1
|
Mekonnen TC, Melaku YA, Shi Z, Gill TK. Joint analysis of diet quality, inflammatory potential of diet and ultra-processed food exposure in relation to chronic respiratory diseases and lung cancer mortality. Respir Med 2025; 243:108138. [PMID: 40319928 DOI: 10.1016/j.rmed.2025.108138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2025] [Revised: 04/19/2025] [Accepted: 05/02/2025] [Indexed: 05/07/2025]
Abstract
OBJECTIVE Examined the combined effects of ultra-processed food (UPF), Dietary Inflammatory Index (DII), Healthy Eating Index-2015 (HEI-2015), and Dietary Antioxidant Index (DAI) on mortality from chronic respiratory diseases (CRDs), chronic obstructive pulmonary disease (COPD), and lung cancer. METHODS A prospective analysis included 96,607 participants (53 % women). Diet intake was measured using food frequency questionnaire. Associations of dietary exposures with CRD, COPD, and lung cancer mortality were examined using Cox regression. RESULTS During 1,459,299 person-years of follow-up, there were 30,623 all-cause deaths, including 5218 from CRDs, 1613 from COPD, and 2127 from lung cancer. A 10 % increase in UPF intake (% grams/day) showed a non-linear association with higher CRD and COPD mortality but not lung cancer. Stronger curvature was observed between DII and mortality from all three conditions. However, HEI-2015 was inversely associated with CRD, COPD, and lung cancer mortality, while DAI showed an inverse relationship with CRD and COPD mortality but not lung cancer. Adjusting for DII attenuated UPF-related mortality risks by 39 % (CRD), 11 % (COPD), and 18 % (lung cancer), while HEI-2015 adjustment showed less attenuation. Additionally, the DII-mortality associations were less attenuated after adjusting for UPF intake but were offset after adjusting for HEI-2015. However, the HEI-2015-mortality associations remained unaffected when adjusted for UPF, DII, or DAI. CONCLUSIONS The findings highlight that the UPF-mortality relationship is potentially explained by DII and, to a lesser extent, by HEI-2015. Adhering to HEI-2015 guidelines can counterbalance the effects of DII on respiratory health but may not offset the effects associated with UPF.
Collapse
Affiliation(s)
- Tefera Chane Mekonnen
- Adelaide Medical School, The University of Adelaide, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, 5000, Australia; School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, 1145, Ethiopia.
| | - Yohannes Adama Melaku
- Adelaide Medical School, The University of Adelaide, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, 5000, Australia; Flinders Health and Medical Institute, Flinders University, Adelaide, 5001, South Australia, Australia.
| | - Zumin Shi
- Human Nutrition Department, College of Health Sciences, Qatar University, Qatar.
| | - Tiffany K Gill
- Adelaide Medical School, The University of Adelaide, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, 5000, Australia.
| |
Collapse
|
2
|
Barb JJ, Yang L, Martinez-Steele E, Ahmed A, Medina PV, Valencia EM, Roberts AE, Farmer N, Wallen GR. Consumption of ultra-processed foods by foreign-born adults rise with increased levels of acculturation in the United States. Front Public Health 2025; 13:1570832. [PMID: 40443924 PMCID: PMC12121413 DOI: 10.3389/fpubh.2025.1570832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2025] [Accepted: 04/14/2025] [Indexed: 06/02/2025] Open
Abstract
Objective Ultra-processed food (UPF) consumption has been linked to increased risks of negative health outcomes such as type 2 diabetes, obesity, and all-cause mortality. Some studies have shown an increase of UPF consumption with acculturation, whereas the influence of the Western diet on non-US born individuals is an area of increasing interest. The aim of this work was to investigate UPF consumption with an acculturation index and to assess whether there was an interaction of UPF consumption with race/ethnicity in non-US born adults. Methods Dietary intake of non-US born adults participating in the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2018 was assessed using day one of 24-h dietary recall, and the relative daily energy intake comprised of UPFs was used as the outcome of interest. The effect of acculturation assessed by an acculturation index (AcI) on UPF consumption was investigated after controlling for significant covariates. Complex survey sample regression analyses were used to evaluate the association between UPF consumption and AcI. Results Population sample (n = 3,639) was comprised of non-US born adults (50% male) between 19 and 70 (43.1 ± 0.40) years of age. Of the adults assessed, 42.2% had lower AcI scores of 0 to 2, whereas 57.8% were more accultured (AcI scores of 3-5). Overall, dietary energy from UPFs was about 43.3%. When controlling for co-variates, acculturation was significantly associated with UPF consumption (β = 0.03, s.e. = 0.004, p < 0.001), meaning that for every unit increase in AcI score, there was a 3 % increase in mean UPF consumption. When the interaction between AcI and race/ethnicity was assessed, there was no difference in the impact of AcI on UPF consumption among race/ethnicity groups (p = 0.052). Conclusion Our findings indicate that greater acculturation is associated with higher UPF consumption. Given the links between high UPF consumption and adverse health outcomes, targeted interventions that promote healthier dietary choices-while preserving culturally relevant eating habits-are essential to support the well-being of non-US born populations.
Collapse
Affiliation(s)
- Jennifer J. Barb
- Translational Biobehavioral and Health Disparities Branch, NIH Clinical Center, Bethesda, MD, United States
| | - Li Yang
- Translational Biobehavioral and Health Disparities Branch, NIH Clinical Center, Bethesda, MD, United States
| | - Euridice Martinez-Steele
- School of Public Health, Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | - Ayaan Ahmed
- Translational Biobehavioral and Health Disparities Branch, NIH Clinical Center, Bethesda, MD, United States
| | - Patricia V. Medina
- Translational Biobehavioral and Health Disparities Branch, NIH Clinical Center, Bethesda, MD, United States
| | - E. Michael Valencia
- Translational Biobehavioral and Health Disparities Branch, NIH Clinical Center, Bethesda, MD, United States
| | - Anna E. Roberts
- Translational Biobehavioral and Health Disparities Branch, NIH Clinical Center, Bethesda, MD, United States
| | - Nicole Farmer
- Translational Biobehavioral and Health Disparities Branch, NIH Clinical Center, Bethesda, MD, United States
| | - Gwenyth R. Wallen
- Translational Biobehavioral and Health Disparities Branch, NIH Clinical Center, Bethesda, MD, United States
| |
Collapse
|
3
|
Mengist B, Lotfaliany M, Pasco JA, Agustini B, Berk M, Forbes M, Lane MM, Orchard SG, Ryan J, Owen AJ, Woods RL, McNeil JJ, Mohebbi M. The risk associated with ultra-processed food intake on depressive symptoms and mental health in older adults: a target trial emulation. BMC Med 2025; 23:172. [PMID: 40128798 PMCID: PMC11934811 DOI: 10.1186/s12916-025-04002-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2024] [Accepted: 03/13/2025] [Indexed: 03/26/2025] Open
Abstract
BACKGROUND Longitudinal cohort studies across the lifespan suggest an association between ultra-processed food (UPF) and depression. However, the effect of UPF on depression and mental health in older adults has not been determined. Therefore, this study investigated the effect of UPF on depressive symptoms and mental health in community-dwelling older adults. METHODS A pragmatic target trial was designed and emulated using the ASPirin in Reducing Events in the Elderly longitudinal data. Participants were community-dwelling older adults (≥ 70 years) in Australia. We specified and emulated the protocol of a two-arm randomised pragmatic clinical trial using the level of UPF consumption as the intervention. Greater than or equal to 4 servings of UPF per day was considered the intervention, with less than 4 servings per day the control. Dietary consumption was assessed using a mail-based diet screening questionnaire, and the level of food processing was classified based on the NOVA classification. The study outcomes were depressive symptoms, defined as a score of ≥ 8 on the Center for Epidemiological Studies Depression 10-item scale, and general mental health, defined by the mental component summary score of the Short Form-12. We applied inverse probability treatment weighting to balance confounders. Marginal structural models were employed to estimate the population-level average effect of intervention using generalised estimated equations. RESULTS A total of 11,192 participants (3415 intervention and 7777 control) were eligible for the emulation. High UPF consumption at time zero was associated with an increased risk of depressive symptoms at follow-ups (RR: 1.10; CI: 1.04-1.18). The finding was consistent with sensitivity analyses; after excluding participants on antidepressants at time zero, the risk of depressive symptoms in the intervention group was increased by 11% compared to the control (RR: 1.11; 95% CI: (1.04-1.20)). Consumption of UPF adversely affected the mental component quality of life (β: - 0.40; CI: - 0.65 to - 0.15). CONCLUSIONS A higher level of UPF consumption was associated with a higher risk of depressive symptoms and adversely affected mental health among older adults.
Collapse
Affiliation(s)
- Belayneh Mengist
- Deakin University, the Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Geelong, VIC, Australia.
- College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia.
| | - Mojtaba Lotfaliany
- Deakin University, the Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Geelong, VIC, Australia
| | - Julie A Pasco
- Deakin University, the Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Geelong, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, Victoria, Australia
| | - Bruno Agustini
- Deakin University, the Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Geelong, VIC, Australia
| | - Michael Berk
- Deakin University, the Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Geelong, VIC, Australia
| | - Malcolm Forbes
- Deakin University, the Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Geelong, VIC, Australia
| | - Melissa M Lane
- Deakin University, the Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Geelong, VIC, Australia
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Alice J Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Mohammadreza Mohebbi
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, VIC, Australia
| |
Collapse
|
4
|
Aguilera JM. Food matrices as delivery units of nutrients in processed foods. J Food Sci 2025; 90:e70049. [PMID: 39921292 DOI: 10.1111/1750-3841.70049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2024] [Revised: 01/19/2025] [Accepted: 01/22/2025] [Indexed: 02/10/2025]
Abstract
Processed food products (PFPs) are amply consumed and important sources of nutrients worldwide. Evaluating PFPs by their composition fails to recognize that nutrients are embedded in food matrices and processing modifies their nutritional functionality, for example, the bioaccessibility and bioavailability. PFPs with equivalent chemical composition may experience the "food matrix effect": a difference in the nutritional outcome and health potential. This review presents food matrices attained after processing and their nutritional significance. It also delves into the complex kinetics of digestion conducive to nutrient release from matrices and nutrient interactions before absorption in the small intestine, and the role of microbial fermentation in the colon. Matrices of PFPs can be designed or redesigned and manufactured to be tasty, nutritious, sustainable, as special foods for vulnerable groups, innovative products from novel food sources, and to feed a healthy microbiota. The potential for nutritional improvement of PFPs is driven by understanding the food materials science and changes in food matrices during processing, control of formulation and manufacturing variables, the application of novel technologies, and a multifactor toolbox that supports the rational design of healthy food matrices.
Collapse
Affiliation(s)
- Jose Miguel Aguilera
- Department of Chemical and Bioprocess Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|
5
|
Conway RE, Heuchan GN, Heggie L, Rauber F, Lowry N, Hallen H, Llewellyn CH. Ultra-processed food intake in toddlerhood and mid-childhood in the UK: cross sectional and longitudinal perspectives. Eur J Nutr 2024; 63:3149-3160. [PMID: 39363048 PMCID: PMC11519182 DOI: 10.1007/s00394-024-03496-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 08/29/2024] [Indexed: 10/05/2024]
Abstract
PURPOSE (i) Characterize ultra-processed food (UPF) intakes in toddlerhood and mid-childhood, including identifying principal UPF sub-groups and associations with nutrient profile; (ii) explore stability and change in UPF intake between toddlerhood and mid-childhood. METHODS Data were from children in the UK Gemini twin cohort at 21 months (n = 2,591) and 7 years (n = 592) of age. UPF intakes were estimated using diet diaries and Nova classification. Complex samples general linear or logistic regression models were used to explore associations between UPF intake, UPF sub-groups and nutrients, and changes in intake over time. RESULTS The contribution of UPF to total energy was 46.9% (± 14.7) at 21 months and 59.4% (± 12.5) at 7 years. Principal UPF sub-groups were yogurts, higher-fiber breakfast cereals, and wholegrain breads in toddlerhood, and puddings and sweet cereal products and white breads in mid-childhood. At both ages, mean free sugar and sodium intakes exceeded recommended maximums and higher UPF consumption was associated with consuming more of each nutrient (P < 0.001). UPF intake was negatively associated with fat, saturated fat and protein intake in toddlerhood, and fiber intake in mid-childhood (P < 0.001). Being in the highest UPF intake quintile in toddlerhood was predictive of being in the highest quintile in mid-childhood (OR 9.40, 95%CI 3.94-22.46). CONCLUSIONS UPF accounted for nearly half of toddlers' energy, increasing to 59% in mid-childhood. Higher UPF consumers had higher intakes of free sugar and sodium. UPF intake in toddlerhood was predictive of mid-childhood intake. Effective policies are needed to reduce UPF intakes in the early years.
