Ultra-processed food and the risk of overweight and obesity: a systematic review and meta-analysis of observational studies

Degree of food processing and serum poly- and perfluoroalkyl substance concentrations in the US National Health and Nutrition Examination Survey, 2003-2018

BACKGROUND

Ultra-processed foods account for >50% of total energy consumed among U.S. individuals and may be a source of poly- and perfluoroalkyl substances (PFAS) exposure - chemicals linked with cancer/cardiometabolic disorders.

OBJECTIVE

To evaluate associations between degree of food processing and PFAS exposure.

METHODS

Serum concentrations of seven PFAS were analyzed in 11,530 individuals ≥12-years-old from the U.S. National Health and Nutrition Examination Survey (2003-2018). We averaged responses from two 24-h dietary recalls to calculate relative energy intakes of unprocessed/minimally processed foods, processed culinary ingredients, processed foods, and ultra-processed foods using the Nova food classification system. We estimated percent differences in concentrations (β; PFAS with ≥70% detection) or odds ratios of detection (OR; PFAS with <70% detection) using linear or logistic regression, respectively. We explored associations stratified by cycle, life stage, sex, body mass index, race/ethnicity, and poverty/income ratio.

RESULTS

Each 10% increase in ultra-processed food intake was associated with higher serum perfluorohexanesulfonic acid (PFHxS; β: 1.40; 95%CI: -0.12, 2.94), but lower perfluorodecanoic acid (PFDA; β: -4.41; 95%CI: -5.55, -3.26) and perfluoroundecanoic acid (PFUnDA; OR: 0.82; 95%CI: 0.79, 0.86) concentrations. Positive associations between ultra-processed foods and PFHxS were driven by adolescents and under-/normal weight individuals. Additionally, each 10% increase in unprocessed/minimally processed food intake was associated with lower perfluorooctanoic acid (PFOA; β: -1.10; 95%CI: -2.38, 0.20) and PFHxS (β: -1.50; 95%CI: -3.03, 0.06), but higher perfluorononanoic acid (PFNA; β: 1.71; 95%CI: 0.24, 3.21), PFDA (β: 5.33; 95%CI: 3.78, 6.90), and PFUnDA (OR: 1.22; 95%CI: 1.16, 1.27). Positive and negative associations of unprocessed/minimally processed foods and ultra-processed foods, respectively, with PFDA and PFUnDA were strongest in recent survey cycles, males, and non-Hispanic Asians.

SIGNIFICANCE

Unprocessed/minimally processed foods, more than ultra-processed, were associated with serum PFAS concentrations. Efforts should focus on eliminating PFAS from multiple parts of the food chain.

Dietary Relationships between Obesity and Inflammatory Bowel Diseases: A Narrative Review of Diets Which May Promote Both Diseases

PURPOSE OF REVIEW

The pandemic of obesity preceded global spread of Inflammatory Bowel diseases by almost 2 decades. A pathogenic relationship has been described between obesity and inflammatory bowel diseases, but Crohn`s disease may be selectively impacted. The role of diet in pathogenesis has also gained significant support in the last few decades. This review explores dietary relationships to account for epidemiological observations. Quantifiable indices for diets have been described including a glycemic index, inflammatory indices and levels of food processing. Meta-analyses have been published which examine each for effects on obesity and co-morbidities as well as Crohn's disease and ulcerative colitis. This review suggests that ultra-processed foods provide the best link between obesity and Crohn's disease explaining epidemiological observations. However, the other 2 types of dietary indices likely contribute to ulcerative colitis as well as to co-morbidities related to both obesity and inflammatory bowel diseases. The term ultra-processed foods cover a large number of additives and extensive work is needed to define individual or combined harmful effects. Furthermore, the interactions among the 3 main indices need clarification in order to precisely apply therapeutic diets to both diseases (obesity and inflammatory bowel disease).

The role of hyper-palatable foods in energy intake measured using mobile food photography methodology

OBJECTIVE

Hyper-palatable foods (HPF) contain nutrient combinations that are hypothesized to maximize their rewarding effects during consumption. Due to their strong reinforcing properties, HPF are hypothesized to lead to greater energy intake within a meal. However, this premise has not been tested in free-living conditions. The current study examined the association between within-meal HPF intake and 1) measured energy intake and 2) self-reported overeating, assessed within eating occasions using smartphone-based food photography methodology.

METHODS

A total of 29 participants reported food intake and eating experiences (N=345 total eating occasions) in real-time for 4 days using smartphone-based food photography methodology. HPF were identified using a standardized definition. Bayesian multilevel modeling was conducted to investigate the within-person effects of proportional calorie intake from HPF (%kcal from HPF) on total energy intake and subjective overeating. Pre-meal hunger and proportional energy intake from high energy dense (HED) foods were included as covariates.

RESULTS

Results revealed that when participants consumed more %kcal from HPF than their average, they consumed greater total energy during eating occasions, even when controlling for pre-meal hunger and %kcal from HED foods (median β = 0.09, 95% HDI [0.02, 0.16], pd. = 99.56%). Additionally, consuming more %kcal from HPF than average was associated with greater eating despite feeling full, when controlling covariates (median β = 0.15, 95% HDI [-0.02, 0.34], pd = 96.45%).

CONCLUSIONS

The findings supported the premise that HPF themselves may yield greater energy intake and eating despite satiation, measured in real-time and free-living conditions.

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.

Disputes over the agenda to promote adequate and healthy eating - How the agri-food sector interfered in the Brazilian Tax Reform

BACKGROUND

while the Brazilian Tax Reform (TR) is underway, this study aimed to identify the main food taxes events and to map corporate political activities (CPA) of the agri-food sector.

METHODS

We gathered bibliographical and documentary research from January 2023 to April 2024 of the TR and the CPA from agri-food companies, trade associations and front groups.

RESULTS

We found 78 CPA action strategies and 32 framing strategies. In 2024, CPA strategies occurred 20 times. The most frequent CPA action strategy was 'Manufacture public support for corporate positions'', by the mechanism 'Maximize corporate-favorable media content'. The most frequent CPA framing strategy was 'The 'trivial' and 'individual' problem: created by a minority of consumers', by the mechanism 'Health harms are not caused by Industry's products/services'.

DISCUSSION

CPA strategies resulted in UPFP off the excise tax. Civil society drove the UPFP debate, and the soda tax and the National Basic Food Basket were included in the TR.

CONCLUSION

This study shares industry interference learnings and can help to develop mechanisms that address Commercial Determinants of Health.

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

PURPOSEOF REVIEW

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

RECENT FINDINGS

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

Effectiveness of 8-hour time-restricted eating combined with different dietary patterns on body composition, lipid metabolism, and oxidative stress in healthy adults: An exploratory study from an RCT

OBJECTIVES

To evaluate the effectiveness of a 4-week intervention of time-restricted eating (TRE) alone or in combination with an elimination of ultra-processed foods or vegetarian diet, on body composition, lipid metabolism, and oxidative stress.

METHODS

This was a randomized controlled trial including 70 participants comparing three diet groups maintained for a 4-week period: A, TRE alone; B, TRE with elimination of ultra-processed foods; and C, TRE with a vegetarian diet. Per-protocol analyses of body composition, plasma lipid levels, and oxidative stress markers were performed.

RESULTS

Compared to baseline, Group B significantly reduced weight (P = 0.02), body mass index, waist and hip circumference, as well as fat ratio, total cholesterol, 4-hydroxynonenal an 8-Iso prostaglandin F 2α (all P < 0.05). Group B also increased high-density lipoprotein cholesterol (P < 0.05) and catalase (P = 0.002). Compared to Group A, Group B was more effective in decreasing body mass index (Δ: -0.1 ± 0.7 vs. -0.2 ± 0.3, respectively, P = 0.041) and waist circumference (Δ: -1.1 ± 4.0 vs. -3.5 ± 4.4, P < 0.001). Compared to Group A and B, the increase in superoxide dismutase (Δ: 12.74 ± 8.34, P < 0.05) and glutathione (Δ: 0.63 ± 0.40, P < 0.05) was significantly greater for Group C. Group C also produced a greater decrease in malondialdehyde (Δ: -0.79 ± 0.28) than the Group A (Δ: -0.32 ± 0.51, P < 0.001) and Group B (Δ: -0.20 ± 0.68, P < 0.001) diets.

CONCLUSIONS

Consumption of ultra-processed foods can increase body composition and lipid profile, despite TRE. A vegetarian diet in combination with TRE is effective in reducing oxidative stress injury.

