Ultra-processed food consumption among US adults from 2001 to 2018

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

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

Environmental Risk Factors for Systemic Lupus Erythematosus Through the Lens of Social Determinants of Health

Systemic lupus erythematosus (SLE) is a serious multisystem autoimmune disease, marked by alarming sociodemographic inequities. In the United States and around the world, social disadvantage is strongly tied to higher prevalence, more severe disease, and poorer outcomes. A growing list of environmental exposures that contribute to the risk and incidence of SLE have been investigated, and many are now established. However, these environmental exposures-including exposure to air pollution and other contaminants, lifestyle and behavioral factors, and psychologic stress and distress-are not evenly distributed in any population. Individuals of lower socioeconomic status and historically minoritized groups suffer from an imbalanced burden of adverse environmental exposures. In research, clinical practice, and policy making, the strong association of social determinants of health (SDoH) with these exposures has not been given adequate spotlight. In this narrative review, we examine known associations between environmental exposures and SLE risk through the lens of SDoH, laying the foundation for future research and policies to target the environmental risk factors for SLE with awareness of the populations disproportionately affected and the contributing SDoH.

Association Between Ultraprocessed Food Intake and Self-Reported Arthritis

INTRODUCTION

Ultraprocessed foods are typically high in fat, salt, sugar, and food additives, which may contribute to the development of arthritis. This study examined the association between ultraprocessed food intake and the presence of self-reported arthritis.

METHODS

The 2001-2018 U.S. National Health and Nutrition Examination Survey data was used to analyze the association between ultraprocessed food intake and arthritis in 2025. Ultraprocessed foods were identified by applying Nova classifications to 24-hour dietary recall data and expressed as a percentage of daily total energy intake. The outcomes were self-reported physician's diagnosis of arthritis, osteoarthritis, and rheumatoid arthritis. Survey-weighted logistic regressions were conducted to analyze associations between ultraprocessed food intake and outcomes, controlling for age, gender, race/ethnicity, smoking status, health insurance status, and poverty-to-income ratio.

RESULTS

UPFs contributed 55.2% of the daily total energy intake in the U.S.

POPULATION

After adjusting for covariates, a positive association was found between daily total energy intake from ultraprocessed foods and self-reported arthritis (AOR associated with each 10-percentage point increase in intake: 1.04; 95% CI=1.02, 1.06). For the second, third, and fourth quartiles of ultraprocessed food intake, the AOR of arthritis was 1.14 (95% CI=1.04, 1.25), 1.22 (95% CI=1.10, 1.35), and 1.27 (95% CI=1.14, 1.41), respectively (p for linear trend <0.001). A positive association was also observed between ultraprocessed food intake and rheumatoid arthritis (AOR=1.05; 95% CI=1.02, 1.09) but not for osteoarthritis.

CONCLUSIONS

In this nationally representative sample of U.S. adults, higher consumption of ultraprocessed foods was associated with overall arthritis and rheumatoid arthritis.

Food Rx: Integrating horticulture research to improve nutrition and health

It is clear that the escalating epidemic of insulin resistance and type 2 diabetes has reached a crisis level in the United States, that overweight and obesity are drivers, and that diets and the food system have major roles. It is also clear that nutrition and medical research point to increased healthful fruit and vegetable intake as a key part of any strategy to manage the crisis. But although increasing healthful intake entails both expanding production of fruits and vegetables and improving their healthful characteristics, horticulture has generally been sidelined or taken for granted when strategies are envisioned. This article makes the case that horticulture research and practice can and should be equal partners with nutrition and medicine in the pressing search for effective crisis-management strategies. To do so, it first "runs the numbers" for the scale of the crisis, for trends in fruit and vegetable intake and production, for the scant federal support for horticultural crop production and research, and for horticulture research's high return on investment. The article then sketches a roadmap to integrate horticulture research and community outreach with nutrition and healthcare, stressing new opportunities. The goal is a US food system that i) makes healthful fruits and vegetables accessible, affordable, and appealing for all and ii) complements a healthcare system spanning patient-based to population-based nutrition.

Dietary zinc intake associated with stroke in American adults

Evidence on the relationship between dietary zinc intake and stroke in American populations is limited. This study aimed to investigate the association between dietary zinc consumption and stroke prevalence among US adults. This cross-sectional study analyzed data from adults (≥ 18 years) who participated in the National Health and Nutrition Examination Survey (NHANES) between 2013 and 2020. Dietary zinc intake, stroke history, and other relevant factors were examined. Logistic regression models were used to assess the association between dietary zinc consumption and stroke risk, while restricted cubic splines (RCS) were applied to explore potential non-linear relationships. A total of 2642 adults from four NHANES cycles (2013-2020) were included in the analysis. In multivariate logistic regression, individuals in the second quartile of dietary zinc intake (Q2: 6.09-8.83 mg/day) had a significantly lower odds ratio (OR) for stroke (OR = 0.64, 95% confidence interval (CI) 0.41-0.99, p = 0.044) compared with those in the lowest quartile (Q1: ≤6.08 mg/day). RCS analysis indicated an L-shaped relationship between dietary zinc intake and stroke odds (p = 0.041). Threshold analysis revealed that for individuals consuming less than 8.82 mg of zinc daily, the OR for stroke was 0.858 (95% CI 0.74-0.99, p = 0.037). Our findings suggest an L-shaped association between dietary zinc intake and stroke prevalence in American adults, with higher zinc intake associated with lower odds of stroke within a specific intake range.

Ultra-processed food intake, diet quality, and risk of gestational diabetes mellitus: a cross-sectional analysis from the Mutaba'ah study

BACKGROUND

High intake of Ultra-Processed Foods (UPF) has raised concerns about how they might impact maternal diet and potentially increase the risk of Gestational Diabetes Mellitus (GDM). This study aimed to evaluate the associations between UPF intake or adherence to the Mediterranean Diet and GDM among pregnant women in the United Arab Emirates.

METHODS

Pregnant women (n = 1054) from the dietary subcohort within the prospective Mutaba'ah Study cohort were included. Diet was assessed through a semi-quantitative food frequency questionnaire, and UPF intake in servings/day was classified according to the NOVA system. The alternate Mediterranean Diet (aMED) score specific for pregnancy defined adherence to the Mediterranean Diet. GDM diagnosis was based on the National Institute for Health and Clinical Excellence criteria. Logistic regression models adjusted for maternal age, first trimester body mass index, parity, gestational age, education level, employment status, physical activity, and husband's smoking status were used to assess associations between UPF intake or aMED score and GDM.

RESULTS

Mean ± SD UPF intake was 9.4 ± 3.4 servings/day and mean aMED score was 4.0 ± 1.5. Women in the highest tertile of UPF intake had lower aMED score than those in the lowest tertile (4.3 ± 1.4 vs. 3.6 ± 1.4, P < 0.001). Women in the highest tertile of UPF intake had higher intakes of carbohydrates, saturated fatty acids, sodium, and selenium than those in the lowest tertile, while intakes of protein, total fat, monounsaturated fatty acids, and most micronutrients were lower (P < 0.05). Neither tertiles of UPF intake (third tertile compared to the lowest OR = 0.85, 95% CI: 0.54-1.34) nor continuous UPF intake (OR = 0.97, 95% CI: 0.92-1.03) was associated with GDM. Similarly, aMED score was not associated with GDM in either tertile of the score (third tertile compared to the lowest OR = 0.94, 95% CI: 0.54-1.64) or as a continuous variable (OR = 0.99, 95% CI: 0.87-1.11).

CONCLUSIONS

Higher intake of UPF was associated with a lower adherence to the Mediterranean Diet. However, neither UPF intake nor aMED score was associated with GDM.

Ultra-processed food intake and risk of ovarian and endometrial cancer in the NIH-AARP cohort: a prospective cohort analysis: Ultra-processed food, ovarian & endometrial cancer

BACKGROUND

Ultra-processed food (UPF) accounts for more than half of caloric intake by the US population. UPF intake has been linked to weight gain and obesity, a known risk factor for cancer, including endometrial cancer.

