Ultra-processed foods increase noncommunicable chronic disease risk

Change in glucose, insulin and serum lipids due to ultra-processed food consumption in children with obesity

While the association between ultra-processed food (UPF) consumption and chronic non-communicable diseases in adults is well-established, its relationship with serum markers of chronic diseases in children remains underexplored. This research investigates changes in serum markers in children with obesity during a trial aimed at reducing UPF consumption. The study is a prospective cohort, based on a parallel randomized controlled trial conducted between August 2018 and February 2020, with children aged 7-12 years. Over 6 months, children and their guardians attended monthly consultations and educational activities aimed at reducing UPF consumption. Body weight, height, and 24-h dietary recall were measured at all visits. Serum markers were collected at baseline and at the 2- and 5-month visit (during the intervention). Data from 95 children were analysed. Body mass index (BMI), UPF consumption in grams and energy, and percentage of UPF in grams showed a quadratic trend, initially decreasing, followed by an increase in the following months. Glucose, insulin, and HOMA-IR decreased throughout the study, but after adjustment for BMI, the associations no longer persisted, except for glucose levels, which decreased linearly by 2.25 mg/dL. Reducing UPF consumption may lower blood glucose levels in children with obesity, independent of BMI changes.

Exhaustive Search of Dietary Intake Biomarkers as Objective Tools for Personalized Nutrimetabolomics and Precision Nutrition Implementation

OBJECTIVE

To conduct an exhaustive scoping search of existing literature, incorporating diverse bibliographic sources to elucidate the relationships between metabolite biomarkers in human fluids and dietary intake.

BACKGROUND

The search for biomarkers linked to specific dietary food intake holds immense significance for precision health and nutrition research. Using objective methods to track food consumption through metabolites offers a more accurate way to provide dietary advice and prescriptions on healthy dietary patterns by healthcare professionals. An extensive investigation was conducted on biomarkers associated with the consumption of several food groups and consumption patterns. Evidence is integrated from observational studies, systematic reviews, and meta-analyses to achieve precision nutrition and metabolism personalization.

METHODS

Tailored search strategies were applied across databases and gray literature, yielding 158 primary research articles that met strict inclusion criteria. The collected data underwent rigorous analysis using STATA and Python tools. Biomarker-food associations were categorized into 5 groups: cereals and grains, dairy products, protein-rich foods, plant-based foods, and a miscellaneous group. Specific cutoff points (≥3 or ≥4 bibliographic appearances) were established to identify reliable biomarkers indicative of dietary consumption.

RESULTS

Key metabolites in plasma, serum, and urine revealed intake from different food groups. For cereals and grains, 3-(3,5-dihydroxyphenyl) propanoic acid glucuronide and 3,5-dihydroxybenzoic acid were significant. Omega-3 fatty acids and specific amino acids showcased dairy and protein foods consumption. Nuts and seafood were linked to hypaphorine and trimethylamine N-oxide. The miscellaneous group featured compounds like theobromine, 7-methylxanthine, caffeine, quinic acid, paraxanthine, and theophylline associated with coffee intake.

CONCLUSIONS

Data collected from this research demonstrate potential for incorporating precision nutrition into clinical settings and nutritional advice based on accurate estimation of food intake. By customizing dietary recommendations based on individualized metabolic profiles, this approach could significantly improve personalized food consumption health prescriptions and support integrating multiple nutritional data.This article is part of a Nutrition Reviews special collection on Precision Nutrition.

Ultra-processed Food Intake is Inversely Associated with Cooking Skills in Post-metabolic and Bariatric Surgery Individuals: A Cross-sectional study

PURPOSE

Cooking skills seem to influence individuals' consumption of ultra-processed foods (UPF). However, there are no studies evaluating this relationship in people who have undergone metabolic and bariatric surgery (MBS). This study aimed to assess the association between UPF consumption and the cooking skills of individuals after MBS.

MATERIAL AND METHOD

This is a cross-sectional, online, nationwide study. Cooking skills were assessed using the cooking skills index (CSI), and UPF consumption was measured using the NOVA-UPF score. Data was also collected on sex, age, body mass index (BMI), economic classification, surgical technique, time since surgery, and whether the reported consumption was at the weekend to be included as adjustment variables in the relationship between the NOVA-UPF score and the CSI.

RESULTS

The study included 1525 individuals with a mean of 37.90 (SD 54.12) months who had undergone MBS (median 12 months), an age of 38.53 (8.02) years, and a BMI of 29.97 (5.82) kg/m2. The participants scored an average of 7.84 (SD 1.93) for the CSI and 2.75 (2.19) for the NOVA-UPF score. The CSI was negatively associated with the NOVA-UPF score (β =  - 0.12; 95%CI =  - 0.18; - 0.06), even after adjusting for sex, age, body mass index, economic classification, surgical technique, surgery time, weekend food consumption, marital status, diabetes, and hypertension (β =  - 0.12; 95%CI =  - 0.17; - 0.07). This negative association was also observed in the analysis of the prevalence of food intake in subgroups from the NOVA-UPF score, namely processed drinks, processed meats, sweets, and margarine.

CONCLUSION

CSI is negatively associated with UPF consumption in individuals undergoing MBS.

Association between adherence to the Food Guide golden rule and health characteristics among adult Brazilian women: a cross-sectional study with VIGITEL data, 2018-2021

OBJECTIVE

To assess association of adherence to the golden rule of the Food Guide for the Brazilian Population with health characteristics among adult women according to sociodemographic characteristics.

METHODS

This is a cross-sectional study with 102,057 women interviewed by the Chronic Disease Risk and Protective Factors Surveillance Telephone Survey System in the Brazilian state capital cities and Federal District between 2018 and 2021. Outcome variables included obesity, hypertension, diabetes, depression and negative self-rated health. Adherence to the golden rule was rated by scores (-13 to +12 points) that combined the consumption of ultra-processed foods (negative) and fresh and minimally processed foods (positive). This score was categorized according to consumption tertiles, with low adherence (first tertile), moderate adherence (second tertile) and high adherence (third tertile). Logistic regression was used to calculate the adjusted odds ratios (OR) (by sociodemographic variables) and 95% confidence intervals (95%CI) of the outcomes in relation to adherence to the Guide.

RESULTS

Compared to low adherence, moderate adherence was inversely associated with obesity (OR 0.86; 95%CI 0.78; 0.93) and negative self-rated health (OR 0.72; 95%CI 0.62; 0.84). High adherence was inversely associated with obesity (OR 0.72; 95%CI 0.65; 0.79), hypertension (OR 0.85; 95%CI 0.78; 0.93), depression (OR 0.69; 95%CI 0.59; 0.82) and negative self-rated health (OR 0.55; 95%CI 0.45; 0.67).

CONCLUSION

Adherence to the Guide's golden rule was inversely associated with chronic diseases and negative self-rated health among adult Brazilian women.