Collapse
Affiliation(s)
- Rana E Conway
- Research Department of Behavioral Science and Health, University College London, London, UK.
| | - Gabriella N Heuchan
- Research Department of Behavioral Science and Health, University College London, London, UK
| | - Lisa Heggie
- Research Department of Behavioral Science and Health, University College London, London, UK
| | - Fernanda Rauber
- Centre for Epidemiological Research in Nutrition and Health, University of São Paulo, São Paulo, Brazil
- Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Natalie Lowry
- Research Department of Behavioral Science and Health, University College London, London, UK
| | - Hannah Hallen
- Research Department of Behavioral Science and Health, University College London, London, UK
| | - Clare H Llewellyn
- Research Department of Behavioral Science and Health, University College London, London, UK
| |
Collapse
|
6
|
Machado P, McNaughton SA, Wingrove K, Stephens LD, Baker P, Lawrence M. A Scoping Review of the Causal Pathways and Biological Mechanisms Linking Nutrition Exposures and Health Outcomes. Curr Nutr Rep 2024; 14:3. [PMID: 39613942 DOI: 10.1007/s13668-024-00591-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2024]
Abstract
BACKGROUND/AIM Building on the evidence for multifaceted effects of different nutrients, foods and dietary patterns is a new priority for nutrition science. This review aims to describe the causal pathways and biological mechanisms that elucidate the associations between different nutrition exposures (nutrients, foods and dietary patterns) and health outcomes. METHODS A scoping review was conducted in two stages: 1) review of nutrition science textbooks; and 2) a review of reviews of empirical literature using a systematic approach to elucidate causal pathways and biological mechanisms for nutrition exposures and health outcomes. Reviews were eligible for inclusion if they reported biological mechanistic pathways between exposures and outcomes of interest among free-living healthy adults and/or children. Causal pathways within and between the exposures and the outcomes were identified and summarised visually. RESULTS A total of seven core textbooks and 1,934 reviews of relevant empirical literature were included. The complexity of the causal pathways and the number of biological mechanisms progressively increases as the nutrition exposure changes from nutrients to foods to dietary patterns. The biological mechanisms demonstrate that associations with beneficial or adverse health outcomes are determined by the contrasting chemical composition and physical structure of the different types and forms of nutrition exposures, and that contextual factors (e.g., food processing) can influence these chemical and physical factors for food and dietary pattern exposures. CONCLUSION This review provides models that can guide future research, and has several implications for the generation and interpretation of the nutrition evidence, and its synthesis and translation to inform nutrition guidelines and policies.
Collapse
Affiliation(s)
- Priscila Machado
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia.
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia.
| | - Sarah A McNaughton
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Kate Wingrove
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Lena D Stephens
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Phillip Baker
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2050, Australia
| | - Mark Lawrence
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| |
Collapse
|
7
|
Pacheco PM, Bairros FDS, Neutzling MB, Nunes LN, Knauth DR, dos Santos FS, Drehmer M. 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. Int J Public Health 2024; 69:1607549. [PMID: 39664767 PMCID: PMC11631577 DOI: 10.3389/ijph.2024.1607549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 10/28/2024] [Indexed: 12/13/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Pauline Müller Pacheco
- Postgraduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Fernanda de Souza Bairros
- Postgraduate Studies Program in Collective Health, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Marilda Borges Neutzling
- Postgraduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Luciana Neves Nunes
- Postgraduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Department of Statistics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Daniela Riva Knauth
- Postgraduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Francine Silva dos Santos
- Department of Nutrition, Federal University of Health Science of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Michele Drehmer
- Postgraduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Postgraduate Studies Program in Food, Nutrition and Health, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| |
Collapse
|
8
|
Wang L, Steele EM, Du M, Luo H, Zhang X, Mozaffarian D, Zhang FF. Association Between Ultraprocessed Food Consumption and Mortality Among US Adults: Prospective Cohort Study of the National Health and Nutrition Examination Survey, 2003-2008. J Acad Nutr Diet 2024:S2212-2672(24)00991-2. [PMID: 39608567 PMCID: PMC12104482 DOI: 10.1016/j.jand.2024.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/18/2024] [Accepted: 11/21/2024] [Indexed: 11/30/2024]
Abstract
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.
Collapse
Affiliation(s)
- Lu Wang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | | | - Mengxi Du
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Hanqi Luo
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Xuehong Zhang
- Department of Nutrition, T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts; Division of Cardiology, Tufts Medical Center, Boston, Massachusetts
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.
| |
Collapse
|
9
|
Monteiro CA, Steele EM, Cannon G. Impact of Food Ultra-Processing on Cardiometabolic Health: Definitions, Evidence, and Implications for Dietary Guidance. J Am Heart Assoc 2024; 13:e035986. [PMID: 39494548 PMCID: PMC11935692 DOI: 10.1161/jaha.124.035986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 09/17/2024] [Indexed: 11/05/2024]
Affiliation(s)
- Carlos A. Monteiro
- Center for Epidemiological Studies in Health and Nutrition, School of Public HealthUniversity of Sao PauloBrazil
| | - Eurídice Martínez Steele
- Center for Epidemiological Studies in Health and Nutrition, School of Public HealthUniversity of Sao PauloBrazil
| | - Geoffrey Cannon
- Center for Epidemiological Studies in Health and Nutrition, School of Public HealthUniversity of Sao PauloBrazil
| |
Collapse
|
10
|
Gálvez Espinoza P, Rodríguez Osiac L, Franch Maggiolo C, Egaña Rojas D. Rethinking the Social Determination of Food in Chile Through Practices and Interactions of Actors in Food Environments: Nonexperimental, Cross-Sectional Study. JMIR Res Protoc 2024; 13:e62765. [PMID: 39270213 PMCID: PMC11437218 DOI: 10.2196/62765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/11/2024] [Accepted: 07/12/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Food environments are crucial for promoting healthy and sustainable eating and preventing obesity. However, existing food environment frameworks assume an already installed causality and do not explain how associations in food environments are established or articulated, especially from an integrative and transdisciplinary approach. This research attempts to bridge these gaps through the use of Actor-Network Theory, which traces the relationship network between human (and nonhuman) actors in order to describe how these interact and what agencies (direct or remote) are involved. OBJECTIVE This study aims to explain the practices and interactions of actors in food environments in order to approach the problem of unhealthy eating with a transdisciplinary approach. METHODS This is a nonexperimental, cross-sectional study. Due to the complexity of the study phenomena, a mixed methods approach with 4 consecutive phases will be developed in Chile. Phase 1 involves a systematic literature review of food environment evidence since 2015, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol; phase 2 involves the application of a shortened version of the Nutrition Environment Measure Scale-Perceptions adapted to Chile (NEMS-P-Ch) in 2 neighborhoods with different socioeconomic levels; in phase 3, six focus groups in each neighborhood will be conducted to address social determinants such as gender, employment status, and migration; and in phase 4, participant observation and in-depth interviews will be used to analyze the direct and empirical exploration of the actors in their daily interaction with food environments. The triangulation and complementarity of the data will allow us to create a practical model about the practices and interactions of actors in their food environments, which reflects the complexity and transdisciplinary nature of the study. RESULTS We have advanced in phases 1-3 of the study. In phase 1, a total of 109 manuscripts are being revised for data extraction. In phase 2, we applied the NEMS-P-Ch to 785 people, 49.4% (388/785) of whom belong to a low socioeconomic neighborhood. Participants from phase 2 are being contacted to participate in the focus groups (phase 3). By the end of July, we have conducted 6 focus groups with 5-11 participants. CONCLUSIONS This study will provide a comprehensive understanding of how individuals interact with their food environments, offering deep insights into the factors influencing their food-related decisions. In addition, the study aims to develop a model that more accurately reflects reality by examining not only the food environments themselves but also the interactions among various stakeholders within these environments and their daily practices. The findings of this study will offer evidence-based insights to inform public policies tailored to the specific territories and communities under investigation or those with similar characteristics. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/62765.
Collapse
Affiliation(s)
| | | | | | - Daniel Egaña Rojas
- Department of Primary Care and Family Health, Universidad de Chile, Santiago, Chile
| |
Collapse
|
11
|
Wahnschafft S, Spiller A, Graciano BA. How can advocates leverage power to advance comprehensive regulation on ultra-processed foods? learning from advocate experience in Argentina. Global Health 2024; 20:68. [PMID: 39252038 PMCID: PMC11385800 DOI: 10.1186/s12992-024-01069-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 08/12/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND The use of corporate power to undermine public health policy processes is increasingly well understood; however, relatively little scholarship examines how advocates can leverage power to promote the successful adoption of public health policies. The objective of this paper is to explore how advocates leveraged three forms of power - structural, instrumental and discursive - to promote the passage of the Promotion of Healthy Eating Law (Ley 27,642) in Argentina, one of the most comprehensive policies to introduce mandatory front-of-package (FOP) warning labels and regulate the marketing and sales of ultra-processed foods (UPFs) adopted to date. METHODS We conducted seventeen semi-structured interviews with advocates from different sectors, including civil society, international agencies, and government. Both data collection and analysis were guided by Milsom's conceptual framework for analyzing power in public health policymaking, and the data was analyzed using hybrid deductive and inductive thematic analysis. RESULTS Advocates harnessed structural power through the leveraging of revolving doors, informal alliances, and formal coalitions, enabling them to convene discussion spaces with decision-makers, make strategic use of limited resources, and cultivate the diverse expertise (e.g., research, nutrition science, advocacy, law, political science, activism and communications) needed to support the law through different phases of the policy process. Advocates wielded instrumental power by amassing an armada of localized evidence to promote robust policy design, building technical literacy amongst themselves and decision-makers, and exposing conflicts of interest to harness public pressure. Advocates exercised discursive power by adopting a rights-based discourse, including of children and adolescents and of consumers to transparent information, which enabled advocates to foster a favorable perception of the law amongst both decision-makers and the public. Key contextual enablers include a political window of opportunity, the COVID-19 pandemic, and the ability to learn from the regional precedent of similar policies. CONCLUSIONS Public health policymaking, particularly when encroaching upon corporate interests, is characterized by stark imbalances of power that hinder policy decisions. The strategies identified in the case of Argentina provide important insights as to how advocates might harness and exercise structural, instrumental, and discursive power to counter corporate influence and promote the successful adoption of comprehensive UPF regulation.
Collapse
Affiliation(s)
- Simone Wahnschafft
- Research Training Group in Sustainable Food Systems, Georg-August-Universität Göttingen, Heinrich-Düker-Weg 12, 37073, Göttingen, Germany.