OBJECTIVE

The objective of this study was to evaluate the prospective association of UPF intake with ovarian and endometrial cancer risk.

METHODS

Participants in the NIH-AARP Diet and Health Study reported baseline diet using a food frequency questionnaire (FFQ). We disaggregated FFQ items to assign Nova classification and created quintiles of energy-adjusted UPF intake (grams/day). We used Cox proportional hazard models, adjusted for potential confounding factors, to estimate hazard ratios (HR) and 95% confidence intervals (CI) for epithelial ovarian and endometrial cancer incidence, overall and by histotype.

RESULTS

Among 129,870 female participants, without a history of oophorectomy or cancer, 1234 epithelial ovarian cancer cases were diagnosed during >20 years of follow-up. UPF intake was not associated with ovarian cancer risk (quintile 5 compared with quintile 1: HR=0.92; 95% CI=0.77, 1.11), overall or by histotype. Among 107,592 female participants, without a history of hysterectomy or cancer, 2249 endometrial cancer cases were diagnosed. Participants in the highest quintile of UPF intake tended to have higher BMI (median [IQR] BMI, 27.4 [23.9-31.7] kg/m2) than those in the lowest quintile (24.4 [22.0-28.0] kg/m2). Higher UPF intake was associated with increased endometrial cancer risk (HR=1.25; 1.09, 1.43). The association was no longer observed after adjusting for BMI (HR=0.96; 0.83, 1.10). HR estimates were similar for Type I endometrial cancer, the subtype most strongly associated with BMI.

CONCLUSIONS

In this cohort of US females who were at risk of developing endometrial or ovarian cancer, we found evidence of a positive association between UPF intake and endometrial, but not ovarian cancer. The positive association with endometrial cancer was not independent of BMI.

Ultra-Processed Foods in the Food Supply: Prevalence, Nutritional Composition and Use of Voluntary Labelling Schemes

BACKGROUND

Ultra-processed foods (UPFs) represent a substantial part of modern diets, with a growing prevalence in food environments worldwide. Their unfavourable nutritional composition and adverse health effects present growing public health concerns.

METHODS

This study examines the prevalence of UPFs in the Slovenian food supply, their nutritional quality and the use of different food symbols and labelling schemes on food packaging. A cross-sectional analysis was conducted using the representative Slovenian branded foods database. A total of 23,173 prepacked foods and beverages were categorised into levels of processing according to the NOVA classification system. The nutritional composition of UPFs was compared to less processed products within 16 narrow subcategories. Additionally, the prevalence in the use of front-of-package nutrition labelling (FOPNL) and subjectively nutrition-related elements (SNREs) (such as EU Organic, Vegan labels etc.) were assessed across different food categories and processing levels.

RESULTS

Results show that UPFs represent 54.5% of the available products in the Slovenian food supply, with the highest prevalence in Confectionery (93%), Bread and bakery products (83%), Meat, meat products and alternatives (77%) and Convenience foods (74%). Comparison of nutritional composition indicated that UPFs had significantly poorer nutritional composition compared to less processed counterparts, including higher levels of sugar, salt and saturated fats, and a lower protein content. Breakfast cereals, Snack foods, Meat alternatives and Pre-prepared salads and sandwiches showed the most significant differences between UPFs and less processed counterparts. Analysis of the prevalence of symbols and labelling schemes revealed that 33.8% of products carried at least one FOPNL (15.0%) or SNRE (19.1%), with SNREs being more prevalent on less processed products and FOPNL predominantly used on UPFs (p < 0.05). The most prevalent SNRE was the EU Organic logo (12.7%), followed by the Vegan (4.7%) and Non-GMO (3.1%) logos, whereas the most frequent FOPNL was Reference Intakes (RI), presenting only energy value RI-Energy (12.5%), followed by nutrient-specific RI (1.6%), while other FOPNL were scarce and limited to certain categories. An additional comparison of visual presentation highlighted the potentially selective use of voluntary FOPNL to improve product framing. This raises concerns about their role in guiding consumer choices versus serving as marketing tools, especially when it comes to UPFs.

CONCLUSIONS

Our findings highlight the need for monitoring UPFs in the food supply together with harmonised, mandatory labelling regulations to ensure transparency and empower consumers to make healthier choices.

Impact of ultra-processed foods on hedonic and homeostatic appetite regulation: A systematic review

The rapid rise in ultra-processed foods (UPF) consumption correlates with the growing global obesity prevalence. Investigating the hedonic and homeostatic mechanisms affected by UPF may provide insights for obesity prevention and appetite regulation. This systematic review aimed to examine the current understanding of the potential effects of UPF on appetite regulation and food intake, examining both hedonic and homeostatic pathways. A search was performed in PubMed, Scopus, Web of Science, and EMBASE databases, and studies published in English language were selected. Study selection and inclusion/exclusion criteria were determined based on PECOS framework. The quality of the studies was evaluated using appropriate Cochrane Risk of Bias tools and all articles were found to have low risk of bias. Of the 11 studies included, three were randomized controlled trials, one was cross-over study, one was non-randomized controlled study, and six were observational studies. Results indicated that UPF consumption may influence to hedonic appetite by promoting faster eating rates, enhancing palatability, activating brain reward circuits, and potentially increasing food addiction behaviors. Additionally, UPF intake may disrupt homeostatic appetite regulation by altering gut-brain axis signaling and modulating peripheral peptides such as ghrelin, GLP-1, GIP, and PYY. However, findings on both hedonic and homeostatic mechanisms remain inconclusive due to heterogeneous study designs, general characteristics of participants, and varying baseline UPF intake. These findings suggest that reducing UPF consumption could be a relevant target for appetite and weight management strategies, highlighting the need for more mechanistic and longitudinal research.

A diverse set of solubilized natural fibers drives structure-dependent metabolism and modulation of the human gut microbiota

Growing evidence suggests that inadequate dietary fiber intake, termed the "fiber gap," is linked to disease states through disruption of the gut microbiota. Despite this, our understanding of how various fiber structures influence the microbiota and health is limited by the lack of diverse commercially available fibers. Studies have primarily focused on a limited range of fibers, rather than the diverse array of fibers representative of those commonly found in our diets. In this study, we aimed to investigate how naturally derived fibers impact the human microbiota and their metabolic products. We performed a comprehensive structural characterization and functional evaluation of a unique and highly diverse set of new, highly soluble fibers with varied monosaccharide compositions, glycosidic linkages, and polymer lengths. Using an ex vivo high-throughput human microbiota platform coupled with metabolomic profiling, we demonstrate that these diverse fibers drive distinct and consistent microbial and metabolic profiles across cohorts of donors in a structure-dependent manner. These metabolic effects were accompanied by both general and donor-specific changes in microbial taxa. Finally, we demonstrate that integrating detailed glycomic characterization with microbial and metabolomic data allowed for prediction of functional outcomes driven by a novel material, pineapple pulp fiber. This work highlights the potential for targeted dietary fiber interventions to modulate the microbiota and improve health outcomes, paving the way for the development of new fiber-rich products with specific health benefits.IMPORTANCEFiber deficiency is associated with numerous disease states, many of which are linked to disruption of the gut microbiota. This study encompasses the first systematic and comprehensive characterization of a diverse collection of naturally derived solubilized fibers and their impacts on the microbiota. The results expand our understanding of the beneficial effects of specific carbohydrate structures naturally found in the human diet, highlighting the potential for designing fiber-based health interventions. The high solubility of these fibers increases both the range of products they can be incorporated in as well as their assayability in experiments, enabling a widespread increase in fiber consumption and positive health impacts.

Current and forecasted 10-year prevalence and incidence of inflammatory bowel disease in Hong Kong, Japan, and the United States

BACKGROUND

The rising incidence of inflammatory bowel disease (IBD) globally has increased disease burden and economic impact. Gaps remain in understanding the IBD burden between Asian and Western populations.

AIM

To estimate the current and following 10-year prevalence and incidence of IBD in Hong Kong, Japan, and the United States.