Association between excess body weight and disordered eating attitude among women living with systemic lupus erythematosus

The study aimed to: (i) characterize dietary intake and identify disorders eating attitudes in women with SLE, (ii) evaluate possible differences in both dietary intake and disorders eating attitudes in patients with SLE according to nutritional status, (iii) investigate possible associations between eating disorders attitudes, anthropometric characteristics and food consumption.

METHODS

This cross-sectional study included 46 premenopausal female patients (18-40 years), with inactive disease, using prednisone <10 mg/day and hydroxychloroquine at a stable dose. Patients were allocated into two groups according to their nutritional status by body mass index (BMI): normal weight (BMI between 18.5 and 24.9 kg/m2) and excess weight (BMI >25 kg/m2). Food consumption was assessed according to the processing level and energy and macronutrient content. The Disordered Eating Attitude Scale (DEAS) was applied.

RESULTS

Patients with excess weight had a higher DEAS score when compared to those with normal weight (34 ± 8.7 vs 25 ± 5.9, p = .001). A higher percentage of patients with excess weight demonstrated disturbance in their relationship with food and concerns about food and weight gain versus those with normal weight. DEAS score was positively associated with BMI, abdominal circumference, and fat mass percentage and negatively associated with lipid intake.

CONCLUSION

Disordered eating attitudes differ in SLE patients according to nutritional status, and those with excess weight show higher DEAS scores, which may be related to food and weight gain.

Using a systems thinking approach to map the global rise of ultra-processed foods in population diets

A key driver of obesity and diet-related illness globally has been the increased consumption of ultra-processed foods (UPFs). This paper aimed to identify the key actors, structures, incentives, and dynamics that characterize the global UPF system and have led to the dominance of UPFs in population diets. Based on a narrative review and using a systems thinking approach, we developed a causal loop diagram (CLD) of the global UPF system. The CLD comprises nine reinforcing loops: the commodification of diets; increasing market concentration; increasing UPF levels in food retail environments; the financialization of diets; direct corporate political influence; increasing capture of science, public opinion, and policy narratives; shifts from private to public food governance; state accommodation of corporate power; and an "agricultural regime" promoting the production of relatively cheap UPF inputs. The CLD also contains two balancing loops relating to market saturation and public health policies that curb UPF consumption and a countervailing reinforcing loop depicting other forms of food systems in tension with the UPF system. This study suggests the need for innovative and expansive government policies to protect and promote healthy, sustainable diets and coordinated advocacy efforts among those seeking to challenge the exploitative aspects of corporate food systems.

Food Insecurity and Weight Discrimination: A Gender-Based Study

Food insecurity has been identified as an understudied risk factor for weight-based stigma and discrimination. This study leverages data from 1,904 working-age adults to examine the food insecurity-weight-based discrimination relationship, as well as tests gender differences for this association. Logistic regression models revealed that food insecurity was significantly associated with higher odds of reporting weight-based discrimination in both unadjusted and adjusted models. Importantly, this association was only significant in the female sample. Contrary to expectations, body mass index (BMI) did not moderate this relationship among women. These findings highlight the gendered nature of the food insecurity-weight discrimination link, underscoring the need for targeted interventions and policies addressing food insecurity and weight stigma, particularly among women. Specifically, public health practitioners should consider screening for both food insecurity and experiences of weight discrimination, especially when working with female patients. Furthermore, policymakers should consider the interconnected nature of food insecurity and weight discrimination when designing programs to address either issue. Finally, future research should explore the mechanisms underlying these associations and investigate potential interventions to mitigate the negative impacts of food insecurity and weight discrimination on health and well-being.

Availability, price and nutritional assessment of plant-based meat alternatives in hypermarkets and supermarkets in Petaling, the most populated district in Malaysia

This study investigated the availability, price, nutritional composition, and quality of plant-based meat alternatives (PBMAs) in supermarkets and hypermarkets in Petaling, the most populated district in Malaysia. The survey covered 85 stores through on-site visits, identifying 251 unique PBMA products from 42 brands. The PBMAs were categorized into nine groups: Burgers/Patties, Coated Meat, Luncheon Meat, Minced Meat, Pastries, Pieces/Chunks/Fillets/Strips, Prepacked Cooked Meals, Sausages, and Seafood Balls/Cakes/Meatballs. The survey indicated widespread availability of PBMAs in Petaling, with premium supermarkets offering the most extensive selection. The median prices of PBMAs across categories were below MYR 7 (~USD 1.6) per 100 grams, with Pieces/Chunks/Fillets/Strips being the most affordable. Nutritionally, PBMAs exhibited lower energy, total fat, saturated fat, sodium, and protein levels than meat equivalents, while showing higher carbohydrate content. Nutri-Score profiling revealed generally favourable scores (Grade A to C), indicating moderate to good nutritional quality. These findings suggest that PBMAs offer a viable alternative for consumers in Malaysia seeking healthier and more sustainable food options, particularly for those aiming to reduce their intake of fat and sodium. However, PBMAs may not be recommended for individuals seeking a higher protein and lower carbohydrate diet. Further research is recommended to explore micronutrient profiles to enhance dietary decision-making.

Are vegetarians' diets inherently healthy? Ultra-processed food consumption is associated with overweight among vegetarians: the brazilian survey on the health, food, and nutrition of vegetarians

This cross-sectional study investigated ultra-processed food (UPF) consumption and its association with overweight among Brazilian vegetarian adults (n = 925). Data were collected using a self-administered structured online questionnaire. The prevalence of overweight was 26.2% (95% confidence interval [CI] 23.3-29.1). The median UPF consumption was 1.8 times/day (1.0-3.1 interquartile range [IQR]). The multivariable generalised linear model identified an increase in overweight probability as the UPF intake - categorised into quintiles - increases (prevalence ratio [PR] 1.08 [95%CI 1.01-1.17]). Additionally, age (PR 1.03 [95%CI 1.02-1.04]), eating more than three meals/day away from home (PR 1.56 [95%CI 1.08-2.23]), duration of vegetarianism (PR 0.98 [95%CI 0.97-0.99]) and living in the wealthiest regions in the country (PR 1.35 [95%CI 1.06-1.71]) were associated with overweight. Although vegetarians have a lower average UPF intake and overweight prevalence than the general population, UPF exposure can still lead to excessive weight gain or maintenance. This study endorses generalising the Brazilian Dietary Guidelines for the vegetarian population.

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.

"Warning: ultra-processed": an online experiment examining the impact of ultra-processed warning labels on consumers' product perceptions and behavioral intentions

BACKGROUND

Nutrient content and degree of processing are complementary but distinct concepts, and a growing body of evidence shows that ultra-processed foods (UPFs) can have detrimental health effects independently from nutrient content. 10 + countries currently mandate front-of-package labels (FOPL) to inform consumers when products are high in added sugars, saturated fat, and/or sodium. Public health advocates have been calling for the addition of ultra-processed warning labels to these FOPLs, but the extent to which consumers would understand and be influenced by such labels remains unknown. We examined whether the addition of ultra-processed warning labels to existing nutrient warning labels could influence consumers' product perceptions and purchase intentions.