- Marketing for Food and Agricultural Products, Department of Agricultural Economics and Rural Development, Georg- August-Universität Göttingen, Platz der Göttinger Sieben 5, 37073, Göttingen, Germany.
| | - Achim Spiller
- Marketing for Food and Agricultural Products, Department of Agricultural Economics and Rural Development, Georg- August-Universität Göttingen, Platz der Göttinger Sieben 5, 37073, Göttingen, Germany
| | - Beatriz Andrea Graciano
- Free Chair of Food Sovereignty, School of Nutrition of the Faculty of Medical Sciences, Universidad de Buenos Aires, Marcelo Torcuato de Alvear 2202, Buenos Aires, Argentina
| |
Collapse
|
12
|
Mendoza K, Smith-Warner SA, Rossato SL, Khandpur N, Manson JE, Qi L, Rimm EB, Mukamal KJ, Willett WC, Wang M, Hu FB, Mattei J, Sun Q. Ultra-processed foods and cardiovascular disease: analysis of three large US prospective cohorts and a systematic review and meta-analysis of prospective cohort studies. LANCET REGIONAL HEALTH. AMERICAS 2024; 37:100859. [PMID: 39286398 PMCID: PMC11403639 DOI: 10.1016/j.lana.2024.100859] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 07/24/2024] [Accepted: 07/29/2024] [Indexed: 09/19/2024]
Abstract
Background Prospective associations between total and groups of ultra-processed foods (UPF) and cardiovascular disease (CVD) remained to be characterised. Our aim was to assess the association of total and group-specific UPF intakes with CVD, coronary heart disease (CHD), and stroke in three large prospective cohorts of US adults. Additionally, we conducted a systematic review and meta-analyses on the existing evidence on the associations of total UPF intake with these outcomes. Methods UPF intake was assessed through food frequency questionnaires in the Nurses' Health Study (NHS; n = 75,735), Nurses' Health Study II (NHSII; n = 90,813), and Health Professionals Follow-Up Study (HPFS; n = 40,409). Cox regression estimated cohort-specific associations of total and group-specific UPF intake with risk of CVD (cases = 16,800), CHD (cases = 10,401), and stroke (cases = 6758), subsequently pooled through fixed-effect models. Random-effects meta-analyses pooled existing prospective findings on the UPF-CVD association identified on Medline and Embase up to April 5, 2024, without language restrictions. Risk of bias was assessed with the Newcastle-Ottawa Scale, funnel plots, and Egger's tests, and meta-evidence was evaluated using NutriGrade. Findings The baseline mean (SD) age was 50.8 years (7.2) for the NHS, 36.7 years (4.6) for the NHSII, and 53.4 years (9.6) for the HPFS. The proportion of participants of White race was 97.7% in the NHS, 96.4% in the NHSII, and 94.9% in the HPFS. Among the three cohorts, multivariable-adjusted hazard ratios [HRs (95% CIs)] for CVD, CHD, and stroke for the highest (vs. lowest) total UPF intake quintile were 1.11 (1.06-1.16), 1.16 (1.09-1.24), and 1.04 (0.96-1.12), respectively. UPF groups demonstrated divergent associations. Sugar-/artificially-sweetened drinks and processed meats were associated with higher CVD risk, whereas inverse associations were observed for bread/cold cereals, yoghurt/dairy desserts, and savoury snacks. Meta-analysing 22 prospective studies showed that total UPF intake at the highest category (vs. lowest) was associated with 17% (11%-24%), 23% (12%-34%), and 9% (3%-15%) higher CVD, CHD, and stroke risk. Meta-evidence quality was high for CHD, moderate for CVD, and low for stroke. Interpretation Total UPF intake was adversely associated with CVD and CHD risk in US adults, corroborated by prospective studies from multiple countries, also suggesting a small excess stroke risk. Nutritional advice for cardiovascular health should consider differential consequences of group-specific UPF. Replication is needed in racially/ethnically-diverse populations. Funding National Institutes of Health (NIH) grants supported the NHS, NHSII, and HPFS.
Collapse
Affiliation(s)
- Kenny Mendoza
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Stephanie A Smith-Warner
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sinara Laurini Rossato
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Federal University of Uberlândia, Uberlândia, State of Minas Gerais, Brazil
| | | | - JoAnn E Manson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Lu Qi
- Tulane University Obesity Research Center, Tulane University, New Orleans, LA, USA
| | - Eric B Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Molin Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Qi Sun
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| |
Collapse
|
13
|
Zancheta C, Rebolledo N, Smith Taillie L, Reyes M, Corvalán C. The consumption of ultra-processed foods was associated with adiposity, but not with metabolic indicators in a prospective cohort study of Chilean preschool children. BMC Med 2024; 22:340. [PMID: 39183281 PMCID: PMC11346253 DOI: 10.1186/s12916-024-03556-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 08/12/2024] [Indexed: 08/27/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Camila Zancheta
- Doctoral Program in Public Health, School of Public Health, University of Chile, Santiago, Chile
- Center of Research in Food Environment and Prevention of Obesity and Non-Communicable Diseases (CIAPEC), Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - Natalia Rebolledo
- Center of Research in Food Environment and Prevention of Obesity and Non-Communicable Diseases (CIAPEC), Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - Lindsey Smith Taillie
- Carolina Population Center, Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marcela Reyes
- Center of Research in Food Environment and Prevention of Obesity and Non-Communicable Diseases (CIAPEC), Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - Camila Corvalán
- Center of Research in Food Environment and Prevention of Obesity and Non-Communicable Diseases (CIAPEC), Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile.
| |
Collapse
|
14
|
Monda A, de Stefano MI, Villano I, Allocca S, Casillo M, Messina A, Monda V, Moscatelli F, Dipace A, Limone P, Di Maio G, La Marra M, Di Padova M, Chieffi S, Messina G, Monda M, Polito R. Ultra-Processed Food Intake and Increased Risk of Obesity: A Narrative Review. Foods 2024; 13:2627. [PMID: 39200554 PMCID: PMC11353718 DOI: 10.3390/foods13162627] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 07/15/2024] [Accepted: 08/20/2024] [Indexed: 09/02/2024] Open
Abstract
The prevalence of obesity has become a global health concern, with significant impacts on quality of life and mortality rates. Recent research has highlighted the role of ultra-processed foods (UPFs) in driving the obesity epidemic. UPFs undergo extensive processing, often containing high levels of sugars, fats, and additives, while lacking essential nutrients. Studies have linked UPF consumption to obesity and cardiometabolic diseases, underscoring the importance of dietary patterns rich in whole foods. Thus, the aim of this narrative review is to elucidate the correlation between ultra-processed foods and the increased trend of obesity and its related complications. These foods, prevalent in modern diets, contribute to nutritional deficiencies and excessive caloric intake, exacerbating obesity rates. Lifestyle factors such as busy schedules and quick meal management further drive UPF consumption, disrupting hunger regulation and promoting overeating. UPF consumption correlates with adverse health outcomes, including dyslipidemia, hypertension, and insulin resistance. Promoting whole, minimally processed foods and implementing school-based nutrition education programs are crucial steps. Also, numerous challenges exist, including unequal access to healthy foods, the industry's influence, and behavioral barriers to dietary change. Future research should explore innovative approaches, such as nutrigenomics and digital health technologies, to personalize interventions and evaluate policy effectiveness. Collaboration across disciplines and sectors will be vital to develop comprehensive solutions and improve public health outcomes globally.
Collapse
Affiliation(s)
- Antonietta Monda
- Department of Human Science and Promotion of Quality of Life, Telematic University San Raffaele, 00166 Rome, Italy;
| | - Maria Ida de Stefano
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (M.I.d.S.); (R.P.)
| | - Ines Villano
- Department of Wellness, Nutrition and Sport, Telematic University Pegaso, 80143 Naples, Italy; (I.V.); (F.M.); (A.D.); (P.L.)
| | - Salvatore Allocca
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.A.); (M.C.); (G.D.M.); (M.L.M.); (S.C.); (G.M.)
| | - Maria Casillo
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.A.); (M.C.); (G.D.M.); (M.L.M.); (S.C.); (G.M.)
| | - Antonietta Messina
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Vincenzo Monda
- Department of Economics, Law, Cybersecurity, and Sports Sciences, University of Naples “Parthenope”, 80132 Naples, Italy;
| | - Fiorenzo Moscatelli
- Department of Wellness, Nutrition and Sport, Telematic University Pegaso, 80143 Naples, Italy; (I.V.); (F.M.); (A.D.); (P.L.)
| | - Anna Dipace
- Department of Wellness, Nutrition and Sport, Telematic University Pegaso, 80143 Naples, Italy; (I.V.); (F.M.); (A.D.); (P.L.)
| | - Pierpaolo Limone
- Department of Wellness, Nutrition and Sport, Telematic University Pegaso, 80143 Naples, Italy; (I.V.); (F.M.); (A.D.); (P.L.)
| | - Girolamo Di Maio
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.A.); (M.C.); (G.D.M.); (M.L.M.); (S.C.); (G.M.)
| | - Marco La Marra
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.A.); (M.C.); (G.D.M.); (M.L.M.); (S.C.); (G.M.)
| | - Marilena Di Padova
- Department of Humanistic Studies, University of Foggia, 71122 Foggia, Italy;
| | - Sergio Chieffi
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.A.); (M.C.); (G.D.M.); (M.L.M.); (S.C.); (G.M.)
| | - Giovanni Messina
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.A.); (M.C.); (G.D.M.); (M.L.M.); (S.C.); (G.M.)
| | - Marcellino Monda
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.A.); (M.C.); (G.D.M.); (M.L.M.); (S.C.); (G.M.)
| | - Rita Polito
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (M.I.d.S.); (R.P.)
| |
Collapse
|
15
|
Yao CK, Fitzpatrick J, Machado P, Staudacher HM. Is there an "optimal" diet for prevention of inflammatory bowel disease? JGH Open 2024; 8:e70016. [PMID: 39185483 PMCID: PMC11344165 DOI: 10.1002/jgh3.70016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 07/24/2024] [Accepted: 08/03/2024] [Indexed: 08/27/2024]
Abstract
Nutritional epidemiological studies have evolved from a focus of single nutrients to diet patterns to capture the protective role of healthy diets on chronic disease development. Similarly, in inflammatory bowel disease (IBD), a healthy diet may be protective against its development in individuals with genetic susceptibility, but the definitions of the optimal diet pattern deserve further exploration. Hence, this review article presents evidence, mainly from prospective cohort studies, for the role of diet quality based on adherence to dietary guidelines, traditional and modern diet patterns in the prevention of IBD. Findings from a limited number of studies on diet quality suggest that high diet quality scores are associated with lower risk of developing Crohn's disease, but the data are inconsistent for ulcerative colitis (UC). There are signals that a Mediterranean diet pattern reduces the risk of Crohn's disease but, again, the data are inconsistent and further studies are much needed. Finally, the evidence is conflicting regarding the role of food additives, with difficulties in the assessment of their intake, namely non-nutritive sweeteners and emulsifiers, precluding accurate assessment of a relationship with IBD risk. In contrast, emerging evidence for a role of ultra-processed food in the development of Crohn's disease but not UC is identified. Given the potential influence of diet quality, a Mediterranean diet and ultra-processed food intake on the risk of Crohn's disease, assessment and implementation of dietary advice for these patients need to be tailored. The search for an optimal diet for UC remains elusive and further research for increasing the evidence in the area is greatly needed.
Collapse
Affiliation(s)
- Chu K Yao
- Department of Gastroenterology, Central Clinical SchoolMonash University & Alfred HealthMelbourneVictoriaAustralia
| | - Jessica Fitzpatrick
- Department of Gastroenterology, Central Clinical SchoolMonash University & Alfred HealthMelbourneVictoriaAustralia
| | - Priscila Machado
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition SciencesDeakin UniversityMelbourneVictoriaAustralia
| | - Heidi M Staudacher
- Food & Mood Centre, the Institute for Mental and Physical Health and Clinical TranslationDeakin UniversityMelbourneVictoriaAustralia
| |
Collapse
|
16
|
Lane MM, Travica N, Gamage E, Marshall S, Trakman GL, Young C, Teasdale SB, Dissanayaka T, Dawson SL, Orr R, Jacka FN, O'Neil A, Lawrence M, Baker P, Rebholz CM, Du S, Marx W. Sugar-Sweetened Beverages and Adverse Human Health Outcomes: An Umbrella Review of Meta-Analyses of Observational Studies. Annu Rev Nutr 2024; 44:383-404. [PMID: 39207876 DOI: 10.1146/annurev-nutr-062322-020650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Our aim was to conduct an umbrella review of evidence from meta-analyses of observational studies investigating the link between sugar-sweetened beverage consumption and human health outcomes. Using predefined evidence classification criteria, we evaluated evidence from 47 meta-analyses encompassing 22,055,269 individuals. Overall, 79% of these analyses indicated direct associations between greater sugar-sweetened beverage consumption and higher risks of adverse health outcomes. Convincing evidence (class I) supported direct associations between sugar-sweetened beverage consumption and risks of depression, cardiovascular disease, nephrolithiasis, type 2 diabetes mellitus, and higher uric acid concentrations. Highly suggestive evidence (class II) supported associations with risks of nonalcoholic fatty liver disease and dental caries. Out of the remaining 40 meta-analyses, 29 were graded as suggestive or weak in the strength of evidence (classes III and IV), and 11 showed no evidence (class V). These findings inform and provide support for population-based and public health strategies aimed at reducing sugary drink consumption for improved health.