METHODS

Patients diagnosed with IBD were identified from a territory-wide electronic medical records database in Hong Kong (2003-2022, including all ages) and two large employment-based healthcare claims databases in Japan and the United States (2010-2022, including < 65 age). We used Autoregressive Integrated Moving Average models to predict prevalence and incidence from 2023 to 2032, stratified by disease subtype [ulcerative colitis (UC); Crohn’s disease (CD)], sex, and age, with 95% prediction intervals (PIs). The forecasted annual average percentage change (AAPC) with 95% confidence intervals was calculated.

RESULTS

The age-standardized prevalence of IBD for 2032 is forecasted at 105.88 per 100000 in Hong Kong (95%PI: 83.01-128.75, AAPC: 5.85%), 645.79 in Japan (95%PI: 562.51-741.39, AAPC: 5.78%), and 629.85 in the United States (95%PI: 569.09-690.63, AAPC: 2.85%). Prevalence is estimated to rise most significantly among those under 18 in Japan and the United States. Over the next decade, the incidence of IBD is estimated to increase annually by 3.3% in Hong Kong with forecasted increases across all age groups (although the AAPC for each group is not statistically significant); by 2.88% in Japan with a significant rise in those under 18 and stability in 18-65; and remaining stable in the United States. By 2032, the prevalence of CD is estimated to surpass UC in Hong Kong and the United States, whereas UC will continue to be more prevalent in Japan. A higher prevalence and incidence of IBD is forecast for males in Hong Kong and Japan, whereas rates will be similar for both males and females in the United States.

CONCLUSION

The prevalence of IBD is forecasted to increase in Hong Kong, Japan, and the United States, while estimates of incidence vary. The forecasts show distinct patterns across disease subtype, sex, and age groups. Health systems will need to plan for the predicted increasing prevalence among different demographics.

Agreement between the National Cancer Institute's Diet History Questionnaire II and III in a preconception cohort

Food frequency questionnaires require updating over time due to population changes in diet, posing analytical challenges in consistently measuring diet in prospective studies. We compared reliability and agreement between nutrients in versions of the National Cancer Institute's web-based Diet History Questionnaire (DHQ, III vs II) in an ongoing North American preconception study. We invited 51 consecutively enrolled US female participants aged 21-45 years to complete both DHQ versions within a 2-week period in a randomized order. We compared 30 nutrients from both DHQ versions and calculated within-person reliability using intraclass correlation coefficients (ICCs). Bland-Altman plots and 95% limits of agreement (LOA) were generated to assess nutrient agreement between DHQ versions. We observed highest reliability in percent energy from carbohydrates and cholesterol (ICCs, 0.88; 95% IC, 0.80-0.93) and lowest for percent energy from protein and vitamin D (ICCs, 0.56; 95% IC, 0.34-0.72). At the group level, all nutrients had most observations within the LOA. Bland-Altman plots showed assessment differences between DHQs for protein, fat, monounsaturated fat, and vitamin D. The remaining nutrients showed good agreement and good to moderate reliability. Some nutrients may require adjustment and calibration analysis before using them interchangeably across DHQ versions.

Ultra-processed foods and premenstrual syndrome symptoms: Does consumption amount increase symptom severity?

Background: Nutrition can influence the occurrence of Premenstrual Syndrome (PMS) symptoms such as depression and food addiction. However, there is insufficient evidence on how ultra processed foods (UPFs) characterised by high sugar, fat and additive content contribute to PMS symptoms. Aim: This study aimed to examine the relationship between UPF consumption and PMS symptoms including depressed affect, anxiety, fatigue, irritability, and pain severity among female university students. Methods: The study is cross sectional. It was conducted among 432 female students from Bandirma Onyedi Eylul University. The data collection tools included descriptive information form, UPF consumption frequency questionnaire, and the PMS scale. Numbers, percentages, mean, standard deviation and multiple linear regression analysis were used in the analysis of the data. Results: In this study in Model 1 and Model 2 and Model 3 adjusted for confounding variables, an increase in UPF consumption was found to be associated with an increase in PMS scale subscale scores (p < 0.05). Conclusion: This study shows that an increase in UPF consumption exacerbates PMS symptoms such as depression, anxiety, fatigue, irritability, depressive thoughts, pain, appetite changes, and sleep changes, except bloating. Given these results, limiting UPF intake and adopting a balanced diet rich in whole foods, fiber, and essential nutrients may help alleviate PMS symptoms. Future interventions should focus on dietary education and awareness programs to promote healthier eating habits among young women.

Performance of a Food Frequency Questionnaire for Estimating Ultraprocessed Food Intake According to the Nova Classification System in the United States NIH-American Association of Retired Persons (AARP) Diet and Health Study

BACKGROUND

How accurately ultraprocessed food (UPF) intake is measured by food frequency questionnaire (FFQ) is unknown.

OBJECTIVES

We evaluated the performance of a 124-item FFQ for estimating UPF intake with Nova.

METHODS

In 1311 NIH-American Association of Retired Persons Diet and Health Study participants who completed 2 nonconsecutive 24-hour dietary recalls (24HDR) and 2 FFQ, we used 2 methods to estimate UPF intake. First, 4 experts independently matched FFQ items to food descriptions from another FFQ classified previously according to Nova. Discordant descriptions were discussed, and a consensus reached. Second, data from the 1994-1996 Continuing Survey of Food Intake of Individuals were used to match disaggregated FFQ items to Food and Nutrient Database for Dietary Studies (FNDDS) and standard reference (SR) codes. Nova classification of FNDDS and SR codes was based on database linkage. We evaluated FFQ performance using a measurement error model with 2 24HDR as the reference to estimate validity coefficients (ρQ,T) and attenuation factors (λQ). We applied parametric bootstrapping to construct 95% confidence intervals, accounting for the repeated measures structure in the data.

RESULTS

For energy-adjusted, kilocalories from UPF (kcal/d), ρQ,T were 0.50 (0.39-0.61) and 0.44 (0.30-0.59), for males and females, respectively, for the expert consensus method (ECM) and 0.52 (0.40-0.63) and 0.43 (0.29-0.57) for the food code method (FCM). For energy-adjusted, gram weight from UPF (g/d), ρQ,T were 0.65 (0.60-0.71) and 0.66 (0.60-0.72) for the ECM and 0.66 (0.52-0.65) and 0.66 (0.59-0.72) for the FCM; λQ were ≥0.50 for both methods. UPF variables, defined using the ECM and FCM but expressed in the same unit, were highly correlated (r ≥ 0.97).

CONCLUSIONS

FCM, performed similarly to ECM but has the potential to standardize UPF exposures across studies because the Nova categorization is assigned at a more granular level through database linkage. UPF intake based on energy-adjusted gram weight outperformed intake based on energy alone.

Associations of Ultra-Processed Food Intake and Its Circulating Metabolomic Signature with Mental Disorders in Middle-Aged and Older Adults

BACKGROUND

The global rise in ultra-processed food (UPF) consumption and the persistent burden of mental disorders have raised growing public health concerns. Emerging evidence suggests that unfavorable dietary patterns, particularly with high UPF intake, contribute to the development of mental disorders.

OBJECTIVE

To assess the associations of UPF-related metabolic signatures and mental disorders.

METHODS

In this population-based cohort study of 30,059 participants from the UK Biobank, we first identified a plasma metabolic signature associated with UPF intake leveraging nuclear magnetic resonance metabolomics. We then applied Cox and logistic regression models to investigate the associations of both UPF consumption and its metabolic signature with incident mental disorders and specific psychological symptoms, respectively.

RESULTS

Higher UPF intake was significantly associated with increased risks of overall mental disorder (hazard ratio per 10% increment [95% confidence interval]: 1.04 [1.02, 1.06]), depressive disorder (1.14 [1.08, 1.20]), anxiety disorder (1.12 [1.06, 1.18]), and substance use disorder (1.06 [1.01, 1.11]), as well as several psychological symptoms including suicidal ideation (odds ratios [95% confidence interval]: 1.12 [1.03, 1.16]) and anxiety feeling (1.05 [1.01, 1.09]). Similarly, the UPF-related metabolic signature was independently associated with elevated risks of these mental health outcomes and partially mediated the associations between UPF intake and mental disorders.