METHODS

In 2023, a sample of adults in Brazil (n = 1,004) answered an open-ended question about the meaning of the term "ultra-processed," followed by an online experiment where they saw four ultra-processed products carrying warning labels. Participants were randomly assigned to view either only nutrient warning labels or nutrient plus ultra-processed warning labels. Participants then answered questions about their intentions to purchase the products, product perceptions, and perceived label effectiveness.

RESULTS

Most participants (69%) exhibited a moderate understanding of the term "ultra-processed" prior to the experiment. The addition of an ultra-processed warning label led to a higher share of participants who correctly identified the products as UPFs compared to nutrient warning labels alone (Cohen's d = 0.16, p = 0.02). However, the addition of the ultra-processed warning label did not significantly influence purchase intentions, product healthfulness perceptions, or perceived label effectiveness compared to nutrient warning labels alone (all p > 0.05). In exploratory analyses, demographic characteristics and prior understanding of the concept of UPF did not moderate the effect of ultra-processed warning labels.

CONCLUSIONS

Ultra-processed warning labels may help consumers better identify UPFs, although they do not seem to influence behavioral intentions and product perceptions beyond the influence already exerted by nutrient warning labels. Future research should examine how ultra-processed warning labels would work for products that do and do not require nutrient warnings, as well as examine the benefits of labeling approaches that signal the health effects of UPFs.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT05842460. Prospectively registered March 15th, 2023.

Association between ultraprocessed food consumption and excess adiposity in children and adolescents: A systematic review

Ultraprocessed foods (UPF) consumption is associated with excess adiposity in adults, but this linkage remains unclear among children and adolescents. The present systematic review sought to address this research gap. Publications up to November 2023 were retrieved from PubMed, Web of Science, and Scopus databases. Outcomes included overweight/obesity anthropometric and body composition indicators; the exposure was UPF consumption based on the NOVA classification system. The review included 23 studies (i.e., 8 cohort and 15 cross-sectional); approximately half were carried out in Brazil. Inconclusive and heterogeneous evidence exists as few cohort studies found positive/mixed associations between UPF consumption and excess adiposity in pediatric populations, whereas most cross-sectional studies reported null associations. Such inconsistencies may be attributed to underlying methodological issues, especially heterogeneity in the outcomes assessed and UPF consumption operationalization and/or categorization. Future studies should adopt longitudinal designs with sufficiently extended follow-up periods, account for relevant confounding factors, employ validated and standardized measurement tools to assess dietary exposure, ensure consistent operationalization of variables, and encompass diverse geographic contexts. Ultimately, strengthening the quality of existing research evidence may better inform current and forthcoming policy and practice interventions aimed at mitigating the increasing prevalence of overweight/obesity in childhood and across the life course.

Differential association of dietary scores with the risk of type 2 diabetes by metabotype

PURPOSE

We aimed to examine the association between dietary patterns and type 2 diabetes mellitus (T2DM) while considering the potential effect modification by metabolic phenotypes (metabotypes). Additionally, we aimed to explore the association between dietary scores and prediabetes.

METHODS

A total of 1460 participants (11.8% with T2DM) from the cross-sectional population-based KORA FF4 study were included. Participants, classified into three metabotype subgroups, had both their FSAm-NPS dietary index (underpinning the Nutri-Score) and ultra-processed foods (UPF) intake (using NOVA classification) calculated. Glucose tolerance status was assessed via oral glucose tolerance tests (OGTT) in non-diabetic participants and was classified according to the American Diabetes Association criteria. Logistic regression models were used for both the overall and metabotype-stratified analyses of dietary scores' association with T2DM, and multinomial probit models for their association with prediabetes.

RESULTS

Participants who had a diet with a higher FSAm-NPS dietary index (i.e., a lower diet quality) or a greater percentage of UPF consumption showed a positive association with T2DM. Stratified analyses demonstrated a strengthened association between UPF consumption and T2DM specifically in the metabolically most unfavorable metabotype (Odds Ratio, OR 1.92; 95% Confidence Interval, CI 1.35, 2.73). A diet with a higher FSAm-NPS dietary index was also positively associated with prediabetes (OR 1.19; 95% CI 1.04, 1.35).

CONCLUSION

Our study suggests different associations between poorer diet quality and T2DM across individuals exhibiting diverse metabotypes, pointing to the option for stratified dietary interventions in diabetes prevention.

Ultra-processed food and drink consumption and lipoprotein subclass profiles: A cross-sectional study of a middle-to older-aged population

BACKGROUND AND AIMS

Studies have consistently demonstrated associations between ultra-processed food and drink (UPFD) consumption and non-communicable diseases. However, there is a lack of data investigating relationships between UPFD intake and intermediate cardiometabolic disease markers. In this study we explored UPFD associations with lipoprotein subclasses.

METHODS

This was a cross-sectional study of 1986 middle-to older-aged men and women randomly selected from a large primary care centre. The percentage contribution of UPFDs to total energy intake was calculated for each participant using the NOVA classification. Lipoprotein particle subclass concentrations and size were determined using nuclear magnetic resonance spectroscopy. Correlation and multivariate-adjusted linear regression analyses were performed to examine UPFD intake relationships with lipoprotein subclasses.

RESULTS

In fully adjusted regression models, higher UPFD consumption was associated with reduced high-density lipoprotein (HDL) cholesterol concentrations (β = -0.024, p = 0.001), large low-density lipoprotein (LDL) levels (β = -18.645, p = 0.002), total and medium HDL concentrations (β = -0.328, p = 0.012; β = -0.510, p < 0.001), smaller LDL and HDL size (β = -0.026, p = 0.023; β = -0.023, p = 0.024), and increased medium very low-density lipoprotein levels (β = 0.053, p = 0.022), small LDL and HDL concentrations (β = 20.358, p = 0.02; β = 0.336, p = 0.011), and higher lipoprotein insulin resistance scores (β = 0.048, p = 0.012), reflecting greater lipoprotein-related insulin resistance.

CONCLUSIONS

Findings from this research suggest that increased intake of UPFDs is associated with a more pro-atherogenic, insulin-resistant metabolic profile in middle-to older-aged adults which may be a potential mechanism underlying reported associations between UPFD consumption and chronic disease risk and mortality.

Ultra-Processed Food Intake and Increased Risk of Obesity: A Narrative Review

The prevalence of obesity has become a global health concern, with significant impacts on quality of life and mortality rates. Recent research has highlighted the role of ultra-processed foods (UPFs) in driving the obesity epidemic. UPFs undergo extensive processing, often containing high levels of sugars, fats, and additives, while lacking essential nutrients. Studies have linked UPF consumption to obesity and cardiometabolic diseases, underscoring the importance of dietary patterns rich in whole foods. Thus, the aim of this narrative review is to elucidate the correlation between ultra-processed foods and the increased trend of obesity and its related complications. These foods, prevalent in modern diets, contribute to nutritional deficiencies and excessive caloric intake, exacerbating obesity rates. Lifestyle factors such as busy schedules and quick meal management further drive UPF consumption, disrupting hunger regulation and promoting overeating. UPF consumption correlates with adverse health outcomes, including dyslipidemia, hypertension, and insulin resistance. Promoting whole, minimally processed foods and implementing school-based nutrition education programs are crucial steps. Also, numerous challenges exist, including unequal access to healthy foods, the industry's influence, and behavioral barriers to dietary change. Future research should explore innovative approaches, such as nutrigenomics and digital health technologies, to personalize interventions and evaluate policy effectiveness. Collaboration across disciplines and sectors will be vital to develop comprehensive solutions and improve public health outcomes globally.