Collapse
Affiliation(s)
- Melissa M Lane
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Victoria, Australia;
| | - Nikolaj Travica
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Victoria, Australia;
| | - Elizabeth Gamage
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Victoria, Australia;
| | - Skye Marshall
- Research Institute for Future Health, Gold Coast, Queensland, Australia
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Science and Medicine, Bond University, Gold Coast, Queensland, Australia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Gina L Trakman
- Department of Food, Nutrition, and Dietetics, Sport, Performance, and Nutrition Research Group, La Trobe University, Melbourne, Victoria, Australia
| | - Claire Young
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Victoria, Australia;
| | - Scott B Teasdale
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Mindgardens Neuroscience Network, Randwick, New South Wales, Australia
| | - Thusharika Dissanayaka
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Victoria, Australia;
| | - Samantha L Dawson
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Victoria, Australia;
| | - Rebecca Orr
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Victoria, Australia;
| | - Felice N Jacka
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Victoria, Australia;
- Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Immunology, Therapeutics, and Vaccines, James Cook University, Townsville, Queensland, Australia
| | - Adrienne O'Neil
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Victoria, Australia;
| | - Mark Lawrence
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Phillip Baker
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Casey M Rebholz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shutong Du
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Wolfgang Marx
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Victoria, Australia;
| |
Collapse
|
17
|
Trumbo PR, Bleiweiss-Sande R, Campbell JK, Decker E, Drewnowski A, Erdman JW, Ferruzzi MG, Forde CG, Gibney MJ, Hess JM, Klurfeld DM, Latulippe ME, O’Connor LE, Reimers KJ, Rolls BJ, Schulz J, Weaver C, Yu L. Toward a science-based classification of processed foods to support meaningful research and effective health policies. Front Nutr 2024; 11:1389601. [PMID: 39055388 PMCID: PMC11271201 DOI: 10.3389/fnut.2024.1389601] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 06/12/2024] [Indexed: 07/27/2024] Open
Abstract
Processed foods have been part of the American diet for decades, with key roles in providing a safe, available, affordable, and nutritious food supply. The USDA Food Guides beginning in 1916 and the US Dietary Guidelines for Americans (DGA) since 1980 have included various types of commonly consumed processed foods (e.g., heated, fermented, dried) as part of their recommendations. However, there are multiple classification systems based on "level" of food processing, and additional evidence is needed to establish the specific properties of foods classified as "highly" or "ultra"-processed (HPF/UPFs). Importantly, many foods are captured under HPF/UPF definitions, ranging from ready-to-eat fortified whole grain breakfast cereals to sugar-sweetened beverages and baked goods. The consequences of implementing dietary guidance to limit all intake of foods currently classified as HPF/UPF may require additional scrutiny to evaluate the impact on consumers' ability to meet daily nutrient recommendations and to access affordable food, and ultimately, on health outcomes. Based on a meeting held by the Institute for the Advancement of Food and Nutrition Sciences in May 2023, this paper provides perspectives on the broad array of foods classified as HPF/UPFs based on processing and formulation, including contributions to nutrient intake and dietary patterns, food acceptability, and cost. Characteristics of foods classified as UPF/HPFs are considered, including the roles and safety approval of food additives and the effect of food processing on the food matrix. Finally, this paper identifies information gaps and research needs to better understand how the processing of food affects nutrition and health outcomes.
Collapse
Affiliation(s)
- Paula R. Trumbo
- Paula R. Trumbo Consulting, Mount Pleasant, SC, United States
- School of Health Sciences, Liberty University, Lynchburg, VA, United States
| | | | - Jessica K. Campbell
- Bell Institute of Health and Nutrition, General Mills, Golden Valley, MN, United States
| | - Eric Decker
- Department of Food Science, University of Massachusetts, Amherst, MA, United States
| | - Adam Drewnowski
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - John W. Erdman
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana-Champaign, IL, United States
| | - Mario G. Ferruzzi
- Arkansas Children’s Nutrition Center, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Ciaran G. Forde
- Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
| | - Michael J. Gibney
- Institute of Food and Health, University College Dublin, Dublin, Ireland
| | - Julie M. Hess
- USDA-ARS Grand Forks Human Nutrition Research Center, Grand Forks, ND, United States
| | - David M. Klurfeld
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, IN, United States
| | - Marie E. Latulippe
- Institute for the Advancement of Food and Nutrition Sciences, Washington, DC, United States
| | - Lauren E. O’Connor
- Beltsville Human Nutrition Research Center, Agricultural Research Service, United States Department of Agriculture, Beltsville, MD, United States
| | | | - Barbara J. Rolls
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, United States
| | | | - Connie Weaver
- College of Health and Human Services, School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, United States
| | - Lynn Yu
- The Kraft Heinz Company, Chicago, IL, United States
| |
Collapse
|
18
|
Valizadeh P, Ng SW. Promoting Healthier Purchases: Ultraprocessed Food Taxes and Minimally Processed Foods Subsidies for the Low Income. Am J Prev Med 2024; 67:3-14. [PMID: 38573260 DOI: 10.1016/j.amepre.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION Fiscal policies can shift relative food prices to encourage the purchase and consumption of minimally processed foods while discouraging the purchase and consumption of unhealthy ultraprocessed foods, high in calories and nutrients of concern (sodium, sugar, and saturated fats), especially for low-income households. METHODS The 2017-2018 packaged food purchase data among U.S. households were used to derive household income- and composition-specific demand elasticities across 22 food and beverage categories. Policy simulations, conducted in 2022-2023, assessed the impact of national taxes on unhealthy ultraprocessed food and beverage purchases, both separately and alongside subsidies for minimally processed foods and beverages targeted to low-income households. Resultant nutritional implications are reported on the basis of changes in purchased calories and nutrients of concern. In addition, financial implications for both households and the federal government are projected. RESULTS A sugar-based tax on sugar-sweetened beverages would lower both volume and calories purchased with the largest impact on low-income households without children. Meanwhile, targeted subsidies would increase fruit, vegetable, and healthier drink purchases without substantially increasing calories. Under tax simulations, low-income households would make larger reductions in their absolute volume and calorie purchases of taxed foods and beverages than their higher-income counterparts, suggesting that these policies, if implemented, could help narrow nutritional disparities. CONCLUSIONS Levying national taxes on unhealthy ultraprocessed foods/beverages and offering targeted subsidies for minimally processed foods/beverages could promote healthier food choices among low-income households. Such policies have the potential to benefit low-income households financially and at a relatively low cost for the federal government annually.
Collapse
Affiliation(s)
- Pourya Valizadeh
- Department of Agricultural Economics, Texas A&M University, College Station, Texas
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| |
Collapse
|
19
|
Fung TT, Rossato SL, Chen Z, Khandpur N, Rodriguez-Artalejo F, Willett WC, Struijk EA, Lopez-Garcia E. Ultraprocessed foods, unprocessed or minimally processed foods, and risk of frailty in a cohort of United States females. Am J Clin Nutr 2024; 120:232-239. [PMID: 38750726 DOI: 10.1016/j.ajcnut.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/03/2024] [Accepted: 05/07/2024] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND Ultraprocessed foods (UPFs) and poor diet quality have been associated with frailty but existing studies had relatively short follow-up time. It is also unclear whether the association of UPF was primarily due to its correlation with poorer diet quality. OBJECTIVES We examined the association between unprocessed or minimally processed foods (UMFs) and UPF and risk of frailty and explored whether the association with UPF was mainly driven by poor diet quality. METHODS In total, 63,743 nonfrail females aged 60+ y from the Nurses' Health Study (cohort study) were followed up for ≥26 y. Diet was assessed every 4 y by food frequency questionnaires. UPF and UMF intakes were calculated using the Nova classification. Diet quality was estimated using the Alternate Healthy Eating Index (AHEI) 2010. The association of UMF and UPF with risk of frailty was examined using multivariable adjusted Cox proportional hazard model. RESULTS During the follow-up period, we recorded 15,187 incident cases of frailty. The hazard ratio (HR) of frailty for the highest compared with the lowest quintile of UMFs (servings per day) was 0.86 (95% CI: 0.83, 0.95; P-trend < 0.001). However, this was no longer statistically significant after adjustment for AHEI-2010. UPFs (servings per day) was directly associated with risk of frailty, even after adjustment for AHEI-2010 (1.31; 95% CI: 1.23, 1.39; P-trend < 0.001). Among those at the highest category of the AHEI-2010, UPFs remained directly associated with frailty (HR comparing top with bottom quintile: 1.40; 95% CI:1.24, 1.57; P-trend < 0.001). For UPF components, we found a higher frailty risk with each serving per day of artificial and sugar-sweetened beverages; fat, spreads, and condiments; yogurt and dairy-based desserts; and other UPFs. However, processed whole grains were not associated with frailty. CONCLUSIONS Higher intake of UPF is associated with a higher risk of frailty in older females. This is not explained by a lower diet quality contributed by UPFs.
Collapse
Affiliation(s)
- Teresa T Fung
- Department of Nutrition, Simmons University, Boston, MA, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
| | - Sinara L Rossato
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Laboratory of Research and Extension in Epidemiolgy (Lapex-Epi), Institute of Geography Universidade Federal de Uberlândia. Uberlândia, Brazil
| | - Zhangling Chen
- Department of Cardiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Neha Khandpur
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Division of Human Nutrition and Health, Wageningen University, Netherlands; Faculty of Public Health, University of Sao Paulo, Brazil
| | - Fernando Rodriguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-Idi Paz, Madrid, Spain
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Ellen A Struijk
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-Idi Paz, Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Esther Lopez-Garcia
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-Idi Paz, Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain; Instituto Madrileño De Estudios Avanzado-Food Institute, Campus de Excelencia Internacional Universidad Autónoma de Madrid+Centro Superior de Investigaciones Científicas, Madrid, Spain
| |
Collapse
|
20
|
Campanella A, Tatoli R, Bonfiglio C, Donghia R, Cuccaro F, Giannelli G. Ultra-Processed Food Consumption as a Risk Factor for Gastrointestinal Cancer and Other Causes of Mortality in Southern Italy: A Competing Risk Approach. Nutrients 2024; 16:1994. [PMID: 38999742 PMCID: PMC11243523 DOI: 10.3390/nu16131994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/18/2024] [Accepted: 06/21/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Ultra-Processed Foods (UPFs) are increasingly consumed worldwide, even in regions with strong dietary traditions like the Mediterranean and can play a crucial role in the development of chronic diseases, including cancer. This population-based prospective cohort study investigates the association between UPF consumption and gastrointestinal cancers and other causes of mortality in Southern Italy. METHODS Data were collected from 4870 participants in the MICOL and NUTRIHEP cohorts. The EPIC questionnaire was used to elicit information on food and drink consumption and UPFs were categorized by degree of processing according to the NOVA classification. Cox proportional hazards regression and competing risk models were employed for statistical analysis. RESULTS UPF consumption was positively associated with all-cause mortality: participants in the 3rd UFP quartile, as compared to the lowest, had a 27% higher risk of death (SHR 1.27 95% CI, 1.03; 1.57), while in the highest quartile as compared to the lowest, the risk was 34% higher (SHR 1.34 95% CI, 1.00; 1.79). Higher UPFs intake was also correlated with an increased gastrointestinal cancers mortality risk, especially the 2nd (SHR 1.65, 95% CI: 1.01; 2.71) and 4th quartile (SHR 3.14 95% CI: 1.56; 6.32), with a dose-dependent effect. For the other cancers, a SHR 1.61 (95% CI 1.03; 2.54) was observed for the 3rd quartile. CONCLUSIONS Our results reinforce the link between UPF consumption and cancer risk, emphasizing the urgent need for interventions targeting dietary patterns.