Ultra-processed foods and cardio-kidney-metabolic syndrome: A review of recent evidence

The rapid increase in the consumption of ultra-processed foods (UPFs) has become a significant global public health concern. UPFs are typically high in unhealthy fats, refined sugars, sodium, and other additives while being low in proteins, fibers, and other essential nutrients. Their high glycemic index and glycemic load lead to blood sugar spikes, contributing to metabolic dysregulation. Emerging evidence links UPF intake to the development of the cardiovascular-kidney-metabolic (CKM) syndrome and a higher risk of adverse health outcomes, such as all-cause and cardiovascular mortality. The pathophysiological mechanisms likely involve chronic inflammation, oxidative stress, dysregulated lipid metabolism, insulin resistance, immune dysfunction, and gut microbiota disruption. The adverse effects are even more concerning in vulnerable populations, including individuals with chronic kidney disease, kidney failure, and the elderly. This review article explores how UPF intake contributes to chronic diseases across the CKM spectrum, including cardiovascular disease, kidney disease, obesity, and type 2 diabetes mellitus, while also exacerbating frailty and reducing quality of life. The focus goes beyond risks of individual metabolic complications to address the broader health implications of UPFs on the increased prevalence of multiple coexistent non-communicable diseases, frailty, reduced quality of life, meta-inflammation, metabolic memory, and syndemics, which are particularly critical for the aging geriatric population.

Late eating and shortened fasting are associated with higher ultra-processed food intake across all age groups: a population-based study

PURPOSE

Global dietary patterns are increasingly driven by ultra-processed foods-cheap, highly palatable, and ready-to-eat options. Exploring time-related eating patterns and its association with ultra-processed foods could help in intervention efforts, but knowledge on this topic is still limited. This study assessed the association of time-related eating patterns with unprocessed/minimally processed and ultra-processed food consumption across different life stages.

METHODS

Two 24-hour food recalls from a nationally representative sample in Brazil (Brazilian Household Budget Survey, POF, 2017-2018; n = 46,164) were used to estimate tertiles of first and last intake times, eating midpoint, caloric midpoint time, and night fasting (independent variables). All consumed foods were classified according to the Nova classification system, and the outcomes of interest were consumption of unprocessed/minimally processed and ultra-processed foods. Multiple linear regression models were performed for all individuals and stratified for each age group: adolescents (10-19 years, n = 8,469), adults (20-59 years, n = 29,332), and older individuals (≥ 60 years, n = 8,322).

RESULTS

The later tertile of first food intake time, last food intake time, caloric midpoint, and eating midpoint were positively associated with consumption of ultra-processed foods (β = 3.69, 95%CI = 3.04, 4.34; β = 1.89, 95%CI = 1.32, 2.47; β = 5.20, 95%CI = 4.60, 5.81; β = 3.10, 95%CI = 2.49, 3.71, respectively) and negatively associated with consumption of unprocessed or minimally processed foods (β=-2.79, 95%CI=-3.37; -2.22; β=-1.65, 95%CI=-2.24, -1.05; β=-3.94, 95%CI=-4.44, -3.44; β=- 2.35, 95%CI=-2.93, -1.78, respectively) compared to the first "earlier" tertile (reference). An inverse association was found for night fasting (β=-1.74, 95%CI=-2.28, -1.22 and β = 1.52, 95%CI = 0.98, 2.06 for ultra-processed and unprocessed/minimally processed foods, respectively). These associations were consistent across all age groups.

CONCLUSION

Chrononutrition patterns characterized by late intake timing and shortened overnight fasting were associated with higher consumption of ultra-processed foods and lower intake of unprocessed/minimally processed foods across all age groups.

Association of ultra-processed foods consumption with increased liver steatosis in U.S. adults

Background

Recent studies demonstrated a strong association between dietary habits and liver health, particularly in the development of steatosis and fibrosis. This study aimed to examine the impact of ultra-processed foods (UPFs) on liver health, focusing specifically on their influence on the risks of liver steatosis and fibrosis.

Methods

A cross-sectional analysis was conducted on 4,992 participants aged 18 years and older from the 2017-2020 National Health and Nutrition Examination Survey (NHANES). Dietary intake was assessed using one or two 24-h dietary recalls, and foods were categorized by their processing level using the NOVA classification system. UPFs consumption was measured in grams and divided into quartiles. Liver health was assessed using controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) via elastography, to evaluate steatosis and fibrosis, respectively. Linear regression models were applied to assess the relationship between UPFs consumption and liver outcomes, adjusting for sociodemographic (age, sex, ethnicity), lifestyle (alcohol consumption, physical activity), and biomedical factors (liver enzyme levels).

Results

Higher UPF intake was significantly associated with increased CAP values, indicating a higher risk of liver steatosis. While liver fibrosis, measured by LSM, was also associated with UPF consumption, this relationship did not reach statistical significance. Multivariate analysis showed that increased UPF consumption did not significantly affect LSM (p = 0.110) but was strongly associated with elevated CAP values (p = 0.009). In participants with fatty liver (CAP > 248 dB/m), the association between UPF intake and CAP remained significant (p = 0.020). Participants in the highest quartile of UPFs consumption (Q4) exhibited higher CAP values compared to those in the lowest quartile (Q1) (β = 1.22; 95% CI: 1.02, 1.47). Stratified analysis revealed that the association between UPF intake and CAP was more pronounced in obese individuals (HR = 1.08, 95% CI: 1.03-1.15, p = 0.022) and those with high waist circumference (HR = 1.06, 95% CI: 1.01-1.10, p = 0.032).

Conclusion

These results underscore the adverse impact of UPFs on liver health, particularly by increasing steatosis, while the connection with fibrosis remains less straightforward.

Impact of ultra-processed foods on excess weight and dyslipidemia in schoolchildren

OBJECTIVE

To analyze the impact of the association between the consumption of ultra-processed foods (UPF), excess weight, and dyslipidemia in schoolchildren.

METHODS

This is a cross-sectional study in which 420 schoolchildren aged 6 to 10 years from public schools in the municipality of Rio das Ostras, Brazil, were evaluated. Food consumption was assessed using the Previous Day Food Questionnaire (PDFQ-3), and physical activity (PA) was assessed using the Previous Day Physical Activity and Food Questionnaire (PDPAFQ). The following parameters were also evaluated: body weight, height, body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR); serum concentrations of triglycerides (TG), total cholesterol (TC), LDL-cholesterol (LDL-c), HDL-cholesterol (HDL-c), and non-HDL-cholesterol. All foods and UPF groups were categorized according to the NOVA classification, and UPF consumption was expressed as a score and classified into tertiles. For statistical analysis, binary logistic regression models were tested and crude and adjusted Odds Ratios (OR) for PA were estimated with 95% confidence intervals (CI).

RESULTS

Among the schoolchildren, 98.2% reported consuming UPFs the previous day. The schoolchildren in the "high consumption" tertile evidenced a higher intake of sugary beverages (SB), bread and savory crackers, and french fries. French fries consumption was higher among schoolchildren in the "high consumption" group compared to those in the lower tertiles (p<0.001). The bread and savory crackers group and yogurt were more consumed by those in the "moderate and high consumption" tertiles compared to the "low consumption" tertile (p<0.001). Schoolchildren in the high consumption tertile were more active (43.75% vs. 20.14%) (p<0.001), while those in the low consumption tertile were less active (44.72% vs. 21.14%) (p<0.001). A high prevalence of dyslipidemia (82.96%), excess weight (30.08%), abdominal obesity (AO) (18.3%), and no direct association between UPF consumption and excess weight and dyslipidemia were observed even after adjustment for PA (p>0.05).

CONCLUSIONS

Despite the high prevalence of dyslipidemia, excess weight, and abdominal obesity observed, no direct association between UPF consumption and these conditions was identified. The practical implications of this study highlight the relevance of public policies and educational strategies aimed at promoting healthier eating habits and encouraging the practice of physical activities among school-age children.

Associations between degree of food processing and colorectal cancer risk in a large-scale European cohort

Industrial food processing has been linked to various health outcomes including cancer. To examine associations between the degree of food processing and risk of colorectal cancer (CRC) and its sub-sites, data from the European Prospective Investigation into Cancer (EPIC) including 6155 incident CRC cases (n = 450,111 participants), were analyzed. Dietary intakes were assessed using baseline food frequency questionnaires. Foods were classified into culinary ingredients, unprocessed, processed (PFs), and ultra-processed foods (UPFs) according to the Nova classification. Cox proportional hazards models, adjusted for established CRC risk factors, were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) associated with a 10% increase in proportion of consumption (%g/d) of each Nova group. Substitution analysis examined the effect of replacing UPFs and PFs with unprocessed foods on CRC risk. A 10% increase in proportion of UPFs was associated with 6% higher CRC risk (95% CI:1.02-1.10). A positive association was also found between PFs and CRC risk (HR per 10% increase: 1.10 [95% CI, 1.05-1.15]). Conversely, unprocessed food consumption was inversely associated with CRC risk (HR per 10% increase: 0.93[95% CI, 0.90-0.95]). Substitution of 10% of the overall proportion of the diet comprising UPFs or PFs with 10% unprocessed foods was associated with a decreased risk of CRC (HRUPFs: 0.94 [95% CI, 0.90-0.97]; HRPFs: 0.90 [95% CI, 0.86-0.94]). In conclusion, UPF was positively associated with CRC risk while diets richer in unprocessed foods were associated with lower CRC risk. Further studies are needed to understand the mechanisms by which food processing affects CRC risk.