Barriers and facilitators to nutritional recommendations identified by participants of a cardiovascular rehabilitation program in a low resource context in Brazil

OBJECTIVES

Nutritional recommendations, a core component of cardiovascular rehabilitation, play a vital role in managing cardiovascular diseases. However, adherence to these recommendations is complex, particularly in low-resource settings. This study explored the barriers and facilitators influencing adherence to nutritional recommendations among participants in a low-resource cardiovascular rehabilitation program in Brazil.

METHODS

A mixed-methods approach was employed. Sociodemographic data, the Mediterranean diet score, scale for assessing nutrition, and open-ended questions on adherence were collected. Those who completed the questionnaires (phase 1) were invited to participate in one focus group session (phase 2). The participants were characterized according to the responses provided in phase 1 (Mediterranean diet score and scale for assessing nutrition) in low adherence or high adherence to dietary practice. Descriptive statistics and thematic content analysis within the context of the theory of planned behavior were employed.

RESULTS

Seventy-four participants completed phase 1, with 41.9% classified into low adherence and 27.0% in high adherence; of those, 17 participated in phase 2. Focus group findings revealed 9 themes/29 subthemes. Barriers included food prices, income, knowledge, routine, food access, family patterns, disease, work, anxiety, eating habits, and food planning. Facilitators included affordable food, health considerations, taste preferences, knowledge, family/professional support, government assistance, personal willpower, income stability, easy food access, media influence, and a quiet eating place.

CONCLUSIONS

The study findings underscore the need for targeted interventions, including individualized meal planning, community engagement, and enhanced access to healthcare professionals, to optimize dietary adherence and improve cardiovascular outcomes.

Associations Between rs9939609 FTO Polymorphism With Nutrient and Food Intake and Adherence to Dietary Patterns in an Urban Argentinian Population

BACKGROUND

The A allele of rs9939609 polymorphism at the FTO gene has been consistently associated with higher body mass index in different populations, but conflicting results have been found regarding its contribution to food intake variability.

OBJECTIVE

This study aimed to investigate the association between this genetic variant and nutrient and food intake in an urban Argentinian population.

DESIGN

A cross-sectional, analytic investigation was performed between October 2018 and February 2020.

PARTICIPANTS/SETTINGS

Adults of both sexes residing in La Plata, Argentina, were recruited through social networks (Instagram and Facebook). Of 179 eligible adults, a total of 173 adults were included in the final analyses.

OUTCOME MEASURES

Nutrient and food group intake data were obtained by an interview-administered food frequency questionnaire. Height and weight were measured, and genotypes were obtained by real-time polymerase chain reaction.

STATISTICAL ANALYSES

The per-allele effect on nutrient and food group intake was assessed by general linear models, adjusting for age, sex, educational level, total energy intake, and body mass index. Dietary patterns were derived by principal component analysis. The association of the A allele with adherence to each dietary pattern was also evaluated by the general linear model.

RESULTS

The frequency of the risk allele was 27%. A-carriers showed a higher total fat (1.88 [0.55, 3.21] % of total energy intake), saturated fatty acids (0.82 [0.25-1.39] % of total energy intake), and monounsaturated fatty acids (0.66 [0.08, 1.24] % of total energy intake), and a lower carbohydrate (-1.99 [-3.48, -0.50] % of total energy intake) intake than TT homozygous. A-carriers also reported a higher "milk and yogurt" (1.08 [0.24, 1.91] % of total energy intake), "animal fats" (1.09 [0.14-2.03] % of total energy intake), and fat-rich ultraprocessed foods (2.10 [0.52, 3.67] % of total energy intake) intake in comparison with TT homozygous. Furthermore, A-carriers showed higher adherence to the Western dietary pattern.

CONCLUSION

The A allele contributed to nutrient and food intake variability in the studied population and was associated with the consumption of saturated fatty acids-enriched foods.

Industrially Produced Plant-Based Food Products: Nutritional Value and Degree of Processing

The plant-based food market is rapidly growing, offering innovative options to meet consumer expectations. However, a comprehensive analysis of the nutritional quality of these foods is lacking. We aimed to characterize industrial plant-based food products' nutritional value and degree of processing. A cross-sectional study was conducted on two market-leading Portuguese food retail chains by assessing the nutritional composition of all the available pre-packaged plant-based food products (n = 407). These products were categorized into meal alternatives, dairy alternatives, and other products containing dairy/meat alternative ingredients including ready meals and desserts. The products' nutritional quality was assessed according to the cut-offs established by the Portuguese Directorate General of Health [DGS] on total fat, saturated fat, sugar, and salt, and considering the degree of processing using NOVA classification. One-tenth of the products were classified as having a high total fat, saturated fat, sugars, or salt content. In some sub-categories, half of foods were classified as high in saturated fat, and over two-thirds were considered high salt products. Less than one-third exhibit a good nutritional profile based on the national cut-offs. A total of 84.3% of plant-based food products were ultra-processed. These findings emphasize the need to improve the nutritional profile of plant-based options.

Adherence to the Mediterranean Diet and its association with sustainable dietary behaviors, sociodemographic factors, and lifestyle: a cross-sectional study in US University students

BACKGROUND

Promoting healthy and sustainable diets is increasingly important and the Mediterranean Diet (MD) has been recognized as an appropriate example that can be adapted to different countries. Considering that the college years are the time when US young adults are most likely to adopt unhealthy eating habits, the present study assessed adherence to the MD and the sustainability of dietary behaviors in a nationally representative sample of US university students, aiming to identify crucial levers for improving their eating behaviors.

METHODS

MD adherence and the adoption of healthy and sustainable dietary patterns were assessed through the KIDMED and the Sustainable-HEalthy-Diet (SHED Index questionnaires, respectively, administered through an online survey that also included sociodemographic and behavioral questions. Non-parametric and logistic regression analyses were performed.

RESULTS

A sample of 1485 participants (median (IQR) age 21.0 (19.0-22.0); 59% women) correctly completed the survey. A medium adherence to the MD was the most prevalent (47%). According to multivariate logistic regression analysis, the likelihood of being more compliant with the MD increased when meeting physical activity recommendations, having a high SHED Index score, having the willingness to purchase and eat healthy and sustainable dishes, eating ultra-processed plant-based meat alternatives foods daily, and regularly attending the university canteen.