Collapse
Affiliation(s)
- Angelo Campanella
- National Institute of Gastroenterology-IRCCS "Saverio de Bellis", 70013 Castellana Grotte, Italy
| | - Rossella Tatoli
- National Institute of Gastroenterology-IRCCS "Saverio de Bellis", 70013 Castellana Grotte, Italy
| | - Caterina Bonfiglio
- National Institute of Gastroenterology-IRCCS "Saverio de Bellis", 70013 Castellana Grotte, Italy
| | - Rossella Donghia
- National Institute of Gastroenterology-IRCCS "Saverio de Bellis", 70013 Castellana Grotte, Italy
| | | | - Gianluigi Giannelli
- National Institute of Gastroenterology-IRCCS "Saverio de Bellis", 70013 Castellana Grotte, Italy
| |
Collapse
|
21
|
Franchini C, Biasini B, Sogari G, Wongprawmas R, Andreani G, Dolgopolova I, Gómez MI, Roosen J, Menozzi D, Mora C, Scazzina F, Rosi A. Adherence to the Mediterranean Diet and its association with sustainable dietary behaviors, sociodemographic factors, and lifestyle: a cross-sectional study in US University students. Nutr J 2024; 23:56. [PMID: 38797846 PMCID: PMC11129378 DOI: 10.1186/s12937-024-00962-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/21/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Promoting healthy and sustainable diets is increasingly important and the Mediterranean Diet (MD) has been recognized as an appropriate example that can be adapted to different countries. Considering that the college years are the time when US young adults are most likely to adopt unhealthy eating habits, the present study assessed adherence to the MD and the sustainability of dietary behaviors in a nationally representative sample of US university students, aiming to identify crucial levers for improving their eating behaviors. METHODS MD adherence and the adoption of healthy and sustainable dietary patterns were assessed through the KIDMED and the Sustainable-HEalthy-Diet (SHED Index questionnaires, respectively, administered through an online survey that also included sociodemographic and behavioral questions. Non-parametric and logistic regression analyses were performed. RESULTS A sample of 1485 participants (median (IQR) age 21.0 (19.0-22.0); 59% women) correctly completed the survey. A medium adherence to the MD was the most prevalent (47%). According to multivariate logistic regression analysis, the likelihood of being more compliant with the MD increased when meeting physical activity recommendations, having a high SHED Index score, having the willingness to purchase and eat healthy and sustainable dishes, eating ultra-processed plant-based meat alternatives foods daily, and regularly attending the university canteen. CONCLUSIONS Encouraging dietary patterns rich in plant-based foods and with a moderate intake of animal products is crucial to increasing the adoption of healthy and sustainable diets, and university dining services represent a suitable setting to build a supportive environment that educates students on human and planetary health.
Collapse
Affiliation(s)
- Cinzia Franchini
- Department of Food and Drug, University of Parma, Parma, 43124, Italy
| | - Beatrice Biasini
- Department of Food and Drug, University of Parma, Parma, 43124, Italy
| | - Giovanni Sogari
- Department of Food and Drug, University of Parma, Parma, 43124, Italy
| | | | - Giulia Andreani
- Department of Food and Drug, University of Parma, Parma, 43124, Italy
| | - Irina Dolgopolova
- Department of Marketing and Supply Chain Management, School of Business and Economics, Maastricht University, LM Maastricht, 6211, The Netherlands
| | - Miguel I Gómez
- Charles H. Dyson School of Applied Economics and Management, Cornell University, Ithaca, NY, 14853, USA
| | - Jutta Roosen
- Marketing and Consumer Research, School of Management, Technical University of Munich, 85354, Freising, Weihenstephan, Germany
| | - Davide Menozzi
- Department of Food and Drug, University of Parma, Parma, 43124, Italy
| | - Cristina Mora
- Department of Food and Drug, University of Parma, Parma, 43124, Italy
| | - Francesca Scazzina
- Department of Food and Drug, University of Parma, Parma, 43124, Italy.
- Medical School, Building A, Via Volturno 39, Parma, 43125, Italy.
| | - Alice Rosi
- Department of Food and Drug, University of Parma, Parma, 43124, Italy
| |
Collapse
|
22
|
Werneck AO, Steele EM, Delpino FM, Lane MM, Marx W, Jacka FN, Stubbs B, Touvier M, Srour B, Louzada ML, Levy RB, Monteiro CA. Adherence to the ultra-processed dietary pattern and risk of depressive outcomes: Findings from the NutriNet Brasil cohort study and an updated systematic review and meta-analysis. Clin Nutr 2024; 43:1190-1199. [PMID: 38613906 DOI: 10.1016/j.clnu.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/24/2024] [Accepted: 03/24/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND & AIMS We aimed to analyze the prospective association between adherence to the ultra-processed dietary pattern and risk of depressive outcomes using original data from the NutriNet Brasil cohort and via a systematic review and meta-analysis of observational studies that have investigated the same association. METHODS In our original research analysis, we used data from 15,960 adults (≥18 y) participating in the NutriNet Brasil cohort study, free of depression or depressive symptoms during the baseline (77.5% women, 45.8 ± 13.0 y). The mean dietary share of ultra-processed foods (%Kcal/d), calculated from two baseline 24-h dietary recalls, was used to measure the adherence to the ultra-processed dietary pattern. New cases of depressive symptoms were assessed using the Patient Health Questionnaire-9 over the follow-up period (mean: 18.3 months). Cox proportional hazards models were used for the main analyses. In our systematic review and meta-analysis, we incorporated effect estimates from six prospective cohort studies that have examined the same association, including ours. RESULTS In the adjusted model, each 10% increase in the dietary share of ultra-processed foods was associated with a 10% increase in the hazard of incident cases of depressive symptoms (HR:1.10; 95%CI: 1.07-1.14). This association was slightly attenuated in the models including potential mediators. In our meta-analysis of six prospective studies, high versus low exposure to ultra-processed foods was associated with a summary hazard ratio of depressive outcomes of 1.32; 95%CI: 1.19-1.46; I2: 71%. CONCLUSION A higher adherence to the ultra-processed dietary pattern was associated with a higher risk of developing depressive outcomes in the NutriNet Brasil cohort and in the meta-analysis.
Collapse
Affiliation(s)
- André O Werneck
- Center for Epidemiological Research in Nutrition and Health, Department of Nutrition, School of Public Health, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Euridice M Steele
- Center for Epidemiological Research in Nutrition and Health, Department of Nutrition, School of Public Health, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Felipe M Delpino
- Postgraduate in Nursing, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
| | - Melissa M Lane
- Deakin University, IMPACT (the Institute for Mental and Physical Health and Clinical Translation), Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Wolfgang Marx
- Deakin University, IMPACT (the Institute for Mental and Physical Health and Clinical Translation), Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Felice N Jacka
- Deakin University, IMPACT (the Institute for Mental and Physical Health and Clinical Translation), Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Mathilde Touvier
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Villetaneuse, France
| | - Bernard Srour
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Villetaneuse, France
| | - Maria Lc Louzada
- Center for Epidemiological Research in Nutrition and Health, Department of Nutrition, School of Public Health, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Renata B Levy
- Center for Epidemiological Research in Nutrition and Health, Department of Nutrition, School of Public Health, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Carlos A Monteiro
- Center for Epidemiological Research in Nutrition and Health, Department of Nutrition, School of Public Health, University of São Paulo (USP), São Paulo, SP, Brazil.
| |
Collapse
|
23
|
Roggema R, Krstikj A, Flores B. Spatial Barriers to Transforming toward a Healthy Food System in the Noreste of Mexico. Nutrients 2024; 16:1259. [PMID: 38732506 PMCID: PMC11085837 DOI: 10.3390/nu16091259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/14/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024] Open
Abstract
In the past five decades, global food systems have undergone a notable transition, moving from predominantly rural settings to increasingly urban and industrialized environments, largely driven by processes of globalization and supply chain integration. However, this evolution has not adequately addressed equitable access to nutritious diets and food environments, resulting in adverse health outcomes. This study delves into the spatial and non-spatial barriers that impede the adoption of healthy diets in the Noreste of Mexico, particularly focusing on the challenges associated with accessing and cultivating plant-based foods. Through an examination of suitable areas for urban agriculture and an exploration of the socio-cultural factors influencing the adoption of plant-based diets, the research focuses on interventions aimed at promoting healthier and more sustainable eating practices in Monterrey. The findings of the study reveal significant disparities in food access across the Monterrey metropolitan area, with central urban zones exhibiting superior access to fresh foods compared to suburban and peripheral regions. This inequality disproportionately affects marginalized areas characterized by higher poverty rates, exacerbating issues of food insecurity. Nevertheless, traditional dietary practices could offer promising avenues for creating culturally significant and healthier dietary transitions, even amidst the ongoing process of urbanization.
Collapse
Affiliation(s)
- Rob Roggema
- School of Architecture, Art and Design, Campus Monterrey, Tecnologico de Monterrey, Monterrey 64849, Mexico
| | - Aleksandra Krstikj
- School of Architecture, Art and Design, Campus State of Mexico, Tecnologico de Monterrey, López Mateos 52926, Mexico;
| | - Brianda Flores
- School of Humanities and Education, Campus Monterrey, Tecnologico de Monterrey, Monterrey 64849, Mexico;
| |
Collapse
|
24
|
Vlassopoulos A, Katidi A, Noutsos S, Kapsokefalou M. Precision Food Composition Data as a Tool to Decipher the Riddle of Ultra-Processed Foods and Nutritional Quality. Foods 2024; 13:1259. [PMID: 38672931 PMCID: PMC11049098 DOI: 10.3390/foods13081259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/14/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Epidemiology supports a link between ultra-processed foods (UPFs) and health, mediated mainly through the clustering of foods with suboptimal nutrient profiles within UPFs. However, successful NOVA categorization requires access to a food's ingredient list, which we hypothesized can impact both UPF identification and the link between processing and composition. METHODS Foods (n = 4851) in the HelTH branded food composition database were classified as NOVA1-4, with or without using the ingredient lists (generic and branded approach, respectively), to identify differences in NOVA classification (chi-square test) and the estimated average nutritional composition of each NOVA group (Kruskal-Willis U test). RESULTS Using the ingredients list increased UPF identification by 30%. More than 30% of foods commonly assumed to be minimally processed (NOVA1-plain dairy, frozen vegetables, etc.) were reclassified as UPFs when using ingredient lists. These reclassified foods, however, had nutritional compositions comparable to NOVA1 foods and better than UPFs for energy, fat, sugars, and sodium (p < 0.001). In fact, UPFs did not show a uniform nutritional composition covering foods from Nutri-Score A (~10%) to Nutri-Score E (~20%). CONCLUSIONS The assumption that all UPFs have the same unfavorable nutritional composition is challenged when NOVA is applied using the appropriate branded food composition database.
Collapse
Affiliation(s)
- Antonis Vlassopoulos
- Laboratory of Chemistry and Food Analysis, Department of Food Science and Human Nutrition, Agricultural University of Athens, 11855 Athens, Greece; (A.K.); (S.N.); (M.K.)
| | | | | | | |
Collapse
|
25
|
Principato L, Carullo D, Gruppi A, Duserm Garrido G, Giuberti G, Lambri M, Spigno G, Bassani A. A Potentially Ecosustainable Hazelnut/Carob-Based Spread. INTERNATIONAL JOURNAL OF FOOD SCIENCE 2024; 2024:4863035. [PMID: 38515832 PMCID: PMC10957253 DOI: 10.1155/2024/4863035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 08/04/2023] [Accepted: 08/14/2023] [Indexed: 03/23/2024]
Abstract
Commercial cocoa and hazelnut-based sweet spreads typically present a poor nutribiochemical level due to their ingredients and recipes, while nowadays, there is the need of developing sustainable food products addressing both an improved nutritional and environmental profile. The aim of this work was then to develop an innovative hazelnut/carob-based spread with potential high sustainability and nutritional profile, including the exploitation of grape-processing residues (grape skin flour and grapeseed oil) and carob pulp as cocoa surrogate. Rheological (rotational/oscillatory), oxidative, and thermal features of the spread were assessed and compared with two commercial nut-cocoa-based products. Tribology was used to mimic and evaluate the spreads' behavior during oral consumption, and sensory profile (by quantitative descriptive analysis) was also assessed. All products exhibited a pseudoplastic behavior, with the elastic component prevailing over the viscous one. The innovative product showed the highest lubricity from both rheological and sensory analysis, thus well correlating to the obtained lowest viscosity and friction factor trends. Grapeseed oil provided a better nutritional profile, but the largest amount of unsaturated fatty acids promoted oxidation, despite the higher total phenolic content and antioxidant capacity coming from the use of carob and grape skin powders. The sensory perception investigation revealed a characteristic mouthfeel/flavor for the new spread identified having a more fluid consistency and a bitter/sour taste, together with a greater stickiness and a poorer smoothness due to a higher fiber content and solid fat absence.