Ultra-processed foods and plant-based alternatives impair nutritional quality of omnivorous and plant-forward dietary patterns in college students

The health benefits of a plant-based diet may be outweighed by an increased consumption of ultra-processed foods (UPF) and plant-based alternatives. This study compares diet quality (intakes of protein, saturated fatty acids, sugar, fiber, and micronutrients) and nutritional status (prevalence of low holotranscobalamin and ferritin levels) among different dietary patterns: 22.5% vegans, 46.5% vegetarians, 31% omnivores in 142 first-year college students (20 ± 1.6 years, BMI 21.9 ± 3.1 kg/m², 83% female). Intakes of vitamin B12, folate, iron, zinc, and calcium were on average below reference values, especially in vegans and vegetarians. However, the prevalence of low holotranscobalamin and ferritin levels did not differ between the dietary groups, presumably due to supplementation. Irrespective of the diet, UPF contributed to 49% of daily energy intake. UPF exhibited a lower content of protein, fiber, vitamin B2, vitamin B12, folate, zinc and calcium compared to processed foods (all p < 0.001). Plant-based alternatives contained more fiber and less saturated fatty acids whereas the content of protein and micronutrients was lower compared with animal products (all p < 0.05). In conclusion, UPF consumption contributes to the inadequate intake of many micronutrients by young adults. This is further aggravated by plant-forward eating patterns including the consumption of plant-based alternatives.

Exposure to mouse dams to bonito broth during gestation or lactation reduces fat intake in offspring

Overconsumption of fat contributes to obesity and low adherence to dietary therapy in patients with obesity. The frequency of consuming soup dishes containing "dashi" (Japanese broth), a characteristic element of the Japanese diet, is negatively associated with obesity indicators. The use of dashi is considered one of the reasons why the low-fat Japanese diet is popular; however, whether and how dashi controls the selection and intake of fat is unknown. In this study, we tested the hypothesis that bonito broth, a typical Japanese dashi, affects fat consumption in a mouse model. First, we examined the long-term or short-term intake of corn oil emulsion in adult mice fed bonito broth. No significant effect was observed. Next, mouse dams were fed bonito broth during gestation or lactation and licking of 0.5, 1, 2.5, 5, and 10% corn oil in their adult pups was evaluated in acute tests. Compared to the control group, there were significant decreases in licks for some corn oil concentrations in the gestation and lactation groups. Finally, corn oil licking was tested in pups fed bonito broth after weaning. No significant effect was detected. This study suggests that dams' intake of bonito broth during gestation or lactation reduces the intake of fat by their pups in adulthood.

[Culinary skills in Brazilian food and nutrition public policies: a documentary analysis]

The development of cooking skills (CS) is a strategy to facilitate the implementation of healthy and sustainable diets. This study aims to analyze the approach to CS in Brazilian documents to promote adequate and healthy eating, in line with the political, epidemiological and social context of their publication periods, starting from the first edition of the National Food and Nutrition Policy (PNAN). Public documents included in the virtual libraries of the Secretariats of Primary Health Care and Social Development were searched, starting from the date of publication of the first PNAN edition (1999) until 2022. It was identified 25 documents; 4 themes were generated and analyzed. There was an evolution of the CS approach, expanding the focus on biological-nutritional and hygienic-sanitary aspects of cooking to an approach that takes biopsychosocial-cultural and environmental factors into account, especially after the publication of the second edition of the Brazilian Food Guidelines, which highlights the expansion of the perspective on cooking and consolidates it as a golden rule for adequate and healthy food.

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

CONTEXT

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

OBJECTIVE

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

DATA SOURCES

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

DATA EXTRACTION

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

DATA ANALYSIS

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

CONCLUSIONS

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

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023442783.

Adequate Food and Nutrition in School: Acceptability and Consumption by Students of a Brazilian Municipality

OBJECTIVE

This study aimed to evaluate the acceptability of a specific menu preparation based on minimally processed foods and the factors associated with the consumption of school meals by students in Brazilian public schools.

METHODS

A hedonic scale was employed to assess the acceptability of a milk preparation with 100% cocoa and sugar. A structured questionnaire was used to evaluate school food consumption, addressing consumption frequency, dietary habits, environmental conditions, and consumption of competing foods. A binomial logistic regression model was conducted to verify the association between individual variables and conditions of meal supply and consumption. Data analyses were performed using the Jamovi 2022 software.

RESULTS

A total of 1080 students participated, with 630 taking part in the acceptability test, and 450 completing the consumption questionnaire. The study highlighted acceptance below the minimum PNAE standards (79.68%) for the tested preparation, indicating a need for further investigation into student preferences. Pleasant taste was the most frequently cited reason (53.2%) for consumption. Disliking the served lunch increased the likelihood of not consuming school meals by 2.73% (p = 0.03). Bringing snacks from home showed no significant impact on consumption (p = 0.677). Using inadequate cutlery increased the likelihood of not consuming school meals by 6.44% (p = 0.009).

CONCLUSIONS

The study underscored the low acceptance of milk prepared with 100% cocoa and sugar, along with irregular school meal consumption, emphasizing the need for strategies to align students' taste preferences with healthier menu options. While PNAE ensures nutrient-rich meals, improving flavor, variety, and dining conditions, alongside permanent food and nutrition education, is essential to enhance adherence and support students' health. Although snacks do not affect the consumption of school meals, controlling snack intake is important from a health perspective.

Ultra-Processed Food Consumption and Obesity: A Narrative Review of Their Association and Potential Mechanisms

Obesity is a major global health concern, with diet playing a crucial role in its development and treatment. Ultra-processed foods (UPFs) have become prevalent in diets due to changes in the food environment. These foods are energy-dense; high in fat, sugars, or salt; and low in fiber, protein, vitamins, and minerals, raising concerns about their effects on health. In addition to traditional research focused on nutrients, food, and dietary quality, growing evidence has linked UPF consumption to obesity. Therefore, this study provides a comprehensive review of the levels and trends of UPF consumption, current epidemiological evidence on the association between UPF consumption and obesity, and UPFs' potential role in the etiology of obesity and weight gain. Additionally, this study reviews strategies for reducing UPF consumption and outlines future studies of the link between UPF consumption and obesity.

An assessment of compliance with proposed regulations to restrict on-package marketing of packaged foods to improve nutrition in South Africa

BACKGROUND

Ultra-processed products (UPPs), high in sugar, fat and sodium, contribute to increasing burdens of obesity and non-communicable diseases in South Africa (SA). Increased consumption and acceptability of UPPs is driven, in part by aggressive marketing. Front of package labelling laws, particularly warning labels (WLs) coupled with marketing restrictions, have been recommended to improve consumer awareness of unhealthy products, incentivise reformulation and underpin other interventions. The SA government published a draft regulation to introduce WLs and restrict marketing, called R3337. This study aims to analyse on-package marketing and create a baseline to evaluate compliance with the proposed R3337.

METHODS

This study is an analysis of a dataset of 6768 packaged food products, collected as pictures of products in four major grocery stores in Cape Town, SA between March and July 2019. A codebook was developed based on R337. The codebook was used to identify and assess child-directed marketing (CDM) and health claims on products potentially subject to front-of-package WLs. Food packages and their nutritional information were coded and analyzed to determine whether the product would be required to carry a WL and whether the package included regulated marketing.

RESULTS

The majority (80.16%) of products analyzed would require WLs under R3337 due to high levels of sugar, sodium, or saturated fat. CDM was prevalent, with 59.26% of products displaying some form of marketing, primarily animated characters and depictions of children. Health claims were also common, with 83% occurring on WL products.

DISCUSSION

Using a WL system in SA could effectively target common forms of on-package marketing of unhealthy products, given the high prevalence of CDM and health claims on products likely to carry WLs. Such interventions may contribute to improving diets and reducing UPP consumption. Some forms of CDM are not regulated under R3337 and we recommend expanding the regulation to include these. This study provides a baseline which should be used for future research to evaluate R3337 when it is implemented.

Trends in the prevalence of obesity and estimation of the direct health costs attributable to child and adolescent obesity in Brazil from 2013 to 2022

INTRODUCTION

Childhood obesity is a major global public health issue globally and in Brazil. The impacts of childhood obesity include higher risk of disease during childhood and of obesity and non-communicable diseases in adulthood and represent an important epidemiological and economic burden to countries. This study aims to analyze the trends and to estimate the direct healthcare costs of childhood and adolescent obesity to the National Health System from 2013 to 2022.

METHODS

We used Prais-Winsten regressions for determining the trends in the prevalence of obesity and modeled the attributable to childhood and adolescent obesity in the Brazilian National Health System using previous meta-analysis of studies.