CONCLUSIONS

These findings highlighted the potential metabolic pathways underlying the neuropsychiatric risks of UPF consumption and underscored the importance of dietary quality in mental health.

Identification and validation of poly-metabolite scores for diets high in ultra-processed food: An observational study and post-hoc randomized controlled crossover-feeding trial

BACKGROUND

Ultra-processed food (UPF) accounts for a majority of calories consumed in the United States, but the impact on human health remains unclear. We aimed to identify poly-metabolite scores in blood and urine that are predictive of UPF intake.

METHODS AND FINDINGS

Of the 1,082 Interactive Diet and Activity Tracking in AARP (IDATA) Study (clinicaltrials.gov ID NCT03268577) participants, aged 50-74 years, who provided biospecimen consent, n = 718 with serially collected blood and urine and one to six 24-h dietary recalls (ASA-24s), collected over 12-months, met eligibility criteria and were included in the metabolomics analysis. Ultra-high performance liquid chromatography with tandem mass spectrometry was used to measure >1,000 serum and urine metabolites. Average daily UPF intake was estimated as percentage energy according to the Nova system. Partial Spearman correlations and Least Absolute Shrinkage and Selection Operator (LASSO) regression were used to estimate UPF-metabolite correlations and build poly-metabolite scores of UPF intake, respectively. Scores were tested in a post-hoc analysis of a previously conducted randomized, controlled, crossover-feeding trial (clinicaltrials.gov ID NCT03407053) of 20 subjects who were admitted to the NIH Clinical Center and randomized to consume ad libitum diets that were 80% or 0% energy from UPF for 2 weeks immediately followed by the alternate diet for 2 weeks; eligible subjects were between 18-50 years old with a body mass index of >18.5 kg/m2 and weight-stable. IDATA participants were 51% female, and 97% completed ≥4 ASA-24s. Mean intake was 50% energy from UPF. UPF intake was correlated with 191 (of 952) serum and 293 (of 1,044) 24-h urine metabolites (FDR-corrected P-value < 0.01), including lipid (n = 56 serum, n = 22 24-h urine), amino acid (n = 33, 61), carbohydrate (n = 4, 8), xenobiotic (n = 33, 70), cofactor and vitamin (n = 9, 12), peptide (n = 7, 6), and nucleotide (n = 7, 10) metabolites. Using LASSO regression, 28 serum and 33 24-h urine metabolites were selected as predictors of UPF intake; biospecimen-specific scores were calculated as a linear combination of selected metabolites. Overlapping metabolites included (S)C(S)S-S-Methylcysteine sulfoxide (rs = -0.23, -0.19), N2,N5-diacetylornithine (rs = -0.27 for serum, -0.26 for 24-h urine), pentoic acid (rs = -0.30, -0.32), and N6-carboxymethyllysine (rs = 0.15, 0.20). Within the cross-over feeding trial, the poly-metabolite scores differed, within individual, between UPF diet phases (P-value for paired t test < 0.001). IDATA Study participants were older US adults whose diets may not be reflective of other populations.

CONCLUSIONS

Poly-metabolite scores, developed in IDATA participants with varying diets, are predictive of UPF intake and could advance epidemiological research on UPF and health. Poly-metabolite scores should be evaluated and iteratively improved in populations with a wide range of UPF intake.

Sociodemographic and dietary predictors of maternal and placental mycoestrogen concentrations in a US pregnancy cohort

BACKGROUND

Zearalenone (ZEN) is a mycotoxin contaminating grains and processed foods. ZEN alters nuclear estrogen receptor α/β signaling earning its designation as a mycoestrogen. Experimental evidence demonstrates that mycoestrogen exposure during pregnancy is associated with altered maternal sex steroid hormones, changes in placental size, and decreases in fetal weight and length. While mycoestrogens have been detected in human biospecimens worldwide, exposure assessment of ZEN in US populations, particularly during pregnancy, is lacking.

OBJECTIVE

To characterize urinary and placental concentrations of ZEN and its metabolites in healthy US pregnant people and examine demographic, perinatal, and dietary predictors of exposure.

METHODS

Urine samples were collected in each trimester from pregnant participants in the UPSIDE study and placenta samples were collected at delivery (Rochester, NY, n = 317). We used high performance liquid chromatography and high-resolution tandem mass spectrometry to measure total urinary (ng/ml) and placental mycoestrogens (ng/g). Using linear regression and linear mixed effect models, we examined associations between mycoestrogen concentrations and demographic, perinatal, and dietary factors (Healthy Eating Index [HEI], ultra-processed food [UPF] consumption).

RESULTS

Mycoestrogens were detected in 97% of urines (median 0.323 ng/ml) and 84% of placentas (median 0.012 ng/g). Stability of urinary mycoestrogens across pregnancy was low (ICC: 0.16-0.22) and did not correlate with placental levels. In adjusted models, parity (multiparous) and pre-pregnancy BMI (higher) predicted higher urinary concentrations. Birth season (fall) corresponded with higher placental mycoestrogens. Dietary analyses indicated that higher HEI (healthier diets) predicted lower exposure (e.g., Σmycoestrogens %∆ -2.03; 95%CI -3.23, -0.81) and higher percent calories from UPF predicted higher exposure (e.g., Σmycoestrogens %∆ 1.26; 95%CI 0.29, 2.24).

IMPACT

The mycotoxin, zearalenone (ZEN), has been linked to adverse health and reproductive impacts in animal models and livestock. Despite evidence of widespread human exposure, relatively little is known about predictors of exposure. In a pregnant population, we observed that maternal ZEN concentrations varied by maternal pre-pregnancy BMI and parity. Consumption of ultra-processed foods, added sugars, and refined grains were linked to higher ZEN concentrations while healthier diets were associated with lower levels. Our research suggests disparities in exposure that are likely due to diet. Further research is needed to understand the impacts of ZEN on maternal and offspring health.

Ultra-Processed Food and Chronic Kidney Disease Risk: A Systematic Review, Meta-Analysis, and Recommendations

Background: Ultra-processed foods (UPFs) are formulations of ingredients that are mostly of exclusive industrial use and may contain additives like artificial colors, flavors, or stabilizers. The sale and consumption of these foods have been increasing despite their associations with increased risk for several non-communicable diseases, including chronic kidney disease (CKD). Compared to less processed and perishable foods, UPFs have longer shelf stability, are widely accessible, and are convenient. They also tend to be more affordable and lower in nutritional quality. The aim of this systematic review and meta-analysis (PROSPERO ID: CRD42023488201) was to investigate whether consumption of UPF is associated with a higher risk of CKD in adults. Methods: We completed a systematic search using Medline, EMBASE, CINAHL, and Cochrane Central databases to identify observational studies published since the wide acceptance of UPF classification and conducted a random-effects model to pool the risk estimates. Results: A total of seven studies met the inclusion criteria for the systematic review, of which four were eligible for meta-analysis. Across these studies, there were 19,645 incident CKD cases from individuals free of baseline CKD. Using a random-effects model, higher UPF intake was significantly associated with increased CKD risk (pooled log-hazard ratio = 0.17; 95% CI: 0.07-0.28; p < 0.001). Conclusions: Given the substantial evidence from this systematic review and meta-analysis indicating an association between UPF and CKD, it is recommended for public health policies to address this risk. Promoting dietary guidelines that encourage the consumption of minimally processed foods could potentially mitigate the prevalence of CKD and improve overall public health outcomes.

The Power of Lifestyle Psychiatry: A New Approach to Mental Health

The field of psychiatry has evolved over the past 2500 years. Between dynamic psychotherapy and psychopharmacology, lifestyle psychiatry holds a different space. This approach capitalizes on the lifestyle medicine movement, as it promotes change within 6 domains of activity. Apart from incorporating these lifestyle pillars as adjunctive therapy for either psychodynamic therapy or psychotropic medication regimens, lifestyle psychiatry is on the frontier similar to the other growing fields of precision psychiatry, advanced learning in psychiatry, psychedelics in psychiatry, digital mental health, and psychiatric genetics. Any disruption into the historical practice of psychiatry, particularly with the prescription of medications, can be met with scrutiny. We encourage the field of psychiatry to keep an open mind as our field continues to evolve. What makes lifestyle psychiatry particularly powerful and unique in its ability to assess and evaluate internal and external factors that contribute to individual behaviors, and may impact the ability to incorporate healthy lifestyle actions. Internal factors include: emotional regulation, internalized trauma, cognitive factors, and personality traits. On the other hand, external factors include environmental barriers and work-related burnout.