Collapse
Affiliation(s)
- Laura Principato
- DiSTAS-Department for Sustainable Food Process, Università Cattolica del Sacro Cuore, Piacenza 29121, Italy
| | - Daniele Carullo
- DiSTAS-Department for Sustainable Food Process, Università Cattolica del Sacro Cuore, Piacenza 29121, Italy
| | - Alice Gruppi
- DiSTAS-Department for Sustainable Food Process, Università Cattolica del Sacro Cuore, Piacenza 29121, Italy
| | - Guillermo Duserm Garrido
- DiSTAS-Department for Sustainable Food Process, Università Cattolica del Sacro Cuore, Piacenza 29121, Italy
| | - Gianluca Giuberti
- DiSTAS-Department for Sustainable Food Process, Università Cattolica del Sacro Cuore, Piacenza 29121, Italy
| | - Milena Lambri
- DiSTAS-Department for Sustainable Food Process, Università Cattolica del Sacro Cuore, Piacenza 29121, Italy
| | - Giorgia Spigno
- DiSTAS-Department for Sustainable Food Process, Università Cattolica del Sacro Cuore, Piacenza 29121, Italy
| | - Andrea Bassani
- DiSTAS-Department for Sustainable Food Process, Università Cattolica del Sacro Cuore, Piacenza 29121, Italy
| |
Collapse
|
26
|
Ferreira SRG, Macotela Y, Velloso LA, Mori MA. Determinants of obesity in Latin America. Nat Metab 2024; 6:409-432. [PMID: 38438626 DOI: 10.1038/s42255-024-00977-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/04/2024] [Indexed: 03/06/2024]
Abstract
Obesity rates are increasing almost everywhere in the world, although the pace and timing for this increase differ when populations from developed and developing countries are compared. The sharp and more recent increase in obesity rates in many Latin American countries is an example of that and results from regional characteristics that emerge from interactions between multiple factors. Aware of the complexity of enumerating these factors, we highlight eight main determinants (the physical environment, food exposure, economic and political interest, social inequity, limited access to scientific knowledge, culture, contextual behaviour and genetics) and discuss how they impact obesity rates in Latin American countries. We propose that initiatives aimed at understanding obesity and hampering obesity growth in Latin America should involve multidisciplinary, global approaches that consider these determinants to build more effective public policy and strategies, accounting for regional differences and disease complexity at the individual and systemic levels.
Collapse
Affiliation(s)
| | - Yazmín Macotela
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, UNAM Campus-Juriquilla, Querétaro, Mexico
| | - Licio A Velloso
- Obesity and Comorbidities Research Center, Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, Brazil
| | - Marcelo A Mori
- Institute of Biology, Universidade Estadual de Campinas, Campinas, Brazil.
| |
Collapse
|
27
|
Freisling H, Córdova R, Aune D, Wagner KH. Ultra processed foods and cancer-authors' reply. THE LANCET REGIONAL HEALTH. EUROPE 2024; 38:100865. [PMID: 38375449 PMCID: PMC10875608 DOI: 10.1016/j.lanepe.2024.100865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 02/21/2024]
Affiliation(s)
- Heinz Freisling
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Reynalda Córdova
- Department of Nutritional Sciences, University of Vienna, Vienna, Austria
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- Department of Nutrition, Oslo New University College, Oslo, Norway
- Department of Research, The Cancer Registry of Norway, Oslo, Norway
| | - Karl-Heinz Wagner
- Department of Nutritional Sciences, University of Vienna, Vienna, Austria
| |
Collapse
|
28
|
Olstad DL, Nejatinamini S, Blanchet R, Moubarac JC, Polsky J, Vanderlee L, Livingstone KM, Hosseini Pozveh S. Protecting traditional cultural food practices: Trends in diet quality and intake of ultra-processed foods by Indigenous status and race/ethnicity among a nationally representative sample of adults in Canada. SSM Popul Health 2023; 24:101496. [PMID: 37701069 PMCID: PMC10493595 DOI: 10.1016/j.ssmph.2023.101496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/29/2023] [Accepted: 08/20/2023] [Indexed: 09/14/2023] Open
Abstract
Background The traditional cultural food practices of Indigenous people and adults from racial/ethnic minority groups may be eroded in the current food system where nutrient-poor and ultra-processed foods (UPF) are the most affordable and normative options, and where experiences of racism may promote unhealthy dietary patterns. We quantified absolute and relative gaps in diet quality and UPF intake of a nationally representative sample of adults in Canada by Indigenous status and race/ethnicity, and trends between 2004 and 2015. Methods Adults (≥18 years) in the Canadian Community Health Survey-Nutrition self-reported Indigenous status and race/ethnicity and completed a 24-h dietary recall in 2004 (n = 20,880) or 2015 (n = 13,970) to calculate Healthy Eating Index-2015 (HEI-2015) scores from 0 to 100 and proportion of energy from UPF. Absolute and relative dietary gaps were quantified for Indigenous people and six racial/ethnic minority groups relative to White adults and trends between 2004 and 2015. Results Adults from all six racial/ethnic minority groups had higher mean HEI-2015 scores (58.7-61.9) than White (56.3) and Indigenous adults (51.9), and lower mean UPF intake (31.0%-41.0%) than White (45.9%) and Indigenous adults (51.9%) in 2015. As a result, absolute gaps in diet quality were positive and gaps in UPF intake were negative among racial/ethnic minority groups-indicating more favourable intakes-while the reverse was found among Indigenous adults. Relative dietary gaps were small. Absolute and relative dietary gaps remained largely stable. Conclusions Adults from six racial/ethnic minority groups had higher diet quality and lower UPF intake, whereas Indigenous adults had poorer diet quality and higher UPF intake compared to White adults between 2004 and 2015. Absolute and relative dietary gaps remained largely stable. Findings suggest racial/ethnic minority groups may have retained some healthful aspects of their traditional cultural food practices while highlighting persistent dietary inequities that affect Canada's Indigenous people.
Collapse
Affiliation(s)
- Dana Lee Olstad
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Sara Nejatinamini
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Rosanne Blanchet
- Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, 7101 Avenue du Parc, 3e étage, Montréal, Québec, H3N 1X9, Canada
| | - Jean-Claude Moubarac
- Département de Nutrition, Faculté de Médecine, Université de Montréal, Pavillon Liliane de Stewart, Montréal, Québec, H3T 1A8, Canada
| | - Jane Polsky
- Health Analysis Division, Statistics Canada, 150 Tunney's Pasture Driveway, Ottawa, Ontario, K1A 0T6, Canada
| | - Lana Vanderlee
- École de Nutrition, Université Laval, Québec, Québec, G1V 0A6, Canada
| | - Katherine M. Livingstone
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 1 Gheringhap St, Geelong, Victoria, 3220, Australia
| | - Seyed Hosseini Pozveh
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| |
Collapse
|
29
|
Cordova R, Viallon V, Fontvieille E, Peruchet-Noray L, Jansana A, Wagner KH, Kyrø C, Tjønneland A, Katzke V, Bajracharya R, Schulze MB, Masala G, Sieri S, Panico S, Ricceri F, Tumino R, Boer JM, Verschuren W, van der Schouw YT, Jakszyn P, Redondo-Sánchez D, Amiano P, Huerta JM, Guevara M, Borné Y, Sonestedt E, Tsilidis KK, Millett C, Heath AK, Aglago EK, Aune D, Gunter MJ, Ferrari P, Huybrechts I, Freisling H. Consumption of ultra-processed foods and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2023; 35:100771. [PMID: 38115963 PMCID: PMC10730313 DOI: 10.1016/j.lanepe.2023.100771] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 12/21/2023]
Abstract
Background It is currently unknown whether ultra-processed foods (UPFs) consumption is associated with a higher incidence of multimorbidity. We examined the relationship of total and subgroup consumption of UPFs with the risk of multimorbidity defined as the co-occurrence of at least two chronic diseases in an individual among first cancer at any site, cardiovascular disease, and type 2 diabetes. Methods This was a prospective cohort study including 266,666 participants (60% women) free of cancer, cardiovascular disease, and type 2 diabetes at recruitment from seven European countries in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Foods and drinks consumed over the previous 12 months were assessed at baseline by food-frequency questionnaires and classified according to their degree of processing using Nova classification. We used multistate modelling based on Cox regression to estimate cause-specific hazard ratios (HR) and their 95% confidence intervals (CI) for associations of total and subgroups of UPFs with the risk of multimorbidity of cancer and cardiometabolic diseases. Findings After a median of 11.2 years of follow-up, 4461 participants (39% women) developed multimorbidity of cancer and cardiometabolic diseases. Higher UPF consumption (per 1 standard deviation increment, ∼260 g/day without alcoholic drinks) was associated with an increased risk of multimorbidity of cancer and cardiometabolic diseases (HR: 1.09, 95% CI: 1.05, 1.12). Among UPF subgroups, associations were most notable for animal-based products (HR: 1.09, 95% CI: 1.05, 1.12), and artificially and sugar-sweetened beverages (HR: 1.09, 95% CI: 1.06, 1.12). Other subgroups such as ultra-processed breads and cereals (HR: 0.97, 95% CI: 0.94, 1.00) or plant-based alternatives (HR: 0.97, 95% CI: 0.91, 1.02) were not associated with risk. Interpretation Our findings suggest that higher consumption of UPFs increases the risk of cancer and cardiometabolic multimorbidity. Funding Austrian Academy of Sciences, Fondation de France, Cancer Research UK, World Cancer Research Fund International, and the Institut National du Cancer.