RESULTS

The hospitalizations of children and adolescents with obesity as a primary cause totaled Int$2.6 million to the Brazilian National Health System from 2013 to 2022, demonstrating that obesity is rarely considered as a cause of hospitalization especially among children and adolescents. The additional costs of hospitalizations attributable to childhood obesity totaled Int$101.5 million during the same period. The additional non-hospital, outpatient and medication cost attributable to childhood obesity in Brazil were estimated at Int$6.0 million, so the total estimated healthcare costs were of approximately Int$107.5 million in the last decade.

CONCLUSION

This study highlights that childhood and adolescent obesity are increasing for most age-groups and that its costs are not limited to the economic impacts on adult health and represent a relevant economic burden to the Brazilian National Health System and to families because of additional costs during childhood and adolescence. Therefore, the prevention and control of childhood and adolescent obesity must be public health priorities.

Beyond the family's cooking frequency: The influence of cooking techniques on vegetable and fruit consumption among the U.S. population

BACKGROUND

Despite the well-established health benefits of fruits and vegetables, U.S. consumption remains far below the WHO's recommended 400 g per day. Understanding how culinary techniques influence intake could elucidate strategies for improving dietary habits.

OBJECTIVE

To explore whether the use of cooking techniques for fruits and vegetables is associated with increased consumption of these foods and the corresponding variation in total fiber intake among the U.S.

POPULATION

METHODS

Data from the National Health and Nutrition Examination Survey (NHANES) 2009-2010, participants (n = 9754) were categorized into groups based on their self-reported cooking frequency. Cooking techniques were classified into types. The mean consumption of fruits and vegetables was segmented into quartiles. Cooking frequency was evaluated, and differences between groups were assessed using chi-square tests and mean comparison tests. The study also assessed the prevalence of cooking techniques for different food groups. Additionally, linear regression analyses were conducted to adjust the mean daily per capita consumption of fruits, vegetables, and dietary fiber, considering cooking frequency and other socioeconomic variables as predictors.

RESULTS

The studied population's mean consumption of fruits and vegetables was 302.9 g, with half of this amount consisting of fruits. Individuals from households with frequent cooking practices (≥5x a week) consumed, on average, 48.2 g more fruits and vegetables daily than those from households with less frequent cooking (<5x a week). The use of diverse cooking techniques significantly improved vegetable intake, showing a fivefold increase in consumption among those employing multiple techniques. Moreover, frequent home cooking was associated with a 1.0-g increase in daily fiber intake.

CONCLUSION

Public policies aimed at improving fruit and vegetable intake among the U.S. population should consider, in addition to cooking frequency, the role of cooking techniques in influencing the consumption of these food groups.

Investigating the Impact of Ashwagandha and Meditation on Stress Induced Obesogenic Eating Behaviours

Obesity has been identified as a rapidly rising pandemic within the developed world, potentially increasing the risks of type 2 diabetes and cardiovascular disease. Various studies have identified a positive association between stress, elevated cortisol levels and obesity. Mechanisms of the stress response lead to hyperpalatable food preference and increased appetite through the activation of the HPA axis, elevated cortisol and the resulting interactions with the dopaminergic system, neuropeptide Y, ghrelin, leptin and insulin. The methodology of this review involved a Systematic Search of the Literature with a Critical Appraisal of papers considering ashwagandha, mediation and mindfulness in relation to mechanisms of the stress response. It incorporated 12 searches yielding 330 hits. A total of 51 studies met the inclusion criteria and were critically appraised with ARRIVE, SIGN50 and Strobe checklists. Data from the 51 studies was extracted, coded into key themes and summarized in a narrative analysis. Thematic analysis identified 4 key themes related to ashwagandha and 2 key themes related to meditation. Results provide an overview of evidence assessing the efficacy of ashwagandha and meditation in relation to weight loss interventions by supporting the stress response and the pathways highlighted. Results of Clinical studies indicate that ashwagandha supports weight loss through reduced stress, cortisol and food cravings. Pre-clinical studies also suggest that ashwagandha possesses the capacity to regulate food intake by improving leptin and insulin sensitivity and reducing addictive behaviors through dopamine regulation. Clinical studies on meditation indicate it may enhance a weight loss protocol by reducing the stress response, cortisol release and blood glucose and improving eating behaviors.

Assessing the Consumption of Ultra-Processed Foods in People with Diabetes: Is a Specific NOVA Questionnaire Always Necessary?

BACKGROUND/OBJECTIVES

Despite the accumulating evidence on the detrimental impact of UPFs on health, a common limit of the available studies concerns the instruments used to collect information about the consumption of processed foods. Recently, a specific NOVA-FFQ was proposed for the evaluation of ultra-processed food (UPF) consumption, but it does not allow the simultaneous assessment of energy and nutrient intake. We evaluate the concordance between the NOVA-FFQ and a common questionnaire (EPIC-FFQ) when assessing (1) the intake of foods with different degrees of processing and (2) the relationship between diet composition and cardiometabolic profile.

METHODS

One hundred and thirty people with diabetes (70 men and 60 women) completed the NOVA-FFQ and the EPIC-FFQ in random order two weeks apart. Anthropometric and major cardiovascular risk factors were measured.

RESULTS

Non-significant differences were detected for processed culinary ingredients and processed foods; larger significant differences were observed for minimally processed foods and UPFs, which were somewhat underestimated by the EPIC-FFQ (-24% vs. -21%, respectively; p < 0.001). However, Bland-Altman plots showed intraindividual differences between the two questionnaires within an acceptable range, and the intraclass correlation showed a moderate consistency. Furthermore, the energy and nutrient composition of the diet and the metabolic parameters were comparable for people classified in the highest tertile of UPF consumption by either method.

CONCLUSIONS

The NOVA-FFQ provides more detailed information on the consumption of UPF foods; however, the EPIC-FFQ is a valid alternative, particularly practical when the simultaneous assessment of the overall quality of the diet is needed.

Association between ultraprocessed foods consumption, eating disorders, food addiction and body image: a systematic review

OBJECTIVE

This study aimed to assess the association between ultraprocessed foods (UPF) consumption, eating disorders (EDs), food addiction and body image concerns.

DESIGN

Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

DATA SOURCES

Medline, Scopus, Web of Science, EMBASE, LILACS and APA PsycInfo databases, for studies published between 2009 and July 2024.

ELIGIBILITY CRITERIA

We included cross-sectional and cohort studies involving individuals of all ages, evaluating the association between UPF consumption, classified by the 'NOVA system', EDs, food addiction and body image. No restrictions were placed on diagnostic criteria, age and gender. Studies that modelled UPF consumption as both an exposure and an outcome were included.

DATA EXTRACTION AND SYNTHESIS

Data extraction and quality assessment were performed by two independent reviewers. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal checklist.

RESULTS

We did not identify any longitudinal studies. Nine cross-sectional studies were included (n=54 367 participants). One study assessed EDs types, including restrictive, bulimic, binge eating and other (not otherwise specified); three studies examined body dissatisfaction, while five studies investigated food addiction. The consumption of UPF was significantly associated with bulimic, binge eating and other ED and food addiction. No significant associations were identified between restrictive ED and body dissatisfaction.

CONCLUSION

This systematic review highlights a significant gap in research on this topic. Although some associations have been found, the findings are limited to cross-sectional studies with methodological limitations. The lack of longitudinal studies emphasises the need for more rigorous research to accurately assess the direction of these relationships.

PROSPERO REGISTRATION NUMBER

CRD42022365154.

Greater Frequency of Cooking Dinner at Home and More Time Spent Cooking Are Inversely Associated With Ultra-Processed Food Consumption Among US Adults

BACKGROUND

Cooking at home has been promoted as a strategy to improve diet quality; however, the association between cooking behavior and ultra-processed food intake is unknown.

OBJECTIVE

The objective of this study was to examine associations between frequency of cooking dinner at home and time spent cooking dinner with ultra-processed food intake.

DESIGN

Cross-sectional, nationally representative data from the 2007-2010 National Health and Nutrition Examination Survey were analyzed.

PARTICIPANTS/SETTING

Participants were 9,491 adults (20 years and older) in the United States.

MAIN OUTCOME MEASURES

The main outcome measure was the proportion of energy intake (averaged from two 24-hour dietary recalls) from the following 4 Nova food-processing groups: (1) unprocessed or minimally processed foods, (2) processed culinary ingredients, (3) processed foods, and (4) ultra-processed foods.

STATISTICAL ANALYSES PERFORMED

Separate linear regression models examined associations between cooking frequency and time spent cooking dinner and proportion of energy intake from the 4 Nova food-processing groups, adjusting for sociodemographic characteristics and total energy intake.