Urate-lowering effect of delphinidin-3-glucoside in red kidney beans via binding to the FAD site of the XO enzyme

BACKGROUND

The incidence of hyperuricemia (HUA) is increasing globally, posing serious health risks. The discovery of natural urate-lowering agents is urgently needed.

OBJECTIVE

To discover natural urate-lowering agents and investigate their effect and action mechanisms for ameliorating HUA.

METHODS

Our study comprehensively explored the association between the intake of 13 specific legume varieties in the US population. A composition-target-metabolic (C-T-M) pathway network was constructed to identify key agents and their interactions with key proteins, which were verified by molecular dynamics simulations (MD) and surface plasmon resonance (SPR). Biochemical, in vitro, and in vivo metabolomic studies in male ICR mice were conducted to examine the effects of the key agent in red kidney beans on uric acid production and other metabolisms.

RESULTS

We found that consuming red kidney beans was robustly negatively associated with the risk of HUA. Based on the C-T-M network, delphinidin-3-glucoside (Dp-3G) was identified as the key agent in red kidney beans, focusing on its binding to xanthine oxidase (XO) enzyme. This interaction was subsequently verified by MD and SPR, revealing that Dp-3G binds to the FAD site of the XO enzyme, thereby blocking electron transfer during enzyme catalysis involving Moco, [2Fe-2S], and FAD. Dp-3G consistently reduces uric acid production under biochemical, in vitro, and in vivo conditions and reverses metabolic abnormalities related to HUA in mice, including methionine, proline, and folate.

CONCLUSIONS

This study identifies Dp-3G, a novel natural agent enriched in red kidney beans, as capable of occupying the FAD site of the XO enzyme, thereby interfering with uric acid synthesis, and suggesting its potential for preventing and treating HUA.

Epigenetic Mechanisms of Obesity: Insights from Transgenic Animal Models

Obesity is a chronic disease with prevalence rates that have risen dramatically over the past four decades. This increase is not due to changes in the human genome but rather to environmental factors that promote maladaptive physiological responses. Emerging evidence suggests that external influences, such as high-fat diets, modify the epigenome-the interface between genes and the environment-leading to persistent alterations in energy homeostasis. This review explores the role of epigenetic mechanisms in obesity, emphasizing insights from transgenic animal models and clinical studies. Additionally, we discuss the evolution of obesity research from homeostatic to allostatic frameworks, highlighting key neuroendocrine regulators of energy balance.

Association of Maternal Consumption of Ultra-Processed Foods with Feeding Practices and Malnutrition in Breastfed Infants: A Cross-Sectional Study

Although the adverse health effects of consuming ultra-processed foods (UPFs) are well-documented, limited evidence exists on their impact during lactation. This study examined the association between maternal UPF consumption, feeding practices, and malnutrition in breastfed infants. A cross-sectional analysis was conducted with 111 mother-child pairs up to 150 days postpartum. Infant feeding practices were assessed using WHO indicators, and malnutrition was evaluated by length-for-age and BMI-for-age. Maternal dietary intake was estimated using two 24 h recalls, and UPF consumption was classified by the Nova classification. Dyads were grouped based on the highest UPF consumption quartile, and adjusted binary logistic regression was applied. UPFs accounted for 26% of the maternal diet on average. While 71.2% of infants were exclusively breastfed, one-third were overweight, and 11.7% were stunted. High maternal UPF consumption (>32% of energy) was associated with increased odds of malnutrition by BMI-for-age (wasting or overweight) (OR 3.38; 95% CI: 1.29-8.83) and stunting (OR 3.89; 95% CI: 1.04-14.58). Feeding practices showed no association. These findings highlight that maternal UPF consumption is associated with malnutrition odds in breastfed infants in the population assessed, emphasizing the need for dietary guidance during lactation to improve infant health outcomes.

Tackling the complexity of obesity in the US through adaptation of public health strategies

Obesity prevalence continues to rise in the US despite more than two decades of recommendations and guidelines for its prevention and management. The encouragement of individuals to adopt a healthy diet and lifestyle has remained the focus of clinical interventions and recommendations despite these efforts alone proving ineffective for long-term weight management. There are many recognized barriers to obesity prevention and management in community and clinical settings including political factors, social determinants of health, weight bias and stigma, and inequities in access to treatment and insurance coverage. We discuss these barriers in more detail and attempt to identify areas where public health and healthcare approaches can be better aligned, allowing for better advocating by public health officials to enable a more meaningful and population-level change in obesity prevention and management in the US.

Protein glycation compromises the bioavailability of milk protein-derived lysine in vivo in healthy adult males: a double-blind, randomized cross-over trial

BACKGROUND

Industrial processing and storage of milk products can strongly increase protein glycation level. Previously, we have reported that ingestion of highly glycated milk protein attenuates the postprandial rise in plasma lysine concentrations compared to the ingestion of an equivalent amount of milk protein with a low glycation level. Whether the attenuated increase in plasma lysine availability is attributed to compromised protein digestion and subsequent lysine absorption remains to be established.

OBJECTIVES

The present study combined stable-isotope methodology with the ingestion of specifically produced, intrinsically labeled protein to assess protein digestion and amino acid absorption following ingestion of milk protein with a high versus low glycation level in vivo in humans.

METHODS

Fifteen recreationally active, healthy young males participated in this double-blinded, randomized cross-over study. Subjects ingested 40 g intrinsically L-[1-13C]-lysine-labeled milk protein with either a low (3%) or high (50%) glycation level. Continuous intravenous infusion of L-[4,4,5,5-2H4]-lysine was combined with frequent blood sample collection during a 6-h postprandial period to evaluate dietary protein-derived lysine release into the circulation.

RESULTS

Postprandial plasma lysine concentrations were lower following the ingestion of milk protein with a high versus low glycation level (time × treatment effect: P = 0.002; ƞ2 = 0.214), resulting in a 23 mmol/L x 360 min (95% confidence interval [CI]: 13, 32) lower incremental area under the curve (0 ± 12 vs 23 ± 11 mmol/L x 360 min, respectively, P < 0.001). The postprandial release of milk protein-derived lysine into the circulation was attenuated following ingestion of the protein with the high versus low glycation level (time × treatment effect: P < 0.001; ƞ2 = 0.640) and was 31% (95% CI: 26, 36) lower over the full 6-h postprandial period (18 ± 4 vs 49 ± 10% of the ingested lysine, respectively, P < 0.001).

CONCLUSIONS

A high level of milk protein glycation strongly reduces postprandial plasma lysine availability in vivo in humans. Industrial processing and storage of (milk) protein products can strongly modulate protein bioavailability and, as such, lower the nutritional value of a protein source. This trial was registered at www.

CLINICALTRIALS

gov as NCT05479916.

Exploring the relationship between ultra-processed food consumption and gut microbiota at school age in a Brazilian birth cohort

Dietary patterns significantly impact health outcomes and gut microbiota composition. However, longitudinal studies associating ultra-processed food consumption with gut microbiota composition, especially among adolescents in low- and middle-income countries, are lacking. This study aimed to explore this association using data collected from 364 participants at ages 6, 11, and 12 years from the 2004 Pelotas (Brazil) Birth Cohort. Microbiota data was obtained at age 12 after 16S rRNA gene sequencing of self-collected fecal samples. Linear or logistic regression models evaluated the relationship between age groups and gut microbiota outcomes (alpha diversity, beta diversity and relative abundances at the phylum and genus levels), considering dietary covariates and demographic, socioeconomic, health-related, and behavioral factors. No significant associations between ultra-processed food consumption and alpha diversity were observed after multiple testing corrections, and there was no strong evidence linking ultra-processed food consumption and beta diversity, with unweighted metrics explaining little variance at ages 11 and 12. Nominal associations were found between ultra-processed food and relative abundances of Actinobacteria (p = 0.032) and Proteobacteria (p = 0.045) (phyla), Bacteroides (p = 0.037 at age 6; p = 0.015 at age 11) and Peptostreptococcus (p = 0.025 at age 6; p = 0.010 at age 11) (genera). However, these associations lost statistical significance after adjustments for multiple comparisons. These findings highlight the need for more longitudinal studies to better understand the complex interaction between ultra-processed food intake and gut microbiota composition in adolescent populations in low- and middle-income countries.