Collapse
Affiliation(s)
- Reynalda Cordova
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
- Department of Nutritional Sciences, University of Vienna, Vienna, Austria
| | - Vivian Viallon
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Emma Fontvieille
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | | | - Anna Jansana
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Karl-Heinz Wagner
- Department of Nutritional Sciences, University of Vienna, Vienna, Austria
| | - Cecilie Kyrø
- Danish Cancer Institute Center, Copenhagen, Denmark
| | - Anne Tjønneland
- Danish Cancer Institute Center, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Verena Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rashmita Bajracharya
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Matthias B. Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
| | - Giovanna Masala
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Sabina Sieri
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Salvatore Panico
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Fulvio Ricceri
- Department of Clinical and Biological Sciences, Centre for Biostatistics, Epidemiology, and Public Health, University of Turin, Italy
| | - Rosario Tumino
- Hyblean Association for Epidemiological Research, AIRE ONLUS Ragusa, Italy
| | - Jolanda M.A. Boer
- Centre for Prevention, Lifestyle and Health, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - W.M.Monique Verschuren
- Centre for Prevention, Lifestyle and Health, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Yvonne T. van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Paula Jakszyn
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
- Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain
| | - Daniel Redondo-Sánchez
- Escuela Andaluza de Salud Pública (EASP), Granada 18011, Spain
- Instituto de Investigación Biosanitaria ibs. Granada, Granada 18012, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Pilar Amiano
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain
- Bio Gipuzkoa Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, San Sebastián, Spain
| | - José María Huerta
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council-IMIB, Murcia, Spain
| | - Marcela Guevara
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Salud Pública y Laboral de Navarra, Pamplona 31003, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona 31008, Spain
| | - Yan Borné
- Nutritional Epidemiology, Department of Clinical Sciences Malmö, The Faculty of Medicine, Lund University, Malmö, Sweden
| | - Emily Sonestedt
- Nutritional Epidemiology, Department of Clinical Sciences Malmö, The Faculty of Medicine, Lund University, Malmö, Sweden
| | - Konstantinos K. Tsilidis
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Alicia K. Heath
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Elom K. Aglago
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- Department of Nutrition, Oslo New University College, Oslo, Norway
- Department of Research, The Cancer Registry of Norway, Oslo, Norway
| | - Marc J. Gunter
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Pietro Ferrari
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Inge Huybrechts
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Heinz Freisling
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
| |
Collapse
|
30
|
Wood B, Robinson E, Baker P, Paraje G, Mialon M, van Tulleken C, Sacks G. What is the purpose of ultra-processed food? An exploratory analysis of the financialisation of ultra-processed food corporations and implications for public health. Global Health 2023; 19:85. [PMID: 37957671 PMCID: PMC10644600 DOI: 10.1186/s12992-023-00990-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/08/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND In recent decades there has been a global rise in consumption of ultra-processed foods (UPFs) to the detriment of population health and the environment. Large corporations that have focused heavily on low-cost manufacturing and extensive marketing of UPFs to maximise profits have driven this dietary transition. The same corporations claim to serve the interests of multiple 'stakeholders', and that they are contributing to sustainable development. This paper aimed to test these claims by examining the degree to which UPF corporations have become 'financialised', focusing on the extent to which they have prioritised the financial interests of their shareholders relative to other actors, as well as the role that various types of investors have played in influencing their governance. Findings were used to inform discussion on policy responses to improve the healthiness of population diets. METHODS We adopted an exploratory research design using multiple methods. We conducted quantitative analysis of the financial data of U.S. listed food and agricultural corporations between 1962 and 2021, share ownership data of a selection of UPF corporations, and proxy voting data of a selection of investors between 2012 and 2022. We also conducted targeted narrative reviews using structured and branching searches of academic and grey literature. RESULTS Since the 1980s, corporations that depend heavily on manufacturing and marketing UPFs to generate profits have been increasingly transferring money to their shareholders relative to their total revenue, and at a level considerably higher than other food and agricultural sectors. In recent years, large hedge fund managers have had a substantial influence on the governance of major UPF corporations in their pursuit of maximising short-term returns. In comparison, shareholders seeking to take steps to improve population diets have had limited influence, in part because large asset managers mostly oppose public health-related shareholder proposals. CONCLUSIONS The operationalisation of 'shareholder primacy' by major UPF corporations has driven inequity and undermines their claims that they are creating 'value' for diverse actors. Measures that protect population diets and food systems from the extractive forces of financialisation are likely needed as part of efforts to improve the healthiness of population diets.
Collapse
Affiliation(s)
- Benjamin Wood
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Australia.
| | - Ella Robinson
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Phillip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Guillermo Paraje
- Business School, Universidad Adolfo Ibañez, Santiago de Chile, Chile
| | - Mélissa Mialon
- Trinity Business School, Trinity College, Dublin, Ireland
| | | | - Gary Sacks
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Australia
| |
Collapse
|
31
|
Zhang D, Chen X, Huang K, Zheng Q, Fu Y, Ma J, Ren X, Xu B, Liu P, Liu J, Lu S. Urinary essential and toxic metal mixtures, and type 2 diabetes mellitus: Telomere shortening as an intermediary factor? JOURNAL OF HAZARDOUS MATERIALS 2023; 459:132329. [PMID: 37598517 DOI: 10.1016/j.jhazmat.2023.132329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 08/22/2023]
Abstract
The joint effect of metal mixtures on telomere function and type 2 diabetes mellitus (T2DM) is unclear. This large-scale cross-sectional study sought to assess the role of telomere length (TL) in the relationship between urinary essential and toxic metal mixtures, and T2DM in 7410 Chinese adults ≥ 60 years of age. Essential (Cr, Cu, Zn, Se) and non-essential metals (V, Al, Sb, Sn, Cd, Pb) in urine samples were quantified, while leukocyte TL was measured from blood samples. Restricted cubic splines regression showed nonlinear relationships between single metal and T2DM, and between TL and T2DM. Bayesian kernel machine regression and quantile-based g-computation showed that the overall status of urinary metals was positively associated with risk of developing T2DM, which was mainly explained by exposure to Pb, Cd, and Sb, excessive Se intake, and high excretion of Zn. Mediation analyses showed that shortened TL mediated 27.9% of the overall positive effect of metal exposure on T2DM, and this mediation was mainly explained by toxic metal exposure and excessive Se intake. Tobacco smoke exposure, extensive cooking at home, and black tea consumption were found to be important contributors of toxic metal exposures. Further studies are needed to explore the recommended Zn dosage for T2DM patients at different stages, which may ameliorate pancreatic senescence and glycemic progression.
Collapse
Affiliation(s)
- Duo Zhang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Xiao Chen
- Shenzhen Key Laboratory of Modern Toxicology, Shenzhen Medical Key Discipline of Health Toxicology, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Ke Huang
- Food Inspection and Quarantine Center, Shenzhen Customs, Shenzhen, China
| | - Quanzhi Zheng
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Ying Fu
- Community Health Service Management Center, Shenzhen Luohu Hospital Group, Shenzhen, China
| | - Jiaojiao Ma
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Xiaohu Ren
- Shenzhen Key Laboratory of Modern Toxicology, Shenzhen Medical Key Discipline of Health Toxicology, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Benhong Xu
- Shenzhen Key Laboratory of Modern Toxicology, Shenzhen Medical Key Discipline of Health Toxicology, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Peiyi Liu
- Shenzhen Key Laboratory of Modern Toxicology, Shenzhen Medical Key Discipline of Health Toxicology, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Jianjun Liu
- Shenzhen Key Laboratory of Modern Toxicology, Shenzhen Medical Key Discipline of Health Toxicology, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Shaoyou Lu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China.
| |
Collapse
|
32
|
Scrinis G, Castro IRRD. Framing poor diet quality as malnutrition: the Brazilian National Survey on Child Nutrition (ENANI-2019). CAD SAUDE PUBLICA 2023; 39Suppl 2:e00089222. [PMID: 37792879 PMCID: PMC10552618 DOI: 10.1590/0102-311xen089222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 10/02/2022] [Accepted: 10/10/2022] [Indexed: 10/06/2023] Open
Abstract
Based on the Brazilian National Survey on Child Nutrition (ENANI-2019) results, this article reflects on the adequacy of the "malnutrition in all its forms" framework and system of classification for representing and interpreting these dietary transitions in Brazilian children. We highlight the limitations of this classification system, including the focus on health outcomes and anthropometric measures, the siloed understanding of these forms of malnutrition, the lack of relevance of the obesity category to children under 5 years old, and the failure to adequately address the various measures of poor quality diets captured by ENANI-2019. As an alternative, based on an approach developed by Gyorgy Scrinis to reframing malnutrition in all its forms, we suggest a need for frameworks that focus on describing and classifying the nature of, and changes to, dietary patterns, rather than focused on health outcomes.
Collapse
Affiliation(s)
- Gyorgy Scrinis
- School of Agriculture and Food, University of Melbourne, Melbourne, Australia
| | | |
Collapse
|
33
|
Hall KD. From dearth to excess: the rise of obesity in an ultra-processed food system. Philos Trans R Soc Lond B Biol Sci 2023; 378:20220214. [PMID: 37482782 PMCID: PMC10363698 DOI: 10.1098/rstb.2022.0214] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/23/2023] [Indexed: 07/25/2023] Open
Abstract
More people now have obesity than suffer from starvation thanks to our modern food system. Agriculture was transformed over the 20th century by a variety of technological advancements that relied heavily on fossil fuels. In the United States, government policies and economic incentives led to surplus production of cheap inputs to processed food industries that produced a wide variety of heavily marketed, convenient, rewarding, timesaving, and relatively inexpensive ultra-processed foods. The energy available in the food supply increased by much more than the population needs, albeit with large inequities in nutrition security. While most of the rise in per capita food availability during the late 20th and early 21st centuries in the United States resulted in increased food waste, a variety of mechanisms have been proposed by which changes in the increasingly ultra-processed food environment resulted in excess energy intake disproportionately in people genetically susceptible to obesity. As populations continue to grow, substantial investments in coordinated nutrition and agricultural research are needed to transform our current food system to one that relies less on fossil fuels, preserves biodiversity, ensures environmental health, and provides equitable access to affordable, safe and nutritious food that reduces the prevalence of chronic diet-related diseases like obesity. This article is part of a discussion meeting issue 'Causes of obesity: theories, conjectures and evidence (Part I)'.
Collapse
Affiliation(s)
- Kevin D. Hall
- Integrative Physiology Section Chief, Laboratory of Biological Modeling, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, 12A South Drive, Room 4007, Bethesda, MD 20892-4007, USA
| |
Collapse
|
34
|
Zapata ME, Arrieta E, Beltramo B, Rovirosa A. Ultra-processed food consumption in Argentina according to income level and its association with the intake of healthy foods. NUTR BULL 2023; 48:317-328. [PMID: 37424053 DOI: 10.1111/nbu.12624] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/11/2023]
Abstract
Ultra-processed foods (UPFs) are associated with unhealthy diets and chronic diseases. Hence, knowing the consumption pattern of UPFs in the general population is crucial to design policies to improve public health, such as the recently approved law for the Promotion of Healthy Eating in Argentina (Law N° 27.642). The aim of the study was to characterise the consumption of UPFs according to income level and to assess their association with the intake of healthy foods in the Argentinian population. Healthy foods were defined in this study as those non-UPF groups that have been shown to reduce the risk of non-communicable diseases and excluded certain natural or minimally processed foods such as red meat, poultry and eggs. We retrieved data from the 2018-2019 National Nutrition and Health Survey (ENNyS 2), a cross-sectional, nationally representative survey performed in Argentina, including 15 595 inhabitants. We classified the 1040 food items recorded by the degree of processing using the NOVA system. UPFs represented nearly 26% of daily energy. The intake of UPFs increased with income, with a difference of up to 5 percentage points between the lowest (24%) and the highest (29%) income levels (p < 0.001). Cookies, industrial pastries, cakes and sugar-sweetened beverages were the most consumed UPF items, accounting for 10% of daily energy intake. We found that UPF intake was associated with a decrease in consumption of healthy food groups, mainly fruits and vegetables, where a difference of -28.3 g/2000 kcal and -62.3 g/2000 kcal between tertile 1 and tertile 3 was estimated, respectively. Therefore, Argentina still maintains a UPF consumption pattern of a low- and middle-income country, where UPF intake increases with income, but these foods also compete with the intake of healthy foods.
Collapse
Affiliation(s)
- María Elisa Zapata
- Centro de Estudios Sobre Nutrición Infantil Dr. Alejandro O'Donnell (CESNI), Ciudad Autónoma de Buenos Aires, Argentina
| | - Ezequiel Arrieta
- Instituto de Ciencia y Tecnología de los Alimentos Córdoba (ICYTAC), UNC-CONICET, Córdoba, Argentina
| | - Belén Beltramo
- Food Claims Centre Venlo, Campus Venlo, Faculty of Science and Engineering, Maastricht University, Venlo, The Netherlands
| | - Alicia Rovirosa
- Centro de Estudios Sobre Nutrición Infantil Dr. Alejandro O'Donnell (CESNI), Ciudad Autónoma de Buenos Aires, Argentina
| |
Collapse
|
35
|
Abstract
Food-based dietary guidelines have been the basis of public health recommendations for over half a century, but more recently, there has been a trend to classify the health properties of food not by its nutrient composition, but by the degree to which it has been processed. This concept has been supported by many association studies, narrative reviews and the findings from one randomised controlled feeding trial, which demonstrated the sustained effect of ultra-processed diets on increasing both energy intake and body weight. This has led to widespread speculation as to specific features of ultra-processed foods that promote increased energy intakes. Rising interest in the ultra-processed topic has led to proposals to include guidance and restrictions on the consumption of processed foods in national dietary guidelines, with some countries encouraging consumers to avoid highly processed foods completely, and only choose minimally processed foods. However, there remains a lack of consensus on the role of processed foods in human health when faced with the challenges of securing the food supply for a growing global population, that is, healthy, affordable and sustainable. There has also been criticism of the subjective nature of definitions used to differentiate foods by their degree of processing, and there is currently a lack of empirical data to support a clear mechanism by which highly processed foods promote greater energy intakes. Recommendations to avoid all highly processed foods are potentially harmful if they remove affordable sources of nutrients and will be impractical for most when an estimated two-thirds of current energy purchased are from processed or ultra-processed foods. The current review highlights some considerations when interpreting the dietary association studies that link processed food intake to health and offers a critique on some of the mechanisms proposed to explain the link between ultra-processed food and poor health. Recent research suggests a combination of higher energy density and faster meal eating rates are likely to influence meal size and energy intakes from processed foods and offers new perspectives on how to manage this in the future. In going beyond the ultra-processed debate, the aim is to summarise some important considerations when interpreting existing data and identify the important gaps for future research on the role of processed food in health.