RESULTS

Ultra-processed foods comprised >50% of energy consumed independent of cooking frequency or time spent cooking. Higher household frequency of cooking dinner and greater time spent cooking dinner were both associated with lower intake of ultra-processed foods (P trends < .001) and higher intake of unprocessed or minimally processed foods (P trends < .001) in a dose-response manner. Compared with cooking 0 to 2 times/wk, adults who cooked dinner 7 times/wk consumed a mean of 6.30% (95% CI -7.96% to -4.64%; P < .001) less energy from ultra-processed foods. Adults who spent more than 90 minutes cooking dinner consumed 4.28% less energy from ultra-processed foods (95% CI -6.08% to -2.49%; P < .001) compared with those who spent 0 to 45 minutes cooking dinner.

CONCLUSIONS

Cooking at home is associated with lower consumption of ultra-processed foods and higher consumption of unprocessed or minimally processed foods. However, ultra-processed food intake is high among US adults regardless of cooking frequency.

High-fat and High-sucrose Diet-induced Hypothalamic Inflammation Shows Sex Specific Features in Mice

Hypothalamic inflammation underlies diet-induced obesity and diabetes in rodent models. While diet normalization largely allows for recovery from metabolic impairment, it remains unknown whether long-term hypothalamic inflammation induced by obesogenic diets is a reversible process. In this study, we aimed at determining sex specificity of hypothalamic neuroinflammation and gliosis in mice fed a fat- and sugar-rich diet, and their reversibility upon diet normalization. Mice were fed a 60%-fat diet complemented by a 20% sucrose drink (HFHSD) for 3 days or 24 weeks, followed by a third group that had their diet normalized for the last 8 weeks of the study (reverse diet group, RevD). We determined the expression of pro- and anti-inflammatory cytokines, and of the inflammatory cell markers IBA1, CD68, GFAP and EMR1 in the hypothalamus, and analyzed morphology of microglia (IBA-1+ cells) and astrocytes (GFAP+ cells) in the arcuate nucleus. After 3 days of HFHSD feeding, male mice showed over-expression of IL-13, IL-18, IFN-γ, CD68 and EMR1 and reduced expression of IL-10, while females showed increased IL-6 and IBA1 and reduced IL-13, compared to controls. After 24 weeks of HFHSD exposure, male mice showed a general depression in the expression of cytokines, with prominent reduction of TNF-α, IL-6 and IL-13, but increased TGF-β, while female mice showed over-expression of IFN-γ and IL-18. Furthermore, both female and male mice showed some degree of gliosis after HFHSD feeding for 24 weeks. In mice of both sexes, diet normalization after prolonged HFHSD feeding resulted in partial neuroinflammation recovery in the hypothalamus, but gliosis was only recovered in females. In sum, HFHSD-fed mice display sex-specific inflammatory processes in the hypothalamus that are not fully reversible after diet normalization.

The influence of front-of-pack labelling on consumer decision-making: a comprehensive study using electroencephalography and FaceReader

Front-of-pack labels (FOPL) can influence consumer behaviour in a variety of ways, and companies that prioritise accurate and transparent nutrition labels can see benefits in increased sales and brand loyalty. However, there are several types of FOPL on the market that differ in visual appeal and consumer clarity. The aim of the study was to reveal the impact of the nutrition label Nutri-Score as well as other factors on consumer decision-making when choosing healthier alternatives for selected food types. In addition to traditional research methods such as questionnaires, in-depth interviews, also emerging methods such as eye tracking, FaceReader and electroencephalography were used to collect implicit feedback. Research suggests that there are significant differences between implicit and explicit feedback when examining the impact of Nutri-Score on the decision-making process. Last but not least, the study presents ideas for future research in real-world settings using emerging methods.

Effectiveness of a Nutrition Counseling Intervention on Food Consumption, According to the Degree of Processing: A Community-Based Non-Randomized Trial of Quilombola Communities in South Brazil

Objectives

To evaluate the effectiveness of a nutrition counseling intervention on food consumption according to the Nova classification that reflects levels of food processing.

Methods

Controlled community trial was conducted in quilombola communities in the South of Brazil. Four communities were allocated to the control group (CG) and the intervention group (IG), two communities comprised each group. A total of 158 individuals (CG = 87; IG = 68) were included in the study. The intervention consisted of six theoretical and practical workshops on food and nutrition education, conducted over a 4-month period. We used a 24-hour recall at baseline and another post-intervention.

Results

There was an increase in the consumption of traditional quilombola food as an effect of the intervention (from 14.5% to 20.7% in the IG, and from 12.7% to 16.0% in the CG, p = 0.05). There was no significant variation in the other Nova food groups according to time and intervention.

Conclusion

An increase in traditional quilombola food indicates a resumption of traditional food intake and appreciation of local culture as an effect of this intervention at the community level. Clinical Trial Registration: www.clinicaltrials.gov, identifier NCT02489149.

Association Between Ultraprocessed Food Consumption and Mortality Among US Adults: Prospective Cohort Study of the National Health and Nutrition Examination Survey, 2003-2008

BACKGROUND

Intake of ultraprocessed foods (UPF) provides more than half of the daily energy US adults consume. Still, the prospective association of UPF consumption with mortality in the general US population remains understudied.

OBJECTIVE

To investigate the prospective association of UPF consumption with mortality in a nationally representative sample of US adults.

DESIGN

A prospective cohort analysis was conducted by linking baseline measurement from the National Health and Nutrition Examination Survey with mortality information from the National Death Index. The percentage of total energy consumed from UPF, defined by the Nova classification system, was computed based on dietary data collected using 24-hour diet recalls.

PARTICIPANTS/SETTING

This study included 38 148 nationally representative US adults aged 20 years and older who participated in National Health and Nutrition Examination Survey between 2003-2004 and 2017-2018 and provided dietary intake data, with linkage to mortality data.

MAIN OUTCOME MEASURES

Information on all-cause and cause-specific mortality was obtained from linkage to the National Death Index through December 31, 2019.

STATISTICAL ANALYSIS PERFORMED

Cox proportional hazard models estimated the multivariable-adjusted hazard ratios and 95% CIs for the association between UPF intake and mortality.

RESULTS

During a median follow-up of 8.0 years, 4611 deaths were confirmed, including 2064 deaths from cardiometabolic disorders and 1046 deaths from cancer. After multivariable adjustments, each 10-point increment in usual percentage of total energy from UPF was associated with a 9% higher risk of all-cause mortality (hazard ratio 1.09, 95% CI 1.04 to 1.14). The association remained significant after adjusting for the overall diet quality measured by the Health Eating Index 2015 (hazard ratio 1.06, 95% CI 1.00 to 1.11; P < .05). Among subgroups, sugar-sweetened beverages, ready-to-eat or -heat mixed dishes, ultraprocessed dairy products, and ultraprocessed oil/fat, condiments, and sauces were associated with an increased risk of all-cause or cause-specific mortality. Ultraprocessed vegetables and legumes were associated with a reduced risk.

CONCLUSIONS

In this nationally representative study of US adults, higher consumption of UPF was associated with a higher risk of all-cause mortality, and this association was not fully explained by overall diet quality.

Description and performance of two diet quality scores based on the Nova classification

OBJECTIVE

To describe two low-burden diet quality scores and evaluate their performance in reflecting the dietary share of the least and most processed foods defined within the Nova food system classification.

METHODS

This cross-sectional study included data from the NutriNet-Brasil cohort. Participants answered the Nova24hScreener, a 3-minute self-administered questionnaire measuring the consumption of a set of foods on the day before. Food items included in this tool belong to two main groups of the Nova classification: unprocessed or minimally processed whole plant foods (WPF, 33 items) and ultra-processed foods (UPF, 23 items). Two scores were obtained by summing the number of items checked: the Nova-WPF and the Nova-UPF. We compared the scores, respectively, with the dietary intake (% of total energy) of all unprocessed or minimally processed whole plant foods and all ultra-processed foods obtained from a full self-administered web-based 24-hour recall performed on the same day.

RESULTS

The approximate quintiles of each score had a direct and linear relationship with the corresponding % of energy intake (p-value for linear trend < 0.001). We found a substantial agreement between the intervals of each score and the corresponding % of energy intake (Nova-WPF score: Prevalence-Adjusted and Bias-Adjusted Kappa (PABAK) 0.72, 95%CI 0.64-0.81; Nova-UPF score: PABAK 0.79, 95%CI 0.69-0.88).

CONCLUSIONS

These two scores performed well against the dietary share of unprocessed or minimally processed whole plant foods and ultra-processed foods in Brazil and can be used to evaluate and monitor diet quality.