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

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

Targeting ultra-processed foods for prevention of type 2 diabetes: state of the evidence and future directions

The incidence of type 2 diabetes has risen globally, in parallel with the obesity epidemic and environments promoting a sedentary lifestyle and low-quality diet. There has been scrutiny of ultra-processed foods (UPFs) as a driver of type 2 diabetes, underscored by their increasing availability and intake worldwide, across countries of all incomes. This narrative review addresses the accumulated evidence from investigations of the trends in UPF consumption and the relationship with type 2 diabetes incidence. Hypotheses for why UPFs may be causally implicated in the initiation and progression of weight gain and suboptimal blood glucose levels are varied. There is also uncertainty and debate about whether detrimental effects of UPFs could be owing to additives and other features of industrial processing, independent of established dietary risk factors, namely added sugar, sodium, saturated fat and low fibre content. However, these current research gaps are addressable with rigorous research and coordinated efforts across nutrition-science domains; for example, the strengths of longitudinal cohort studies can be leveraged to refine the characterisation of key UPF subcategories within the enormous and diverse category of UPFs and ultra-processed beverages, and to identify high-risk patterns of intake that are related to the development of chronic-disease outcomes. The notable advantages of dietary intervention studies are the critical gains in the reliability of dietary assessments, and isolating the effects of individual UPF additives and features through carefully formulated diets. Research improving our understanding of the modifiable food environment, the diet's causal drivers of weight gain and suboptimal cardiometabolic health, and the interactions among them, can be used to meaningfully shift the food supply for large-scale improvements in health. Thus, although the global market share of UPFs seems to outpace the research on its detrimental health effects, leaving the scientific community with the responsibility of generating proof, there may still be promising opportunities to reduce the burden of type 2 diabetes.

Gut microbiota in multiple sclerosis and animal models

Multiple sclerosis (MS) is a chronic central nervous system (CNS) neurodegenerative and neuroinflammatory disease marked by a host immune reaction that targets and destroys the neuronal myelin sheath. MS and correlating animal disease models show comorbidities, including intestinal barrier disruption and alterations of the commensal microbiome. It is accepted that diet plays a crucial role in shaping the microbiota composition and overall gastrointestinal (GI) tract health, suggesting an interplay between nutrition and neuroinflammation via the gut-brain axis. Unfortunately, poor host health and diet lead to microbiota modifications that could lead to significant responses in the host, including inflammation and neurobehavioral changes. Beneficial microbial metabolites are essential for host homeostasis and inflammation control. This review will highlight the importance of the gut microbiota in the context of host inflammatory responses in MS and MS animal models. Additionally, microbial community restoration and how it affects MS and GI barrier integrity will be discussed.

Ultra-processed food intake and prevalence of osteoporosis in US adults aged 50 years and older: a cross-sectional analysis

Dietary quality may be a factor in the progression of non-communicable, chronic diseases. This analysis of NHANES data demonstrates association between consumption of UPF and prevalence of osteoporosis and osteopenia in adults 50 years and older. UPF intake is an important consideration when recommending dietary patterns for optimum bone health PURPOSE: Declining bone mineral density in older adults can result in osteoporosis, leading to decreased physical function, quality of life, and increased risk of mortality. Poor dietary quality may contribute to the progression of this disease. This study explores the association between the consumption of ultra-processed foods (UPF) and the prevalence of osteoporosis and osteopenia in adults aged 50 years and older.

METHOD

Using regression analysis and adjusting for covariates, 24-h recall data from adults 50 years and over in four cycles of NHANES were examined for associations between prevalence of osteoporosis and intakes of UPF as a proportion of daily energy intake.

RESULTS

Mean (SE) intake of UPF as a proportion of total daily energy ranged from 29.5% (0.3) in the lowest quintile to 76.3% (0.3) in the highest. 50.5% of women and 28.0% of men had osteopenia, 8.2% and 1.8%, respectively, had osteoporosis. Increased risk of osteopenia or osteoporosis was observed in the highest quintile of UPF intake compared to that of the lowest: OR 1.52 (95% CI 1.28, 1.79). The odds of self-reported prior fractures at hip, wrist, or spine in women increased by 1.9% for every percentage increase in proportion of UPF intake (95% CI 1.003, 1.035). Increased risk of fracture was not observed among men.

CONCLUSIONS

These findings indicate an association between osteoporosis and osteopenia and the intake of UPF as a proportion of total daily energy. Further investigation into the impact of dietary quality on osteoporosis and fracture risk is warranted, particularly in post-menopausal women.

The Relationship Between Dietary Patterns and the Epidemiology of Food Allergy

Food allergies are increasing globally, particularly in Asia; however, the etiologies of allergic diseases remain poorly understood despite comprehensive studies conducted across a variety of populations. Epidemiological research demonstrates that food allergy is more prevalent in Westernized or urbanized societies than in rural or developing ones. As such, comparing the distribution and patterns of food allergies as well as the environmental exposures between regions may provide insight into potential causal and protective factors of food allergy. Diet is an important exposome that has been shown to modulate the immune system both directly and indirectly via pathways involving the microbiota. Changes in dietary patterns, especially the shift to a Westernized diet with reduced dietary fiber and an abundance of processed foods, impact the gut and skin epithelial barrier and contribute to the development of chronic inflammatory diseases, such as food allergy. Although dietary intervention is believed to have tremendous potential as a strategy to promote immunological health, it is essential to recognize that diet is only one of many factors that have changed in urbanized societies. Other factors, such as pollution, microplastics, the use of medications like antibiotics, and exposure to biodiversity and animals, may also play significant roles, and further research is needed to determine which exposures are most critical for the development of food allergies.

The Role of the Planetary Diet in Managing Metabolic Syndrome and Cardiovascular Disease: A Narrative Review

Introduction: The planetary health diet, introduced by the EAT-Lancet Commission, aims to address global health and sustainability challenges by promoting a plant-based diet with reduced consumption of animal-sourced foods. This diet not only contributes to environmental sustainability but also offers significant health benefits, including prevention and management of abdominal obesity, carbohydrate metabolism disorders, dyslipidemia, and elevated blood pressure. These metabolic disorders are components of metabolic syndrome, a cluster of risk factors for cardiovascular disease. Objectives: This narrative review aims to gather the most recent findings on the impact of the planetary diet on individual components of metabolic syndrome and on the prevention and treatment of cardiovascular disease. Methods: The available research on the topic was identified via searches in PubMed, Scopus, and Google Scholar. Results: Abdominal obesity, a major risk factor for a range of chronic diseases, can be effectively mitigated by adhering to plant-based dietary patterns, which have been shown to reduce waist circumference and improve overall cardiometabolic health. Furthermore, the planetary diet plays a crucial role in reducing the risk of type-2 diabetes and improving glycemic control, with specific dietary components such as whole grains and fiber, demonstrating positive effects on blood glucose levels. This diet is additionally associated with favorable lipid profiles, including lower levels of LDL cholesterol and total cholesterol, which are critical in the prevention of atherosclerosis and cardiovascular diseases. Conclusions: These multiple benefits highlight that the planetary diet may be an effective strategy for managing and preventing metabolic syndrome and cardiovascular disease. However, further research is needed to confirm its long-term efficacy and applicability across diverse populations.

Ultra-Processed Foods and Type 2 Diabetes Mellitus: What Is the Evidence So Far?