CONCLUSIONS

Encouraging dietary patterns rich in plant-based foods and with a moderate intake of animal products is crucial to increasing the adoption of healthy and sustainable diets, and university dining services represent a suitable setting to build a supportive environment that educates students on human and planetary health.

Newest Updates to Health Providers on the Hazards of Ultra-Processed Foods and Proposed Solutions

At present, the United States has the lowest life expectancy of all 12 large, rich countries in the world. While overweight and obesity, as well as lack of regular physical activity, are well recognized, another less well-known plausible hypothesis to explain this observation is the unprecedented consumption of ultra-processed food in the United States. Whether ultra-processed food contributes to our currently rising rates of morbidity and mortality from noncommunicable diseases requires direct testing in analytic studies designed a priori to do so. At present, ultra-processed foods are likely to play major roles in a myriad of diseases such as diabetes, coronary heart disease, stroke, a variety of cancers, and even mental health disorders. As was the case with cigarettes, we find ourselves needing to fight a battle where the entertainment industry, the food industry, and public policy do not align with our patients' needs. This does not mean that we should not begin to engage our patients in this vital conversation. Indeed, it makes it all the more important, and timely, that we do so.

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

BACKGROUND

Whole grain (WG) consumption is linked with a reduced risk of chronic disease. However, the recommendations of the Nova classification system tend to contradict this evidence as high WG-containing foods, such as bread and cereals, are considered ultraprocessed, and intake is discouraged.

OBJECTIVES

This study aimed to explore associations of cardiometabolic risk measures with ultraprocessed food (UPF) intake as classified by Nova compared with when foods with ≥25% and ≥50% WG are removed from the Nova UPF category.

METHODS

A cross-sectional analysis of the 2015-18 National Health and Nutrition Examination Survey. Nova was used to identify UPFs, and the WG Initiative's definition of a WG food and front-of-pack labeling requirements was used to identify high WG foods. Regression models were used to explore impacts on the association of UPF intake (quintiles) and cardiometabolic risk measures when high WG foods were excluded from the Nova UPF category.

RESULTS

Participants in the highest quintile of UPF intake had significantly higher weight [83.6 kg (0.8)], BMI (in kg/m2) [30.6 (0.3)], waist circumference [103.1 cm (0.6)], and weight-to-height ratio [0.63 (0.003)] compared to those in the lowest quintile (P < 0.0001 for all). The same was found when foods with ≥25% and ≥50% WG were removed. Positive associations for C-reactive protein were found when ≥25% and ≥50% WG-containing foods were removed only [2.32 mg/L (0.1), P = 0.0209; 2.37 mg/L (0.1), P = 0.0179, respectively]. Participants in the highest quintile had significantly lower total cholesterol after adjustment when foods with ≥50% WG were removed [4.98 mmol/L (0.04), P = 0.0292]. Adjusted R2 values remained relatively unchanged across each approach for all outcomes.

CONCLUSIONS

Foods high in WG may not significantly contribute to the deleterious associations previously observed between UPF intake and cardiometabolic risk factors. Consideration of their contribution to healthful dietary patterns and diet quality in the United States population should be made prior to the endorsement of Nova.

Ultra-processed foods - a scoping review for Nordic Nutrition Recommendations 2023

Ultra-processed foods (UPFs) are increasingly consumed worldwide and have been linked to several chronic diseases. This paper aims to describe the totality of the available evidence regarding UPFs in relation to health-related outcomes as a basis for setting food-based dietary guidelines for the Nordic Nutrition Recommendations 2023. Systematic literature searches were conducted to identify systematic reviews, meta-analyses, randomized controlled trials (RCTs), and prospective cohort studies examining the association between UPF intake and non-communicable diseases or mortality. A total of 12 systematic reviews (including five meta-analyses) and 44 original research studies (43 prospective cohort studies and one RCT) were included. All original research studies were deemed to be of good methodological quality. The current evidence supports that greater consumption of UPFs is associated with weight gain and increased risk of obesity, cardiovascular disease, type 2 diabetes, and all-cause mortality. The available literature also supports an association between UPFs and hypertension, cancer, and depression; however, the limited number of studies and subjects investigated preclude strong conclusions. Due to the highly diverse nature of UPFs, additional studies are warranted, with special emphasis on disentangling mediating mechanisms, whether nutritional or non-nutrient based. Nevertheless, the available evidence regarding UPFs in relation to weight gain, CVD, type 2 diabetes, and all-cause mortality is considered strong enough to support dietary recommendations to limit their consumption.

How Promising Are "Ultraprocessed" Front-of-Package Labels? A Formative Study with US Adults

High levels of food processing can have detrimental health effects independent of nutrient content. Experts and advocates have proposed adding information about food processing status to front-of-package labeling schemes, which currently exclusively focus on nutrient content. How consumers would perceive "ultraprocessed" labels has not yet been examined. To address this gap, we conducted a within-subjects online experiment with a convenience sample of 600 US adults. Participants viewed a product under three labeling conditions (control, "ultraprocessed" label, and "ultraprocessed" plus "high in sugar" label) in random order for a single product. The "ultraprocessed" label led participants to report thinking more about the risks of eating the product and discouraging them from wanting to buy the product more than the control, despite not grabbing more attention than the control. The "ultraprocessed" plus "high in sugar" labels grabbed more attention, led participants to think more about the risks of eating the product, and discouraged them from wanting to buy the product more than the "ultraprocessed" label alone. "Ultraprocessed" labels may constitute promising messages that could work in tandem with nutrient labels, and further research should examine how they would influence consumers' actual intentions and behaviors.

Pressures of the urban environment on the endocrine system: Adverse effects and adaptation

With an increasing collective awareness of the rapid environmental changes, questions and theories regarding the adaptability of organisms are emerging. Global warming as well as chemical and non-chemical pollution have been identified as triggers of these adaptative changes, but can we link different kinds of stressors to certain phenotypic traits? The physiological adaptation, and particularly endocrine system adaptation, of living beings to urban environments is a fascinating way of studying urban endocrinology, which has emerged as a research field in 2007. In this paper, we stress how endocrine disruption in humans and environment can be studied in the urban environment by measuring the levels of pollution, endocrine activities or adversity. We broaden the focus to include not only exposure to the chemicals that have invaded our private spheres and their effects on wild and domestic species but also non-chemical effectors such as light, noise and climate change. We argue that taking into account the various urban stress factors and their effects on the endocrine system would enable the adoption of new approaches to protect living organisms.

Factors That Most Influence the Choice for Fast Food in a Sample of Higher Education Students in Portugal

The frequency of fast food consumption among higher education students is high, causing worrying implications for public health. This study aims to relate the factors that influence the choice for fast food with social factors, nutritional status, and fast food consumption in a sample of higher education students in Portugal. An online questionnaire was developed and disseminated by social networks among students during the first half of 2023. Two hundred and thirty-seven students participated, mainly female (65.4%), who were attending public higher education institutions (59.1%), with a median of age of 20.0 (19.0; 22.0) years, and about 20% of the sample had overweight. Approximately 80% consumed fast food, and almost 40% consumed it more than once or twice a week. Predominantly (78.0%), they chose hamburger meals, spending EUR 8.0 per meal. The factors that most influenced the choice of fast food were ease or convenience of preparation (59.9%), price (48.5%), and flavor (28.3%). There were also differences between sexes and between those attending public and private higher education institutions regarding whether they usually consume fast food or not. The body mass index was positively associated with age (r: 0.142; p = 0.029) and with fast food spending (r: 0.146; p = 0.024). The results have implications for public health and clinical nutrition, and can support more effective strategies to improve food choices in higher education students.