Collapse
Affiliation(s)
- Ciarán G Forde
- Sensory Science and Eating Behaviour, Division of Human Nutrition and Health, Wageningen University and Research, P.O. Box 17, 6700 AA Wageningen, The Netherlands
| |
Collapse
|
36
|
Duque-Estrada P, Petersen IL. The sustainability paradox of processing plant proteins. NPJ Sci Food 2023; 7:38. [PMID: 37491430 PMCID: PMC10368665 DOI: 10.1038/s41538-023-00214-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 07/17/2023] [Indexed: 07/27/2023] Open
Affiliation(s)
- Patrícia Duque-Estrada
- Department of Food Science, Food Analytics and Biotechnology Section, University of Copenhagen, Rolighedsvej 26, 1958, Frederiksberg C, Denmark.
| | - Iben Lykke Petersen
- Department of Food Science, Food Analytics and Biotechnology Section, University of Copenhagen, Rolighedsvej 26, 1958, Frederiksberg C, Denmark
| |
Collapse
|
37
|
Valicente VM, Peng CH, Pacheco KN, Lin L, Kielb EI, Dawoodani E, Abdollahi A, Mattes RD. Ultraprocessed Foods and Obesity Risk: A Critical Review of Reported Mechanisms. Adv Nutr 2023; 14:718-738. [PMID: 37080461 PMCID: PMC10334162 DOI: 10.1016/j.advnut.2023.04.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/02/2023] [Accepted: 04/14/2023] [Indexed: 04/22/2023] Open
Abstract
Epidemiologic evidence supports a positive association between ultraprocessed food (UPF) consumption and body mass index. This has led to recommendations to avoid UPFs despite very limited evidence establishing causality. Many mechanisms have been proposed, and this review critically aimed to evaluate selected possibilities for specificity, clarity, and consistency related to food choice (i.e., low cost, shelf-life, food packaging, hyperpalatability, and stimulation of hunger/suppression of fullness); food composition (i.e., macronutrients, food texture, added sugar, fat and salt, energy density, low-calorie sweeteners, and additives); and digestive processes (i.e., oral processing/eating rate, gastric emptying time, gastrointestinal transit time, and microbiome). For some purported mechanisms (e.g., fiber content, texture, gastric emptying, and intestinal transit time), data directly contrasting the effects of UPF and non-UPF intake on the indices of appetite, food intake, and adiposity are available and do not support a unique contribution of UPFs. In other instances, data are not available (e.g., microbiome and food additives) or are insufficient (e.g., packaging, food cost, shelf-life, macronutrient intake, and appetite stimulation) to judge the benefits versus the risks of UPF avoidance. There are yet other evoked mechanisms in which the preponderance of evidence indicates ingredients in UPFs actually moderate body weight (e.g., low-calorie sweetener use for weight management; beverage consumption as it dilutes energy density; and higher fat content because it reduces glycemic responses). Because avoidance of UPFs holds potential adverse effects (e.g., reduced diet quality, increased risk of food poisoning, and food wastage), it is imprudent to make recommendations regarding their role in diets before causality and plausible mechanisms have been verified.
Collapse
Affiliation(s)
- Vinicius M Valicente
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States
| | - Ching-Hsuan Peng
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN, United States
| | - Kathryn N Pacheco
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States
| | - Luotao Lin
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States
| | - Elizabeth I Kielb
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN, United States
| | - Elina Dawoodani
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States
| | - Afsoun Abdollahi
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States
| | - Richard D Mattes
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States.
| |
Collapse
|
38
|
Harnessing the connectivity of climate change, food systems and diets: Taking action to improve human and planetary health ☆. ANTHROPOCENE 2023; 42:100381. [PMCID: PMC10084708 DOI: 10.1016/j.ancene.2023.100381] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/07/2023] [Accepted: 04/07/2023] [Indexed: 09/02/2024]
Abstract
With climate change, the COVID-19 pandemic, and ongoing conflicts, food systems and the diets they produce are facing increasing fragility. In a turbulent, hot world, threatened resiliency and sustainability of food systems could make it all the more complicated to nourish a population of 9.7 billion by 2050. Climate change is having adverse impacts across food systems with more frequent and intense extreme events that will challenge food production, storage, and transport, potentially imperiling the global population’s ability to access and afford healthy diets. Inadequate diets will contribute further to detrimental human and planetary health impacts. At the same time, the way food is grown, processed, packaged, and transported is having adverse impacts on the environment and finite natural resources further accelerating climate change, tropical deforestation, and biodiversity loss. This state-of-the-science iterative review covers three areas. The paper's first section presents how climate change is connected to food systems and how dietary trends and foods consumed worldwide impact human health, climate change, and environmental degradation. The second area articulates how food systems affect global dietary trends and the macro forces shaping food systems and diets. The last section highlights how specific food policies and actions related to dietary transitions can contribute to climate adaptation and mitigation responses and, at the same time, improve human and planetary health. While there is significant urgency in acting, it is also critical to move beyond the political inertia and bridge the separatism of food systems and climate change agendas that currently exists among governments and private sector actors. The window is closing and closing fast.
Collapse
|
39
|
Galvão LLP, Santos TSS, Slater B, Lyra CDO, Rolim PM, Ramalho AA, Dalamaria T, Martins FA, Höfelmann DA, Crispim SP, Gorgulho BM, Rodrigues PRM, Marchioni DM, Maciel BLL. Diet quality and associated factors in Brazilian undergraduates during the COVID-19 pandemic. Front Nutr 2023; 10:1169147. [PMID: 37293675 PMCID: PMC10244745 DOI: 10.3389/fnut.2023.1169147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/04/2023] [Indexed: 06/10/2023] Open
Abstract
Background Diet quality is associated with psychobiological, psychological, biological, and physiological factors of individuals, and in the context of prolonged stress, such as the COVID-19 pandemic, it can lead to a worsening of the quality of food for undergraduates. This study aimed to analyze diet quality and associated factors in Brazilian undergraduates. Methods Data were collected from 4,799 undergraduate students from all Brazilian regions, from August 2020 to February 2021. The online questionnaire contained socioeconomic variables, the ESQUADA scale to assess diet quality, self-referred changes in weight, the Brazilian food insecurity scale (EBIA), sleep assessment and the perceived stress scale. Unconditional multiple logistic regression analysis was performed to study variables associated with poor and very poor diet quality. Results Most of participants presented a good diet quality (51.7%), while 9.8% had a poor or very poor diet quality and only 1.1% had an excellent diet quality. 58.2% of undergraduates reported to have an increase in weight during the pandemic and 74.3% of the students presented elevated stress during the pandemic. Logistic regressions showed students who gained weight during the pandemic presented the highest AOR = 1.56 (95% CI = 1.12-2.20) for poor or very poor diet quality. The elevated perceived stress was also associated with a higher AOR = 2.85 (95% CI = 1.71-4.74) for poor or very poor diet quality. Conclusion Most of the studied undergraduates presented a good diet quality. Nevertheless, poor/very poor diet quality was associated with higher perceived stress and weight gain. Our study indicated that policies should beaimed at the socioeconomically most vulnerable undergraduates, those in a situation of food and nutritional insecurity, high perceived stress, and who gained weight during the pandemic.
Collapse
Affiliation(s)
- Liana L. P. Galvão
- Health Sciences Postgraduate Program, Nutrition Department, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Thanise S. S. Santos
- Nutrition Interventions Research Group, School of Nursing, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
- Faculty of Public Health, Center for Epidemiological Research in Nutrition and Health (NUPENS), University of São Paulo, São Paulo, SP, Brazil
| | - Betzabeth Slater
- Nutrition Department, School of Public Health, University of São Paulo, São Paulo, SP, Brazil
| | - Clélia de O. Lyra
- Health Sciences Postgraduate Program, Nutrition Department, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Priscilla M. Rolim
- Health Sciences Postgraduate Program, Nutrition Department, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Alanderson A. Ramalho
- Graduate Program in Public Health, Federal University of Acre, Rio Branco, AC, Brazil
- Health and Sports Science Center, Nutrition Course, Federal University of Acre, Rio Branco, AC, Brazil
| | - Tatiane Dalamaria
- Health and Sports Science Center, Nutrition Course, Federal University of Acre, Rio Branco, AC, Brazil
| | - Fernanda Andrade Martins
- Health and Sports Science Center, Nutrition Course, Federal University of Acre, Rio Branco, AC, Brazil
| | - Doroteia A. Höfelmann
- Food and Nutrition Postgraduate Program, Nutrition Department, Federal University of Parana, Curitiba, PR, Brazil
| | - Sandra P. Crispim
- Food and Nutrition Postgraduate Program, Nutrition Department, Federal University of Parana, Curitiba, PR, Brazil
| | - Bartira M. Gorgulho
- Department of Food and Nutrition, Federal University of Mato Grosso, Nutrition Faculty, Cuiabá, MT, Brazil
| | - Paulo R. M. Rodrigues
- Department of Food and Nutrition, Federal University of Mato Grosso, Nutrition Faculty, Cuiabá, MT, Brazil
| | - Dirce M. Marchioni
- Nutrition Department, School of Public Health, University of São Paulo, São Paulo, SP, Brazil
| | - Bruna L. L. Maciel
- Health Sciences Postgraduate Program, Nutrition Department, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| |
Collapse
|
40
|
Ortenzi F, Kolby M, Lawrence M, Leroy F, Nordhagen S, Phillips SM, van Vliet S, Beal T. Limitations of the Food Compass Nutrient Profiling System. J Nutr 2023; 153:610-614. [PMID: 36787879 DOI: 10.1016/j.tjnut.2023.01.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/31/2022] [Accepted: 01/10/2023] [Indexed: 02/04/2023] Open
Abstract
Nutrient Profiling Systems provide frameworks to assess the healthfulness of foods based on food composition and are intended as inputs into strategies to improve diets. Many Nutrient Profiling Systems are founded on a reductionist assumption that the healthfulness of foods is determined by the sum of their individual nutrients, with no consideration for the extent and purpose of processing and its health implications. A novel Nutrient Profiling System called Food Compass attempted to address existing gaps and provide a more holistic assessment of the healthfulness of foods. We propose that the chosen algorithm is not well justified and produces results that fail to discriminate for common shortfall nutrients, exaggerate the risks associated with animal-source foods, and underestimate the risks associated with ultraprocessed foods. We caution against the use of Food Compass in its current form to inform consumer choices, policies, programs, industry reformulations, and investment decisions.
Collapse
Affiliation(s)
| | - Marit Kolby
- Bjørknes University College, Department of Health Sciences, Oslo, Norway
| | - Mark Lawrence
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Australia
| | - Frédéric Leroy
- Industrial Microbiology and Food Biotechnology (IMDO), Faculty of Sciences and Bioengineering Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Stuart M Phillips
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Stephan van Vliet
- Center for Human Nutrition Studies, Utah State University, Logan, UT, United States
| | - Ty Beal
- Global Alliance for Improved Nutrition, Washington, DC, United States; Institute for Social, Behavioral and Economic Research, University of California, Santa Barbara, CA, United States.
| |
Collapse
|