Ultra-processed foods (UPFs) are foods that have undergone extensive industrial processing with the addition of various substances in order to make them more tasty, eye-catching, and easy to consume. UPFs are usually rich in sugars, salt, and saturated fat, whereas they lack essential nutrients. The aim of this review is to elaborate upon the current evidence associating overconsumption of UPFs with the development of type 2 diabetes mellitus (T2DM). We will discuss data interconnecting UPFs and T2DM risk and will further describe specific ingredients that have been suggested to increase this risk. In addition, we will thoroughly explain how additives, such as emulsifiers or sweeteners, or other compounds formed during manufacturing, such as acrylamide and acrolein, and during packaging, such as bisphenol-A, are proposed to be implicated in the pathogenesis of insulin resistance and T2DM.

A case-control study based on the National Health and Nutrition Examination Survey to evaluate the effects of human papilloma virus on bone health in women

BACKGROUND

Human papillomavirus (HPV) infection and osteoporosis (OP) are global health concerns, with higher prevalence observed in women compared to men. However, the impact of HPV infection on bone health remains uncertain.

METHODS

This case-control study utilized data from the National Health and Nutrition Examination Survey (NHANES). Comparable datasets were created using nearest neighbor propensity score matching (PSM) at a ratio of 1:1. The association between HPV infection and bone mineral density (BMD) was analyzed using the Welch two-sample t-test. Furthermore, linear mixed models were employed for validation purposes. Restricted cubic spline (RCS) analysis and Kendall's tau-b tests were performed to explore the effect of different types of HPV infection on BMD.

RESULTS

Individuals with HPV infection (mean age 38.11 ± 11.32 years) had lower BMD in the femur and lumbar spine compared to uninfected individuals (mean age 37.92 ± 11.42 years). RCS analysis revealed that an increasing number of cooccurring HPV types in women was associated with lower BMD. Specifically, four HPV types were negatively associated with femur BMD, while 14 HPV types were negatively associated with lumbar spine BMD. Additionally, HPV types 53, 59, and 89 exhibited effects on both femur and lumbar spine BMD.

CONCLUSIONS

HPV infection is associated with a decrease in BMD, and co-infection with multiple types of HPV implies even lower BMD. Appropriately designed trials are needed to determine if interventions targeted at preventing HPV infection can have a protective effect on BMD.

Long-term trends and patterns in ultra-processed food consumption among Korean adults from 1998 to 2022

Ultra-processed foods are linked to adverse health outcomes, making it crucial to monitor consumption trends. Despite rising consumption due to Westernized diets in Asia, long-term studies targeting Asian adults are lacking. Thus, we analyzed ultra-processed food consumption trends among Korean adults from 1998 to 2022. Additionally, we compared intakes before and during the pandemic to evaluate the potential impact of the COVID-19 pandemic. Furthermore, we compared the nutrient profiles of ultra-processed and non-ultra-processed food group intakes. This study used data from the Korea National Health and Nutrition Examination Survey (KNHANES) from 1998 to 2022, classifying food into four NOVA groups. Dietary intake was assessed In 2020-2022, ultra-processed foods had a higher proportion using a single 24-hour recall for 96,447 individuals aged 20 years or older. Sampling weights were applied to adjust for the complex survey design and non-responses. We calculated the weighted means and confidence intervals for the proportion of energy intake by NOVA food groups and various nutrient profiles. The proportion of energy intake from ultra-processed foods among Korean adults steadily increased from 17.41% in 1998-2005 to 26.71% in 2016-2019 (mean difference: 9.30% [95% CI, 8.62-9.98%]), but declined for the first time during the pandemic, falling to 25.33% (mean difference: -1.39% [95% CI, -2.18% to -0.59%]). In 2020-2022, ultra-processed foods had a higher proportion of calories from carbohydrates (62.12% vs. 58.81%) and fats (28.22% vs. 22.31%) but a lower proportion from protein (10.32% vs. 17.26%) compared to non-ultra-processed foods. From 1998 to 2022, the fat content of both ultra-processed and non-ultra-processed foods significantly increased, rising from 26.24 to 28.15% for ultra-processed foods (mean difference: 1.91% [95% CI, 1.33-2.49%]) and from 16.81 to 22.26% for non-ultra-processed foods (mean difference: 5.45% [95% CI, 4.99-5.91%]). This study examined 25-year trends in ultra-processed food consumption among South Koreans, showing a consistent increase in energy intake from ultra-processed foods until the COVID-19 pandemic, during which it declined for the first time. However, this decline may be temporary, underscoring the need for sustained efforts to reduce ultra-processed food consumption.

Effectiveness of an Intervention to Prevent Ultra-Processed Foods and Added Sugar in the First Year of Life: A Multicentre Randomised Controlled Trial in Brazil

BACKGROUND

The early consumption of ultra-processed foods (UPFs) and added sugars (AS) has been linked to adverse outcomes in infancy. The objective of this study was to determine the effectiveness of a dietary counselling strategy to prevent the consumption of UPFs and AS in the first year of life.

METHODOLOGY

A multicentre randomised controlled trial was conducted with 516 mother-child pairs in three state capitals of Brazil. Mothers were randomly assigned to the control group (CG) or intervention group (IG) after childbirth. The IG received orientation based on UNICEF dietary guidelines and five monthly telephone calls to reinforce the intervention. Dietary intake was measured using food introduction questionnaires and 24-h recalls during home visits at 6 and 12 months. Between-group differences were analysed by generalised estimating equations and presented as mean difference (95% CI).

RESULTS

Children in the IG had lower UPF intake at 6 and 12 months of age (-20.69 g/day; 95% CI: -37.87 to -3.50; p = 0.018 and -32.51 g/day; 95% CI: -61.03 to -3.99; p = 0.025) and lower AS intake at 12 months of age (-4.92 g/day; 95% CI: -9.43 to -0.41; p = 0.033). The intervention also had a positive impact on the period of exclusive breastfeeding, reducing the offer of infant formula, cow's milk, and toddler milk in the first year of life.

PRINCIPAL CONCLUSIONS

The dietary counselling strategy was effective at preventing the early consumption of UPFs and AS in the first year of life. Future research should focus on social and cultural barriers to improve adherence to infant feeding interventions.

Food insecurity and ultra-processed food consumption in the Health and Retirement Study: Cross-sectional analysis

BACKGROUND

Higher ultra-processed foods (UPF), attributed to more than half of daily intake in the US, have been associated with impaired health outcomes. Documented evidence highlights disparities in UPF consumption due to food insecurity, which is a public health challenge among older adults in the US.

OBJECTIVES

The study examined the link between food insecurity and UPF consumption. The potential of participants' sex, age, and race and Supplemental Nutrition Assistance Program (SNAP) participation in modifying the association were explored.

METHOD

The analytical sample comprised 6295 US adults, aged 52 - 101 years, enrolled in the longitudinal Health and Retirement Study (HRS), a nationally representative study of aging. Food insecurity was evaluated in the 2013 HRS Health Care and Nutrition Study using the six-item Short Form Food Security Survey Module. Dietary intake was assessed using a food frequency questionnaire, and UPFs, quantified using the NOVA food classification system, were expressed as a percentage of total energy intake. The association between food insecurity and UPFs was examined using linear regression models, adjusted for sociodemographic characteristics.

RESULTS

The prevalence of food insecurity was 15%. Mean UPFs% (95% confidence intervals) were 49.1 (47.8, 50.3), 48.5 (46.6, 50.4), and 52.3 (50.4, 54.3) among adults with food security, low food security, and very low food security, respectively (P-trend = 0.0156). Race modifies the association between food insecurity and UPFs (P-interaction = 0.0033). A positive linear trend was detected among Whites (P-trend = 0.0036), but an inverse linear trend was found among African Americans (P-trend = 0.0007). There was no evidence for heterogeneity by age, sex, or SNAP participation.

CONCLUSION

Food insecurity was positively correlated with UPF consumption among adults in the US. Race modifies the association with a positive linear trend among Whites and an inverse linear trend among African Americans. Further efforts are needed to promote healthy aging via improving diet quality among food-insecure older adults.

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

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

Association of Serum AGR With All-Cause and Cause-Specific Mortality Among Individuals With Diabetes

CONTEXT

There are insufficient data to support a link between serum albumin-to-globulin ratio (AGR) and mortality in individuals with diabetes.