Association between ultra-processed foods consumption and the risk of hypertension: An umbrella review of systematic reviews

BACKGROUND

Several systematic reviews (SRs) have investigated the association between ultra-processed foods (UPFs) and the risk of hypertension in various populations. However, the quality of the evidence remains unclear. This umbrella review was thus conducted to fill this gap.

METHODS

We searched for SRs with and without meta-analyses comparing high UPF versus low UPF consumption on the risk of hypertension in the Cochrane Library, Embase, PubMed, and Web of Science from inception to August 2022. This study was registered in PROSPERO (No. CRD42022352934). The A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR-2) tool and the Preferred Reporting Item for Systematic Review and Meta-analysis 2009 (PRISMA 2009) statement were used to evaluate the methodological and reporting quality of the included SRs. Stata 15/SE was used to reanalyse the data using the random-effects model, and the risk of bias of observational studies from included SRs was reassessed using the Newcastle-Ottawa Scale (NOS) tool. The certainty of the evidence body was assessed using the GRADE recommendation.

RESULTS

Seven SRs were included in the umbrella review. Among them, nine observational studies (5 cross-sectional and 4 cohort studies), whose available data were resynthesised using meta-analysis. The methodological and reporting quality of the included SRs were relatively poor. The meta-analysis results revealed suggestive evidence of an association between high UPF consumption and the incidence of hypertension (odds ratio: 1.23, 95% confidence interval: 1.11 to 1.37, p < 0.001, 95% prediction interval: 0.92 to 1.64, critically low certainty) compared to low UPF consumption.

CONCLUSION

High UPF consumption is associated with an increased risk of hypertension. However, well-conducted SRs, including high-quality prospective cohort studies, are needed to further verify these findings.

Association between body weight misperception and snacking patterns among adolescents: a population-based cross-sectional study

BACKGROUND

Unhealthy snacking behaviors and body weight misperception are both significant concerns in adolescent health. Weight misperception are common among youth and may influence their motivation to engage in health-related behaviors, however, the effect on snacking patterns choice remains unclear. Our study aimed to examine the relationship between body weight misperception and snacking pattern choice among school adolescents.

METHODS

A cross-sectional study was conducted using an online survey platform. Body weight misperception was defined based on perceived body weight and true weight. Snack intake was measured using a qualitative food-frequency questionnaire. Factor analysis was used to identify snacking patterns, and multiple linear regression was employed to examine the association between body weight misperception and snacking patterns.

RESULTS

190,296 students with the average age of 13.3 ± 1.0 years was included, and 44.5% of students misperceived their weight. Overestimation was more prevalent than underestimation. Two snacking patterns, namely a high-calorie snacking pattern and a healthy snacking pattern, were identified with eigenvalues > 1. Weight underestimation was positively linked to high-calorie snacking pattern scores for both normal weight students (β: 0.16, 95% CI: 0.11, 0.21) and students with overweight/obesity (β: 0.44, 95% CI: 0.35, 0.52), and to healthy snacking scores for students with overweight/obesity (β: 0.28, 95% CI: 0.22, 0.33), but negatively linked to healthy snacking pattern scores for normal weight students (β: -0.12, 95% CI: -0.15, -0.09). Conversely, weight overestimation was negatively linked to both high-calorie and healthy snacking pattern scores for normal weight students (β: -0.07, 95% CI: -0.11, -0.04 and β: -0.13, 95% CI: -0.15, -0.10), but positively linked to healthy snacking scores for underweight students (β: 0.15, 95% CI: 0.08, 0.21). Interactions were found between sex, grade, accommodation, only child, primary guardians, parental education level and weight misperception to snacking patterns.

CONCLUSIONS

Adolescents with normal weight and overweight/obesity who misperceived their weight exhibited less healthy snacking patterns, whereas underweight students who misperceived their weight displayed healthier snacking patterns. Comprehensive programs are crucial to educate and guide adolescents in understanding their weight status and making healthier snack choices, involving families, schools, and society.

What is the purpose of ultra-processed food? An exploratory analysis of the financialisation of ultra-processed food corporations and implications for public health

BACKGROUND

In recent decades there has been a global rise in consumption of ultra-processed foods (UPFs) to the detriment of population health and the environment. Large corporations that have focused heavily on low-cost manufacturing and extensive marketing of UPFs to maximise profits have driven this dietary transition. The same corporations claim to serve the interests of multiple 'stakeholders', and that they are contributing to sustainable development. This paper aimed to test these claims by examining the degree to which UPF corporations have become 'financialised', focusing on the extent to which they have prioritised the financial interests of their shareholders relative to other actors, as well as the role that various types of investors have played in influencing their governance. Findings were used to inform discussion on policy responses to improve the healthiness of population diets.

METHODS

We adopted an exploratory research design using multiple methods. We conducted quantitative analysis of the financial data of U.S. listed food and agricultural corporations between 1962 and 2021, share ownership data of a selection of UPF corporations, and proxy voting data of a selection of investors between 2012 and 2022. We also conducted targeted narrative reviews using structured and branching searches of academic and grey literature.

RESULTS

Since the 1980s, corporations that depend heavily on manufacturing and marketing UPFs to generate profits have been increasingly transferring money to their shareholders relative to their total revenue, and at a level considerably higher than other food and agricultural sectors. In recent years, large hedge fund managers have had a substantial influence on the governance of major UPF corporations in their pursuit of maximising short-term returns. In comparison, shareholders seeking to take steps to improve population diets have had limited influence, in part because large asset managers mostly oppose public health-related shareholder proposals.

CONCLUSIONS

The operationalisation of 'shareholder primacy' by major UPF corporations has driven inequity and undermines their claims that they are creating 'value' for diverse actors. Measures that protect population diets and food systems from the extractive forces of financialisation are likely needed as part of efforts to improve the healthiness of population diets.