The healthiness of Australian food outlets available through online delivery platforms, by level of socioeconomic disadvantage and remoteness

Online food delivery platforms are an emerging but poorly understood aspect of food retail environments. We collected data via web scraping methods from the two leading online food delivery platforms in Victoria, Australia, identifying 11,154 food outlets from Menulog, and 12,939 from Uber Eats (with 21,733 unique outlets available across both platforms). Outlets were classified according to their healthiness using a tool developed with Australian dietitians and public health nutritionists, and assigned a food environment score. Area level (suburb/neighbourhood) socioeconomic disadvantage was determined using the Socio-Economic Indexes for Areas Index of Relative Socio-economic Disadvantage, and relative remoteness was determined using both the Accessibility/Remoteness Index of Australia and the Modified Monash Model. Across both food delivery platforms, approximately 15% of food outlets were classified as "unhealthy", 82% were classified as "less healthy", and 3% were classified as "healthy". More food outlets were available in areas of socioeconomic advantage, and in metropolitan areas. Food environment scores indicated that unhealthy outlets were significantly more available in areas with higher socioeconomic disadvantage and greater relative remoteness. Disparities in the healthiness of food outlets available through online food delivery platforms may have a negative influence on the purchasing and dietary behaviours of residents in these areas, thereby widening diet related health inequalities. Further research is required to understand the potential influence of online food delivery platforms on inequities in population diets and health.

Association of ultra-processed food consumption with cardiovascular risk factors among patients with type-2 diabetes mellitus

BACKGROUND

Ultra-processed foods mainly have high energy content and density and low nutrients. Unhealthy lifestyles mainly develop cardiovascular diseases and, as a result, unhealthy food patterns.

OBJECTIVE

This study aimed to investigate the relationship between the consumption of ultra-processed foods (UPFs) and the risk of novel cardiovascular disease (CVDs) in type-2 diabetes mellitus patients (T2DM).

METHOD

This is a cross-sectional study that was conducted on 490 type-2 diabetes mellitus patients. A validated 168-item food frequency questionnaire evaluated food intake. Ultra-processed foods were assessed according to NOVA classification. Cardiovascular risk factors such as Castelli risk index 1 and 2 (CRI-I and II), atherogenic index of plasma (AIP), lipid accumulation product (LAP), and cholesterol index (CI) were assessed by traditional CVD risk factors. The anthropometric indices predicting CVD, such as a body shape index (ABSI), body roundness index (BRI), and abdominal volume index (AVI), were assessed.

RESULTS

Each 20-gram increase in UPF consumption was associated with a significant elevation in serum level of TC [B (SE): 1.214 (0.537); 95% CI: 0.159-2.269] and lower HDL serum concentration [B (SE): -0.371 (0.155); 95% CI: -0.675 to -0.067]. The crude model for CRI 1 [B (SE): 0.032 (0.012); 95% CI: 0.009-0.056], CRI 2 [B (SE): 0.022 (0.009); 95% CI: 0.004-0.040], and AIP [B (SE): 0.006 (0.003); 95% CI: 0.000-0.012] showed significant adverse effects.

CONCLUSIONS

Our study showed that higher consumption of UPFs is associated with higher chances of developing cardiovascular diseases in T2DM patients.

[Food consumption of the urban population in a municipality in the Legal Amazon, during climate events of flood and drought: a comparative study]

The aim of this study was to compare the food consumption of the population of Coari, Amazonas State, Brazil, according to the NOVA Classification, during the hydrological phases of drought and flooding of the Amazon rivers. An epidemiological, population-based, cross-sectional study was carried out. The sample consisted of 457 adult individuals. Data were collected in two stages using a sociodemographic instrument, a 24-hour food recall and a food frequency questionnaire adapted to local habits. The data were analyzed using the statistical program R version 4.2.4, using Pearson's chi-square, Fischer's exact and Bhapkar's tests. The sample was predominantly female (drought = 70%/flood = 71.2%) and brown (drought = 65.4%/flood = 66.2%). Most of the interviewees ate meals (breakfast, lunch and dinner). Afternoon snacks were the most common intermediate meal, especially during flooding (274/70.2%). In natura or minimally processed foods predominated at the three main meals (95%). Ultra-processed foods were consumed little or not at all and were mentioned especially during the drought (152/33.3%; p = 0.007). On the other hand, consumption of regional foods (tucumã, beiju, tapioca flour and açaí) increased during the flood (p < 0.001). Consumption of in natura or minimally processed foods continues to be the mainstay of the diet in the interior of Amazonas, with a predominance of regional foods during the flood and processed and ultra-processed foods during the drought, demonstrating the influence, albeit subtle, of the hydrological phases on the food consumption of this population.

"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.

Consumer food environments change over a 5-year period

OBJECTIVE

Evaluate the 5-year changes in the consumers' food environment in the area of a health promotion service in Brazilian primary health care. Our hypothesis is that the consumers' food environment in the areas with primary healthcare services has changes that may favour healthy eating habits over time.

DESIGN

Longitudinal study.

SETTING

The territory around the primary healthcare services in Belo Horizonte, Minas Gerais, Brazil.

PARTICIPANTS

All food stores and open-air food markets that sell fruits and vegetables around the primary healthcare services in 2013 (n 272) and in 2018 (n 265).

RESULTS

Fruit diversity increased by 13·4 % (P < 0·001) and vegetables variety and quality by 16·1 % (P = 0·003) and 12·5 % (P < 0·001), respectively. Corn snacks showed an increase in availability (13·5 %; P = 0·002). The increase in advertising was observed for fruits and vegetables (34·6 %; P < 0·001) and ultra-processed foods (47·6 %; P < 0·001). Supermarkets showed an increase in the Healthy Food Store Index (three points; P < 0·001), while fruits and vegetables stores showed a decrease of one point in the index (P < 0·001).

CONCLUSIONS

The unequal changes in the consumers' food environment according to the food stores types demonstrate the importance of food supply policies that promote a healthy environment and favour the maintenance of traditional healthy food retailers.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSION

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

Mediterranean Diet and Ultra-Processed Food Intake in Older Australian Adults-Associations with Frailty and Cardiometabolic Conditions

Dietary patterns contribute to overall health and diseases of ageing but are understudied in older adults. As such, we first aimed to develop dietary indices to quantify Mediterranean Diet Score (MDS) utilisation and Ultra-processed Food (UPF) intake in a well-characterised cohort of relatively healthy community-dwelling older Australian adults. Second, we aimed to understand the relationship between these scores and the association of these scores with prevalent cardiometabolic disease and frailty. Our major findings are that in this population of older adults, (a) pre-frailty and frailty are associated with reduced MDS and increased UPF intake; (b) adherence to MDS eating patterns does not preclude relatively high intake of UPF (and vice versa); and (c) high utilisation of an MDS eating pattern does not prevent an increased risk of frailty with higher UPF intakes. As such, the Mediterranean Diet pattern should be encouraged in older adults to potentially reduce the risk of frailty, while the impact of UPF intake should be further explored given the convenience these foods provide to a population whose access to unprocessed food may be limited due to socioeconomic, health, and lifestyle factors.

Causality or confounding? Applying E values to examine associations between ultra-processed food consumption and risk of weight gain

BACKGROUND

Ultra-processed food (UPF) consumption is associated prospectively with weight gain and obesity in observational studies of adults. Unaccounted for confounding is a risk when attempting to make causal inference from observational studies. Limited research has examined how feasible it is that unmeasured confounding may explain associations between UPF consumption and weight gain in observational research.

METHODS

We introduce the E value to obesity researchers. The E value is defined as the minimum hypothetical strength of association that one or more unaccounted for confounding variables would need to have with an exposure (UPF consumption) and outcome (weight gain) to explain the association between the exposure and outcome of interest. We meta-analysed prospective studies on the association between UPF consumption and weight gain in adults to provide an effect estimation. Next, we applied the E value approach to this effect estimate and illustrated the potential role that unmeasured or hypothetical residual confounding variables could theoretically have in explaining associations.

RESULTS

Higher consumption of UPFs was associated with increased weight gain in meta-analysis (RR = 1.14). The corresponding E value = 1.55, indicating that unaccounted for confounding variables with small-to-moderate sized associations with UPF consumption and weight gain (e.g., depressive symptoms, trait overeating tendencies, access to healthy and nutritious food) could individually or collectively hypothetically account for observed associations between UPF consumption and weight gain.

CONCLUSIONS

Unaccounted for confounding could plausibly explain the prospective association between UPF consumption and weight gain in adults. High quality observational research controlling for potential confounders and evidence from study types devoid of confounding are now needed.

Enhancing the palatability of cultivated meat

Cultivated meat (CM) has transitioned from a futuristic concept to a present reality, with select products approved for consumption and sale in Singapore, Israel, and the USA. This evolution has emphasized scalable, cost-effective, and sustainable production, as well as navigation of regulatory pathways. As CM develops, a crucial challenge lies in delivering products that are highly appealing to consumers. Central to this will be refining CM palatability, a term encompassing food's taste, aroma, texture, tenderness, juiciness, and color. We explore the scientific and engineering approaches to producing palatable CM, including cell-line selection, cell differentiation, and post-processing techniques. This includes a discussion of the structural and compositional properties of meat that are intrinsically coupled to palatability.

