny, France
| | - Mathilde Touvier
- Université Sorbonne Paris Nord, Bobigny, France
- Université Paris Cité, Paris, France
- INSERM, Paris, France
- INRAE, Paris, France
- CNAM, Paris, France
- Nutritional Epidemiology Research Team (EREN) of the Center of Research in Epidemiology and StatisticS (CRESS), Bobigny, France
| | - Carlos A Monteiro
- Department of Nutrition, School of Public Health, University of Sao Paulo, São Paulo, Brazil.
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil.
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Reproducibility and Validity of a Semi-Quantitative Food Frequency Questionnaire for Children Aged 6-12 in Western China. Nutrients 2023; 15:nu15040856. [PMID: 36839215 PMCID: PMC9959506 DOI: 10.3390/nu15040856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/04/2023] [Accepted: 02/05/2023] [Indexed: 02/11/2023] Open
Abstract
The Food Frequency Questionnaire (FFQ) is often used to assess dietary intake in large-scale epidemiological studies. This study aimed to evaluate the reproducibility and validity of the FFQ newly developed for children aged 6 to 12 in western China. A total of 133 children were included in the analysis, and all the children and their caregivers completed the FFQs twice with a three-month interval period, and three 24 h recalls were carried out one month after the first FFQ. We assessed the relative validity and reproducibility using various methods, such as the Spearman correlation coefficient, intra-class correlation coefficient, weighed Kappa, quartile agreement, and Bland-Altman analysis. The Spearman correlation coefficients for food ranged from 0.30 to 0.84, and for nutrients from 0.46 to 0.82 regarding reproducibility. The food intra-class correlation coefficients ranged from 0.20 to 0.85, while nutrients' ranged from 0.37 to 0.75. In terms of relative validity, the average Spearman correlation coefficients for food were 0.20, and 0.30 for energy and nutrients. The energy-adjusted and de-attenuation coefficients were calculated. Moreover, the average percentage of participants misclassified into the extreme quartile for food and nutrients was 8.0% and 7.0%, respectively. Weighted Kappa values indicated acceptable agreement between the FFQs and 24 h recalls. Furthermore, the percentage of results in the limits of agreement (LOA) were all above 93.0%. In conclusion, The FFQ showed good reproducibility and acceptable relative validity for assessing the dietary intake of children aged 6-12 in western China.
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Oviedo-Solís CI, Monterrubio-Flores EA, Cediel G, Denova-Gutiérrez E, Barquera S. Trend of Ultraprocessed Product Intake Is Associated with the Double Burden of Malnutrition in Mexican Children and Adolescents. Nutrients 2022; 14:4347. [PMID: 36297032 PMCID: PMC9607204 DOI: 10.3390/nu14204347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Ultraprocessed products (UPPs) have been associated with unfavorable health outcomes; however, until now, they have not been associated with the coexistence of undernutrition and overnutrition, known as the double burden of malnutrition (DBM) at the individual level. METHODS Cross-sectional analyses were performed on data collected from children and adolescents participating in the 2006 and 2016 Mexican National Health and Nutrition Surveys. The food and beverages reported in the food frequency questionnaire (SFFQ) were classified as UPPs as defined by the NOVA classification system. Associations of UPPs with anemia, excess weight, and the DBM were estimated with logistic regression models. A pseudo-panel was generated using the cohorts of children born from 1997 to 2001 to estimate the effect of the UPPs on anemia, excess weight, and the DBM. RESULTS The consumption of UPPs (% energy) was higher in 2016 (children 30.1% and adolescents 28.3%) than in 2006 (children 27.3% and adolescents 23.0%) in both age-groups. The higher contribution of UPPs was positively associated with excess weight and the DBM in children's lower tertile of socioeconomic status (SES) and the DBM in higher tertile of SES in adolescents. The pseudo-panel analysis shows the positive association between UPPs and DBM in lower SES. CONCLUSIONS These results provide evidence of the association between the consumption of UPPs and the DBM and excess weight in children and adolescents.
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Affiliation(s)
- Cecilia Isabel Oviedo-Solís
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca 62100, Morelos, Mexico
| | - Eric A. Monterrubio-Flores
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca 62100, Morelos, Mexico
| | - Gustavo Cediel
- School of Nutrition and Dietetics, University of Antioquia, Medellín 050010, Colombia
| | - Edgar Denova-Gutiérrez
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca 62100, Morelos, Mexico
| | - Simón Barquera
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca 62100, Morelos, Mexico
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10
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Oviedo-Solís CI, Monterrubio-Flores EA, Rodríguez-Ramírez S, Cediel G, Denova-Gutiérrez E, Barquera S. A Semi-quantitative Food Frequency Questionnaire Has Relative Validity to Identify Groups of NOVA Food Classification System Among Mexican Adults. Front Nutr 2022; 9:737432. [PMID: 35187027 PMCID: PMC8850985 DOI: 10.3389/fnut.2022.737432] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 01/05/2022] [Indexed: 01/19/2023] Open
Abstract
Background Ultra-processed foods are recognized as indicators of an unhealthy diet in epidemiological studies. In addition to ultra-processed foods, the NOVA food classification system identifies three other groups with less processing. Unprocessed foods that, together with minimally processed foods (MPF), make NOVA group 1, NOVA group 2 is processed culinary ingredients, and NOVA group 3 is processed foods. Objective To assess the relative validity of the semi-quantitative food frequency questionnaire (SFFQ) to estimate the energy intake for each group NOVA classification system by comparing it with two 24 h-dietary-recall (24DRs) Mexican adults. Methods We analyzed dietary information from 226 adults included <60 and ≥60 years with complete SFFQ and two 24DRs from the National Health and Nutrition Survey 2012. We reported mean differences, Spearman correlation coefficients, intra-class correlations coefficients, Bland–Altman plots, and weighted kappa between measures. Results The percentage energy intake from unprocessed and minimally processed foods group, Spearman correlation coefficients was 0.54 in adults <60 years and 0.42 in adults ≥60 years, while ultra-processed foods group was 0.67 and 0.48, respectively. The intra-class correlation coefficients in the unprocessed and minimally processed foods group was 0.51 in adults <60 years and 0.46 in adults ≥60 years, and for the ultra-processed foods group were 0.71 and 0.50, respectively. Bland–Altman plots indicated reasonably consistent agreement for unprocessed and minimally processed foods group and ultra-processed foods group in adults <60 years and adults in the ≥60 age group. Weighted kappa was 0.45 in the ultra-processed foods group to adults <60 years and was 0.36–≥60 years. Conclusion The SFFQ had acceptable validity to rank the percentage of energy intake from unprocessed and minimally processed foods group and ultra-processed foods group in Mexican adults, both in adults under 60 years and who were 60 years old or older.
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Affiliation(s)
| | | | - Sonia Rodríguez-Ramírez
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Gustavo Cediel
- School of Nutrition and Dietetics, University of Antioquia, Medellín, Colombia
| | - Edgar Denova-Gutiérrez
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
- *Correspondence: Edgar Denova-Gutiérrez
| | - Simón Barquera
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
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