Minimum dietary diversity and consumption of ultra-processed foods among Brazilian children 6-23 months of age

The study aimed to estimate the prevalence of minimum dietary diversity (MDD) and consumption of ultra-processed foods in children 6-23 months of age according to sociodemographic variables. Three indicators of complementary feeding of 4,354 children from the Brazilian National Survey on Child Nutrition (ENANI-2019) were built based on a questionnaire about food consumption on the day before the interview: MDD, consumption of ultra-processed foods, and MDD without the consumption of ultra-processed foods. The prevalence and 95%CI were calculated, stratified by macroregion; race/skin color, education and work status of the mother or caregiver; enrollment in the Brazilian Income Transfer Program; household food security; sanitation; and child enrollment in daycare/school. The overall prevalence of MDD was 63.4%, with lower prevalences among children who lived in the North Region (54.8%), whose mothers or caregivers had 0-7 years of education (50.6%), and lived under moderate or severe food insecurity (52.6%). Ultra-processed foods were consumed by 80.5% of the children, with the highest prevalence in the North Region (84.5%). The prevalence of MDD without ultra-processed foods was 8.4% and less prevalent among children with black mothers or caregivers (3.6%) and among those whose mother or caregiver had 8-10 years of education (3.6%). The most frequently consumed food groups from the MDD indicator were grains, roots and tubers (90.2%), dairy products (81%) and those from ultra-processed food were sweet or salty cookies/crackers (51.3%) and instant flours (41.4%). The ubiquitous presence of ultra-processed foods in the diets of Brazilian children and the low frequency of diversified foods, especially among the most vulnerable populations, indicate the need to strengthen policies and programs to ensure adequate and healthy infant nutrition.

Ultra-processed foods and the development of obesity in adults

Ultra-processed foods (UPF) are ubiquitous in the modern-day food supply and widely consumed. High consumption of these foods has been suggested to contribute to the development of obesity in adults. The purpose of this review is to present and evaluate current literature on the relationship between UPF consumption and adult obesity. Cross-sectional studies (n = 9) among different populations worldwide show a positive association between UPF consumption and obesity. Longitudinal studies (n = 7) further demonstrate a positive association between UPF consumption and development of obesity, suggesting a potential causal influence of UPF consumption on obesity risk. However, only one randomized controlled trial has tested the causality of this association. The study included in this review found greater energy intake and weight gain with consumption of a high UPF diet compared to a high unprocessed food diet. The potential mechanisms by which UPF increase the risk of obesity include increased energy intake due to increased sugar consumption, decreased fiber consumption, and decreased protein density; however, more research is needed. Overall, the evidence identified in the current review consistently support a positive relation between high UPF consumption and obesity. While there is a need for more experimental research to establish causality and elucidate the mechanisms, the sum of the evidence supports a need for research on treatment modalities that include reductions in UPF consumption for the management of adult obesity.

Respective contribution of ultra-processing and nutritional quality of foods to the overall diet quality: results from the NutriNet-Santé study

BACKGROUND

Both the nutritional quality of the foods consumed (as nutrient composition) and their ultra-processed nature have been linked to health risks. However, the respective contribution of each of these correlated dimensions or their synergy to the overall diet quality has been rarely explored.

OBJECTIVE

To identify the respective effects of the nutritional quality of the foods consumed, the ultra-processed nature of foods and their cross-effect contributing to the overall quality of the diet.

DESIGN

Cross-sectional observational study.

SETTING

Web-based French NutriNet-Santé cohort study.

PARTICIPANTS

Participants in the NutriNet-Santé cohort study with at least three available 24 h records as baseline dietary data (N = 98 454 participants).

MAIN OUTCOME MEASURES

The overall quality of the diet (qualified using the adherence to the 2017 French national nutrition and health dietary recommendations dietary score PNNS-GS2) was broken down into: (1) an effect of the nutritional quality of the foods consumed (qualified using the modified Foods Standards Agency nutrient profile model (underlying the Nutri-Score) dietary index FSAm-NPS DI); (2) an effect of the ultra-processed nature of the foods consumed (qualified using the proportion of ultra-processed foods consumed UPFp using the NOVA classification), and (3) a cross-effect of both dimensions.

RESULTS

The overall effect from the 'nutritional quality of the foods consumed' (FSAm-NPS DI) was 1.10, corresponding to 26% of the total effect; the overall effect from ultra-processed foods consumption was 1.29, corresponding to 30% of the total effect; and cross-effect between nutritional quality of the foods consumed and ultra-processing was at 1.91, corresponding to 44% of total effects.

CONCLUSIONS

Our study provides support to the postulate that nutritional quality and ultra-processing should be considered as two correlated but distinct and complementary dimensions of the diet.

Modern Diets and the Health of Our Planet: An Investigation into the Environmental Impacts of Food Choices

Popular modern diets are often seen as a panacea for improving health and promoting weight reduction. While there is a large body of literature reporting the health benefits of popular diets, few studies have described their planetary benefits. Our investigation aims to evaluate the simultaneous impacts of six popular diets within the United States on both human and planetary health. Using carbon footprint databases and representative meal plans, the environmental and health-related impacts of the Standard American, Mediterranean, vegan, paleo, keto, and climatarian diets are compared using the currently available literature. Results indicate that diets that exhibit lower carbon footprints also have positive effects on human health. The diets found to have the lowest environmental impacts were the vegan, climatarian, and Mediterranean diets. These low-carbon-footprint diets can likely be attributed to a reduced reliance on ruminant meat (cattle and sheep) and processed food consumption, while diets with high carbon footprints are more dependent on ruminant meat and saturated fat. Moderate consumption of meats such as chicken, pork, and fish in conjunction with an emphasis on locally grown fruits and vegetables can be maintained without adversely affecting the planetary carbon footprint and with the added benefit of promoting good health. Thus, making simple substitutions within each individual's diet can be advertised as an effective approach to collectively lower the environmental impact in tandem with improving health and longevity.

Ultra-processed food consumption and associations with biomarkers of nutrition and inflammation in pregnancy: The Norwegian Environmental Biobank

Background

A high consumption of ultra-processed foods (UPFs) is often associated with low nutritional quality, but data on associations with biomarkers are scarce. We aimed to explore associations between UPF intake, diet quality, and concentrations of biomarkers of nutrition and inflammation measured in mid-pregnancy.

Methods

This cross-sectional study included n = 2,984 pregnant women recruited during 2002-2008 in the Norwegian Mother, Father, and Child Cohort Study (MoBa). Concentrations of C-reactive protein (CRP) and 21 nutritional biomarkers including carotenes (α-carotene, β-carotene, γ-carotene, α-cryptoxanthin, β-cryptoxanthin, lutein, lycopene), vitamins [α-tocopherol, γ-tocopherol, 25-hydroxyvitamin D (25-OH-D), retinol], creatinine, elements (K, Na, Co, Cu, Mn, Mo, Se, Zn), and ferritin (Fe) were measured in blood and urine collected in mid-pregnancy. Habitual diet in pregnancy was assessed using a validated semi-quantitative food frequency questionnaire. We calculated the relative (%) energy contribution of UPF to overall intake according to the NOVA classification. We also applied a diet quality index (DQI) adapted to assess adherence to Norwegian dietary guidelines (DQI; min-max: 0-110, higher score meaning higher adherence). We present summary statistics for biomarker concentrations and explored associations between UPF intake or the DQI and measured biomarkers using adjusted linear, logistic, and generalized additive regression models.