Ultraprocessed food consumption and risk of gallstone disease: analysis of 3 prospective cohorts

BACKGROUND

Majority of dietary intake in United States adults comes from ultraprocessed foods (UPFs), which have been linked to several adverse health outcomes. Gallstone disease is highly prevalent and constitutes a significant burden to the United States health system but remains understudied.

OBJECTIVES

This study aimed to investigate the association between UPF consumption and incident gallstone disease risk.

METHODS

In this analysis, 44,149 males in the Health Professionals' Follow-up Study (HPFS: 1986-2022), 71,145 females in the Nurses' Health Study (NHS: 1986-2021), and 90,932 females in the NHS II (1991-2021) were prospectively followed. Dietary intake was quadrennially assessed with semiquantitative food frequency questionnaires and used to identify UPFs. The primary outcome was defined as cholecystectomy. Cox proportional hazards model was used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs).

RESULTS

Baseline median age was 54 y in HPFS, 53 y in NHS, and 36 y in NHS II. We identified 32,374 incident gallstone disease cases over 5,077,059 person-years. Participants in the highest UPF quintile had a higher incidence of gallstone disease than those in the lowest quintile (aHR: 1.29; 95% CI: 1.24, 1.36; P < 0.001). Incremental risk of incident gallstone disease was 2.8% per daily serving (95% CI: 2.4%, 3.2%; P < 0.001). This risk was driven by sugar-sweetened beverages and artificially sweetened beverages on UPF subgroup analyses. The proportion of risk mediated by obesity was 12.8% (95% CI: 7.7%, 20.5%; P < 0.001) in HPFS, 14.3% (95% CI: 10.4%, 19.4%; P < 0.001) in NHS, and 39.4% (95% CI: 31.2%, 48.1%; P < 0.001) in NHS II. The partial population attributable risk was estimated at 15.9% (95% CI: 13.4%, 18.3%).

CONCLUSIONS

UPF consumption is associated with a higher risk of gallstone disease, particularly consumption of sugar-sweetened beverages and artificially sweetened beverages. A substantial proportion of this risk is potentially mediated by obesity in younger females.

The consumption of ultra-processed foods was associated with adiposity, but not with metabolic indicators in a prospective cohort study of Chilean preschool children

BACKGROUND

Increasing consumption of ultra-processed foods (UPF) has been identified as a risk factor for obesity and various diseases, primarily in adults. Nonetheless, research in children is limited, especially regarding longitudinal studies with metabolic outcomes. We aimed to evaluate the longitudinal association between consumption of UPF, adiposity, and metabolic indicators in Chilean preschool children.

METHODS

We conducted a prospective analysis of 962 children enrolled in the Food and Environment Chilean Cohort (FECHIC). Dietary data were collected in 2016 at age 4 years with 24-h recalls. All reported foods and beverages were classified according to the NOVA food classification, and the usual consumption of UPF in calories and grams was estimated using the Multiple Source Method. Adiposity (z-score of body mass index [BMI z-score], waist circumference [WC], and fat mass [in kg and percentage]) and metabolic indicators (fasting glucose, insulin, HOMA-IR, triglycerides, total cholesterol, and cholesterol fractions) were measured in 2018, at the age of 6 years. Linear regression models ((0) crude, (1) adjusted for covariables, and (2) adjusted for covariables plus total caloric intake) were used to evaluate the association between UPF and outcomes. All models included inverse probability weights to account for the loss to the follow-up.

RESULTS

At 4 years, usual consumption of UPF represented 48% of the total calories and 39% of the total food and beverages grams. In models adjusted for covariables plus caloric intake, we found a positive association between UPF and BMI z-score (for 100 kcal and 100 g, respectively: b = 0.24 [95%CI 0.16-0.33]; b = 0.21 [95%CI 0.10-0.31]), WC in cm (b = 0.89 [95%CI 0.41-1.37]; b = 0.86 [95%CI 0.32-1.40]), log-fat mass in kg b = 0.06 [95%CI 0.03-0.09]; b = 0.04 [95%CI 0.01-0.07]), and log-percentage fat mass (b = 0.03 [95%CI 0.01-0.04]; b = 0.02 [95%CI 0.003-0.04]), but no association with metabolic indicators.

CONCLUSIONS

In this sample of Chilean preschoolers, we observed that higher consumption of UPF was associated with adiposity indicators 2 years later, but not with metabolic outcomes. Longer follow-up might help clarify the natural history of UPF consumption and metabolic risks in children.

National Policies to Limit Food Marketing and Competitive Food Sales in Schools: A Global Scoping Review

School food environments contribute to children's nutritional intake and overall health. As such, the World Health Organization and other public health organizations encourage policies that restrict children's access and exposure to foods and beverages that do not build health in and around schools. This global scoping review explores the presence and characteristics of policies that restrict competitive food sales and marketing for unhealthy foods across 193 countries using evidence from policy databases, gray literature, peer-reviewed literature, and primary policy documents. Policies were included if they were nationally mandated and regulated marketing and/or competitive foods in the school environments. Worldwide, only 28% of countries were found to have any national-level policy restricting food marketing or competitive food sales in schools: 16% of countries restrict marketing, 25% restrict competitive foods, and 12% restrict both. Over half of policies were found in high-income countries. No low-income countries had either policy type. Eight marketing policies (27%) and 14 competitive foods policies (29%) lacked explicit guidelines for either policy monitoring or enforcement. Future research is needed to assess the prevalence of policies aimed at improving other key aspects of the school food environment, such as dietary quality of school meals or food procurement, as well as assess the implementation and efficacy of existing policies.

Ultraprocessed Food Intake during the Transition to Adulthood Varies According to Sociodemographic Characteristics and Maternal Intake in Cebu, Philippines

BACKGROUND

Ultraprocessed foods (UPFs) are associated with elevated risk of noncommunicable disease, but little is known about UPF intake and the individual-, household-, and community-level factors associated with it among adolescents in low- or middle-income countries.

OBJECTIVES

We estimated the association of UPF intake across adolescence with sociodemographic characteristics and maternal UPF intake in a Filipino cohort.

METHODS

Data were from 4 waves (1994-2005) of the Cebu Longitudinal Health and Nutrition Survey (n = 2068); participants were aged 11, 15, 18, and 21 y. Foods from 24-h recalls were classified using NOVA. We used two-part multilevel models to estimate time-varying associations of the odds and amount (percentage daily kilocalories) of UPF intake with sociodemographic characteristics and maternal UPF intake (none, below median among UPF-consuming mothers ["low"], at or above median ["high"]).

RESULTS

Median UPF intake (interquartile range [IQR]) among adolescents was 7.3% (IQR: 0, 17.2%) of daily kilocalories at age 11 y and 10.6% (IQR: 3.6, 19.6%) at 21 y. The odds and amount of adolescent UPF intake were positively associated with female sex, years of schooling, and household wealth and inversely associated with household size. The odds-but not amount-of adolescent UPF intake was positively associated with maternal education and urbanicity and inversely associated with the distance from a household's primary store/market. The association between odds of adolescent UPF intake and school enrollment was positive in adolescence but disappeared in early adulthood. Compared with offspring whose mothers did not consume UPFs, the odds of UPF intake among those whose mothers had low or high UPF intake was greater in adolescence, but there was no association once offspring became adults. At all ages, maternal UPF intake was positively associated with the amount of offspring intake.

CONCLUSIONS

Adolescent UPF intake varied across sociodemographic characteristics and was positively associated with maternal UPF intake, but not after adolescents entered adulthood.

Development of the modified Highly Processed Food Withdrawal Scale (mProWS)

The Highly Processed Food Withdrawal Scale (ProWS) is a 29-item measure that operationalizes physical and psychological indicators of withdrawal symptoms associated with cutting down on the consumption of ultra-processed foods. The current study developed a briefer 7-item version of the ProWS (modified ProWS; mProWS) using the participant sample from the ProWS validation paper (n = 231). Then, in an independent sample recruited from Amazon Mechanical Turk, 244 participants (55.3% females) completed the mProWS, the ProWS, and measures of eating-related constructs in order to evaluate the psychometric properties of the mProWS, relative to the ProWS. The mProWS and the ProWS performed similarly on indexes of reliability, convergent validity with addictive-like eating behavior (e.g., Yale Food Addiction Scale 2.0 symptom count), discriminant validity with distinct measures (e.g., cognitive desire to restrict food consumption), and incremental validity evidenced by associations with weight cycling above and beyond body mass index (BMI) and YFAS 2.0 symptoms. The mProWS may be an appropriate choice for studies with higher participant burden (e.g., ecological momentary assessment) to assess withdrawal symptoms in real-time when they occur in response to cutting down on ultra-processed foods.