Results

Ultra-processed food intake was positively associated with biomarker concentrations of vitamin E (γ-tocopherol), creatinine, K, and Na [βs: 5.6 to 17% increase in biomarker concentration per interquartile range (IQR) increase in UPF intake] and negatively associated with carotenoids (α-carotene, β-carotene, γ-carotene, α-cryptoxanthin, β-cryptoxanthin, lutein, lycopene), vitamin A, Mo, and Se (βs: -2.1 to -18%). Inversely, high diet quality (i.e., the DQI) was positively associated with concentrations of carotenoids, vitamins [vitamin A (retinol) and D (25-OH-D)], and Se (β: 1.5 to 25%) and negatively associated with vitamin E (γ-tocopherol), creatinine, and Na (β: -4.8 to -8.3%). A weak, positive association was found between UPF and CRP (β: 5.4%, 95% CI 0.12-11%).

Conclusion

High UPF intake was associated with reduced concentrations of nutrition biomarkers in mid-pregnancy. Associations in the opposite direction were found with high adherence to the Norwegian dietary guidelines, suggesting that the two dietary scoring systems capture diet quality in a mirrored manner in this population.

Food-based dietary guidelines for children and adolescents

Objective

This study aimed at reviewing food-based dietary guidelines (FBDGs) with content targeted at children and adolescents to present their main characteristics, thus enabling comparisons among countries.

Design

We conducted a search of the FBDGs available on the Food and Agriculture Organization (FAO) website, followed by a scoping review with a gray literature search to find FBDGs for children or adolescents non-listed on the FAO's website. Data extraction included the year of publication, language, and guidelines for the target group.

Results

From FAO website searches, 109 documents were found, and 17 of them could not be translated. The Scoping review search conducted in 5,190 articles, and none led to new guidelines, nor from the gray literature. Regarding the 92 FBDGs explored, 41 were specific for infants under 24 months old, children, and/or adolescents, and 51 were for the general population with information for the studied group. Twelve percent of the general FBDG and 35% of the specific ones have food icons. All of the guidelines were published after 2001. Latin America and the Caribbean were the regions that presented more specific FBDGs and the majority of countries with guidelines for fruits and vegetables. The information about fat (15 countries) and sugar (26 countries) consumption reduction is frequent. Reduction of sodium intake appears to be in the majority of guidelines after 2015. Food hygiene guidelines are recurrent in Latin American documents. NOVA classification was adopted in five countries and 21 countries approach recommendations for mealtimes. Both exclusive and continued breastfeeding guidance and healthy complementary feeding orientation are present in over 50% of the specific FBDG for infants and children under 24 months old.

Conclusion

Food-based dietary guidelines are diverse due to both the nutritional and political aspects of each region. Latin America stands out for its orientations for the studied group. Further studies should measure the possible impacts and comprehension of FBDGs.

Perspectives on Movement and Eating Behaviours in Brazilian Elderly: An Analysis of Clusters Associated with Disease Outcomes

Aging is a biological process, which is usually associated with health-related problems, which are related to some behaviours, such as those related to movement and eating habits. So, the purpose of the present study was to identify the clustering of behavioural and eating habits related to non-communicable disease in Brazilian elderly, and to estimate the association of these profiles with overweight/obesity, hypertension, and diabetes. This is a cross-sectional based-population study, which sample comes from the VIGITEL 2019 survey. The sample comprised 23,327 subjects (16,295 women), mean age of 71 years. Sociodemographic and anthropometric data (i.e., age, sex, body weight, and body height), health-related information (i.e., eating habits, physical activity and sedentary behaviour, and alcohol consumption), health status and morbidity (diabetes and hypertension) were self-reported. Latent Classes Analysis, and binary logistic regression were performed, considering p<0.05. Results showed that two different classes were identified. Those called as "TV viewer, but no unhealthy diet" presented more chances to have hypertension (OR: 1.213; 95%CI: 1.064-1.382) and diabetes (OR: 1.365; 95%CI: 1.157-1.610), when compared to their peers called as "healthy diet and active". Age, educational level, and sex were associated with hypertension and diabetes. In conclusion, a better health clustered-behaviour was associated with better disease outcomes in Brazilian elderly population.

Dietary Patterns and Dietary Recommendations Achievement From Latin American College Students During the COVID-19 Pandemic Lockdown

This study aimed to compare the diet quality of different dietary patterns among college students from Latin American countries, including vegetarians, vegans, and omnivores during the COVID-19 pandemic. A cross-sectional, observational, multicenter study was conducted including a non- probabilistic sample of university students from 10 countries. University students were invited to participate in the study through social network platforms. Participants were self-reported to have followed a specific dietary pattern; either the Prudent diet, Western diet, Ovo-dairy-vegetarian diet, Fish-vegetarian diet, Strict vegetarian diet (vegan) or other. The last three patterns (vegetarians and vegans) were grouped as following a plant-based diet. A self-assessment survey was used to evaluate healthy eating habits using a questionnaire with values between 1 (do not consume) and 5 (consume) for a total of 9–45 points (higher values represent better eating habits). Unhealthy habits were assessed with nine questions. A total of 4,809 students filled out the questionnaire, and the majority of them were females (73.7%). A high percentage have been in lockdown for more than 5 months and were in lockdown when the survey was released. 74.3% were self-reported to follow a prudent diet, while 11.4% reported following a western dietary pattern and 8.8% a plant-based diet. When compliance with healthy and unhealthy dietary habits was analyzed, although all groups had low compliance, the plant-based diet group (56.09 ± 6.11) performed better than the Western diet group (48.03 ± 5.99). The total diet quality score was significantly higher for plant-based diet followers, who also tended to better achieve the recommendations than omnivorous students, especially the ones following a western diet. These results present evidence that young adults such as college-aged students have unhealthy dietary habits. However, the ones who follow a plant-based diet such as vegetarians and vegans exhibit better scores and healthier dietary conducts.

The Role of Diet Quality in Mediating the Association between Ultra-Processed Food Intake, Obesity and Health-Related Outcomes: A Review of Prospective Cohort Studies

Prospective cohort studies show that higher intakes of ultra-processed food (UPF) increase the risk of obesity and obesity-related outcomes, including cardiovascular disease, cancer and type 2 diabetes. Whether ultra-processing itself is detrimental, or whether UPFs just have a lower nutritional quality, is debated. Higher UPF intakes are inversely associated with fruit, vegetables, legumes and seafood consumption. Therefore, the association between UPFs and poor health could simply be from excess nutrient intake or from a less healthful dietary pattern. If so, adjustment for dietary quality or pattern should explain or greatly reduce the size of the significant associations between UPFs and health-related outcomes. Here, we provide an overview of the literature and by using a novel approach, review the relative impact of adjusting for diet quality/patterns on the reported associations between UPF intake and health-related outcomes in prospective cohort studies. We find that the majority of the associations between UPFs, obesity and health-related outcomes remain significant and unchanged in magnitude after adjustment for diet quality or pattern. Our findings suggest that the adverse consequences of UPFs are independent of dietary quality or pattern, questioning the utility of reformulation to mitigate against the obesity pandemic and wider negative health outcomes of UPFs.