Associations of Ultra-Processed Food Intake with Body Fat and Skeletal Muscle Mass by Sociodemographic Factors

BACKGRUOUND

The effects of excessive ultra-processed food (UPF) consumption on body composition measures or sociodemographic disparities are understudied in Korea. We aimed to investigate the association of UPF intake with percent body fat (PBF) and percent appendicular skeletal muscle mass (PASM) by sociodemographic status in adults.

METHODS

This study used data from the Korea National Health and Nutrition Examination Survey 2008-2011 (n=11,123 aged ≥40 years). We used a NOVA system to classify all foods reported in a 24-hour dietary recall, and the percentage of energy intake (%kcal) from UPFs was estimated. PBF and PASM were measured by dual-energy X-ray absorptiometry. Tertile (T) 3 of PBF indicated adiposity and T1 of PASM indicated low skeletal muscle mass, respectively. Multinomial logistic regression models were used to estimate odds ratios (OR) with 95% confidence interval (CI) after adjusting covariates.

RESULTS

UPF intake was positively associated with PBF-defined adiposity (ORper 10% increase, 1.04; 95% CI, 1.002 to 1.08) and low PASM (ORper 10% increase, 1.05; 95% CI, 1.01 to 1.09). These associations were stronger in rural residents (PBF: ORper 10% increase, 1.14; 95% CI, 1.06 to 1.23; PASM: ORper 10% increase, 1.15; 95% CI, 1.07 to 1.23) and not college graduates (PBF: ORper 10% increase, 1.06; 95% CI, 1.02 to 1.11; PASM: ORper 10% increase, 1.07; 95% CI, 1.03 to 1.12) than their counterparts.

CONCLUSION

A higher UPF intake was associated with higher adiposity and lower skeletal muscle mass among Korean adults aged 40 years and older, particularly in those from rural areas and with lower education levels.

Stress and the Consumption of Ultra-Processed Foods during COVID-19's Social Distancing: Are Mental Disorders Mediators in This Association? ELSA-Brasil Results

The COVID-19 pandemic exacerbated various determinants of mental disorders. Several behavioral changes were observed given this increase, including harmful health consequences, such as excessive consumption of ultra-processed foods (UPFs). To assess this relationship, we investigated the meditational role of symptoms of mental disorders (anxiety and depression) in the association between stress resulting from social distancing during the COVID-19 pandemic and the consumption of UPFs in 3884 Brazilian public employees in a supplementary study of the ELSA-Brasil study. Structural equation models (SEMs) were estimated to assess the direct and indirect effects mediated by symptoms of mental disorders. The results suggested a significant and positive mediational effect of the symptoms of mental disorders on the association between the stress resulting from social distancing and the consumption of UPFs. These findings contribute to informing the need for policies and early interventions in potentially stressful situations, with a focus on the promotion of mental health, and may thus help prevent or reduce the consumption of unhealthy foods.

Costs of obesity attributable to the consumption of sugar-sweetened beverages in Brazil

Excess sugar is considered one of the primary factors contributing to overweight status. In Brazil, sugar-sweetened beverages (SSBs) contain a significant amount of this nutrient and are consumed excessively. These beverages are associated with adverse health outcomes and impose costs on the healthcare system. The literature currently lacks studies that aim to attribute specific nutrients or foods as causes of diseases and also evaluate their economic impact, especially in middle- and low-income countries. This study aims to estimate the direct and indirect costs of obesity, stratified by sex and age group, resulting from the excessive consumption of sugar-sweetened beverages in Brazil from 2008 to 2020, and to project these costs for the year 2036. The estimation of obesity costs attributable to excessive consumption of SSBs was based on relative risks and the population prevalence of obesity, considering expenditures on hospitalizations and outpatient procedures in the Unified Health System (SUS). Cost information was obtained from the health information systems available at SUS. The highest burden attributable to the consumption of SSBs was observed among younger individuals and progressively decreased with advancing age. The total direct costs in the period between 2008 and 2020 amounted to approximately US$ 6.33 million, 87% of which was related to expenses for females. Additionally, deaths resulting from the consumption of SSBs cost the economy US$ 40 million due to the premature loss of productivity. The total costs of obesity attributable to the consumption of SSBs are substantial, impacting public spending and generating social and productivity losses that burden the economy. It is crucial to develop and implement cost-effective fiscal and regulatory policies aimed at preventing and combating obesity.

Association between ultra-processed food and snacking behavior in Brazil

PURPOSE

Ultra-processed food may play a role in facilitating snacking behavior because of their convenience and low satiety potential. This study aimed to describe the association between consumption of ultra-processed foods and frequency of snacking.

METHODS

We analyzed data from 46,164 participants (≥ 10 years old) in the 2017-2018 Brazilian Household Budget Survey. Dietary data were collected by 24-h dietary recalls over one or two days for each participant. We estimated energy intake, ultra-processed food consumption, and level of snacking. We measured the association between ultra-processed food consumption and level of snacking using multinomial logistic regression, stratified by age group (adolescents, 10-19 years old; adults, 20-64 years old; elders, 65 or older).

RESULTS

We found a statistically significant tendency of increased daily energy intake and consumption of snacks and that ultra-processed food consumption was positively associated with the level of snacking for all age groups. For adolescents, adults, and elders in the highest quintile of ultra-processed food consumption as a share of their entire diet, the relative risk ratio (95% CI) of having more than two snacks per day compared to no snacks was 14.21 (9.09-22.21), 4.44 (3.54-5.57), and 4.21 (2.67-6.64), respectively, when compared to the lowest quintile.

CONCLUSION

Higher consumption of ultra-processed food was associated with snacking behavior, and the strength of this association was stronger among adolescents. Efforts to mitigate ultra-processed food attributes that facilitate snacking should be incorporated into strategies to promote healthier food choices, especially among adolescents.

Ultra-processed food consumption, genetic susceptibility, and the risk of hip/knee osteoarthritis

BACKGROUND

The associations between ultra-processed food (UPF) consumption, genetic susceptibility, and the risk of osteoarthritis (OA) remain unknown. This study was to examine the effect of UPF consumption, genetic susceptibility, and their interactions on hip/knee OA.

METHODS

Cohort analyses included 163,987 participants from the UK Biobank. Participants' UPF consumption was derived from their 24-h dietary recall using a questionnaire. Genetic risk scores (GRSs) of 70 and 83 single nucleotide polymorphisms (SNPs) for hip and knee OA were constructed.

FINDINGS

After 1,461,447 person-years of follow-up, 11,540 patients developed OA. After adjustments, compared to participants in the low quartile of UPF consumption, those in the high quartile had a 10 % (hazard ratio [HR], 1.10; 95% confidence interval [CI], 1.03-1.18) increased risk of knee OA. No significant association was found between UPF consumption and hip OA. Replacing 20% of UPF diet weight with an equivalent proportion of unprocessed or minimally processed food caused a 6% (HR, 0.94; 95% CI, 0.89-0.98) decreased risk of knee OA, respectively. A significant interaction was found between UPF consumption, genetic predisposition, and the risk of knee OA (P = 0.01). Participants with lower OA-GRS scores experienced higher knee OA risks due to UPF consumption.

INTERPRETATION

UPF consumption was associated with a higher risk of knee OA but not hip OA, particularly in those with lower genetic susceptibility. These results highlight the importance of reducing UPF consumption to prevent knee OA.

Ultra-processed foods and human health: An umbrella review and updated meta-analyses of observational evidence

BACKGROUND & AIMS

Ultra-processed food (UPF) intake has increased sharply over the last few decades and has been consistently asserted to be implicated in the development of non-communicable diseases. We aimed to evaluate and update the existing observational evidence for associations between ultra-processed food (UPF) consumption and human health.

METHODS

We searched Medline and Embase from inception to March 2023 to identify and update meta-analyses of observational studies examining the associations between UPF consumption, as defined by the NOVA classification, and a wide spectrum of health outcomes. For each health outcome, we estimated the summary effect size, 95% confidence interval (CI), between-study heterogeneity, evidence of small-study effects, and evidence of excess-significance bias. These metrics were used to evaluate evidence credibility of the identified associations.

RESULTS

This umbrella review identified 39 meta-analyses on the associations between UPF consumption and health outcomes. We updated all meta-analyses by including 122 individual articles on 49 unique health outcomes. The majority of the included studies divided UPF consumption into quartiles, with the lowest quartile being the reference group. We identified 25 health outcomes associated with UPF consumption. For observational studies, 2 health outcomes, including renal function decline (OR: 1.25; 95% CI: 1.18, 1.33) and wheezing in children and adolescents (OR: 1.42; 95% CI: 1.34, 1.49), showed convincing evidence (Class I); and five outcomes were reported with highly suggestive evidence (Class II), including diabetes mellitus, overweight, obesity, depression, and common mental disorders.

CONCLUSIONS

High UPF consumption is associated with an increased risk of a variety of chronic diseases and mental health disorders. At present, not a single study reported an association between UPF intake and a beneficial health outcome. These findings suggest that dietary patterns with low consumption of UPFs may render broad public health benefits.