OBJECTIVE

This prospective study sought to investigate the relationship between serum AGR and all-cause and cause-specific mortality in adult diabetics.

METHODS

This study included 8508 adults with diabetes from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. Death outcomes were ascertained by linkage to National Death Index records through December 31, 2019. Hazard ratios (HR) and 95% CIs for mortality from all causes, cardiovascular disease (CVD), and cancer were estimated using weighted Cox proportional-hazards models.

RESULTS

A total of 2415 all-cause deaths, including 688 CV deaths and 413 cancer deaths, were recorded over an average of 9.61 years of follow-up. After multivariate adjustment, there was a significant and linear relationship between higher serum AGR levels and reduced all-cause and cause-specific mortality in a dose-response manner. The multivariate-adjusted HR and 95% CI for all-cause mortality (Ptrend < .0001), cardiovascular mortality (Ptrend < .001), and cancer mortality (Ptrend < .01) were 0.51 (0.42-0.60), 0.62 (0.46-0.83), and 0.57 (0.39-0.85), respectively, for individuals in the highest AGR quartile. There was a 73% decreased risk of all-cause death per 1-unit rise in natural log-transformed serum AGR, as well as a 60% and 63% decreased risk of mortality from CVD and cancer, respectively (all P < .001). Both the stratified analysis and the sensitivity analyses revealed the same relationships.

CONCLUSION

AGR is a promising biomarker in risk predictions for long-term mortality in diabetic individuals, particularly in those younger than 60 years and heavy drinkers.

Acute inflammatory and metabolic effect of high fructose intake in normal-weight women: A randomized, double-masked, crossover trial

OBJECTIVES

We aimed to evaluate the acute effect of a fructose-rich single meal on metabolic and inflammatory biomarkers RESEARCH METHODS AND PROCEDURES: This single-center, double-masked, randomized crossover trial recruited females aged 20 to 47 with a normal body mass index and was conducted at Hospital das Clínicas (Belo Horizonte, MG, Brazil). Participants received a standardized meal with either sucrose, glucose, or a fructose overload. Blood samples were collected after overnight fasting (baseline) and at 30, 60, 120, and 240 minutes postprandial. Serum levels of glucose, triglycerides (primary outcome), total cholesterol, alanine aminotransferase, aspartate aminotransferase, adiponectin, leptin, resistin, interleukin (IL)-2, IL-4, IL-5, IL-6, IL-10, IL-17, interferon-gamma, tumor necrosis factor, eotaxin, and total blood leukocytes were measured.

RESULTS

This trial was completed with 25 enrolled participants, and three dropped out. The per-protocol analysis included 22 participants. As expected, postprandial glycemia increased 30 minutes after consuming meals rich in sucrose (P = 0.045) or glucose (P < 0.001). Triglyceride and leucocyte concentrations increased only at 240 minutes after consuming a high-fructose meal (P < 0.05). Regardless of the type of carbohydrate overload, leptin concentrations decreased postprandially compared to baseline at all time points (P < 0.05). Four participants reported adverse events after consuming the standardized meal with glucose or fructose, including nausea and malaise.

CONCLUSIONS

Our findings indicate that a fructose-rich single meal leads to a more significant increase in triglyceride and leukocyte concentrations compared to glucose and sucrose in healthy women. These findings support concerns regarding the potential inflammatory and metabolic dysfunction associated with frequent consumption of high-fructose meals.

Ultraprocessed Food Intake and Risk of Systemic Lupus Erythematosus Among Women Observed in the Nurses' Health Study Cohorts

OBJECTIVE

We assessed ultraprocessed food (UPF) intake and systemic lupus erythematosus (SLE) incidence within the prospective Nurses' Health Study (NHS) cohorts.

METHODS

A total of 204,175 women were observed (NHS 1984-2016; NHSII 1991-2017). Semiquantitative food frequency questionnaires were completed every two to four years. UPF intake was determined as per the Nova classification. Nurses self-reported new doctor-diagnosed SLE, confirmed by medical records. Time-varying Cox regressions estimated hazard ratios (HRs; 95% confidence intervals [CIs]) for patients with incident SLE and SLE by anti-double-stranded DNA (dsDNA) antibody at diagnosis, according to cumulatively updated daily (a) UPF servings, (b) total intake (in grams and milliliters), and (c) percentage of total intake. Analyses adjusted for age, race, cohort, caloric and alcohol intakes, household income, smoking, body mass index (BMI), physical activity, menarchal age, and oral contraceptive use. We tested for interaction with BMI and examined UPF categories.

RESULTS

Mean baseline age was ~50 years (NHS) and ~36 years (NHSII); 93% self-reported White race. A total of 212 patients with incident SLE were identified. SLE risk was higher in the third versus first UPF tertile (servings per day pooled multivariable [MV] HR 1.56, 95% CI 1.04-2.32; P = 0.03). Results were stronger for dsDNA antibody in patients with SLE (servings per day pooled MV HR 2.05, 95% CI 1.15-3.65; P = 0.01) and for absolute (servings or total) than percentage of total intake. Sugar-sweetened/artificially sweetened beverages were associated with SLE risk (third vs first tertile MV HR 1.45, 95% CI 1.01-2.09). No BMI interactions were observed.

CONCLUSION

Higher cumulative average daily UPF intake was associated with >50% increased SLE risk and with doubled risk for anti-dsDNA antibody in patients with SLE. Many deleterious effects on systemic inflammation and immunity are postulated.

Association between leisure-time physical activity and stroke in patients with chronic obstructive pulmonary disease: A population-based study

BACKGROUND

Stroke is the second leading cause of death worldwide. It remains unclear whether chronic obstructive pulmonary disease (COPD) increases the risk of stroke. The purpose of this study was to evaluate the association between COPD and stroke. As physical activity may prevent strokes, we examined whether leisure-time physical activity (LTPA) moderates stroke risk in COPD patients.

METHODS

13,524 participants from the 2009-2018 National Health and Nutrition Examination Survey (NHANES). We used the Global Physical Activity Questionnaire (GPAQ) questionnaire to obtain self-reported data from LTPA. We used a binary logistic regression model to analyze the association between LTPA, COPD, and stroke risk.

RESULTS

The prevalence of COPD in the present study was 5.54%. The risk of stroke in COPD patients is 1.84 times higher than that in those without COPD, with a 95% confidence interval (95%CI) of 1.32,2.56 and P < 0.001. A lower stroke risk was observed in COPD patients who adhered to LTPA than those who did not (OR, 0.50; 95%CI, 0.26, 0.95; P = 0.03). As shown by the restricted cubic spline (RCS), the duration of LTPA in COPD patients was inversely related to the risk of stroke, which decreased as the duration of weekly LTPA increased.

CONCLUSION

COPD is positively associated with stroke risk. LTPA reduces the risk of stroke in patients with COPD, suggesting that it may be a promising measure for preventing stroke in this population.

Sex Differences in Cardiovascular-Kidney-Metabolic Syndrome: 30-Year US Trends and Mortality Risks-Brief Report

BACKGROUND

The American Heart Association recently published guidelines on how to clinically identify and categorize individuals with cardiovascular-kidney-metabolic (CKM) syndrome. The extent to which CKM syndrome prevalence and prognosis differ by sex remains unknown. This study aimed to examine the impact of sex on trends in prevalence over 30 years and the long-term prognosis of CKM syndrome in the United States.

METHODS

We analyzed nationally representative National Health and Nutrition Examination Survey 1988 to 2018 data collected from 33 868 US adults (aged ≥20 years) who were under surveillance for all-cause mortality through December 31, 2019. We examined the sex-specific prevalence of CKM syndrome and sex-specific CKM associations with all-cause mortality.

RESULTS

Of the 33 868 adults studied, the mean±SD age was 48.4±18.3 years with 52% women and 56% non-White. Overall prevalence of CKM syndrome increased steadily from 1988 to 2018 in both sexes, with a larger temporal rise in prevalent stage 3 CKM seen for men (from 18.9% to 22.4%) compared with women (from 13.9% to 15.2%). Over a median follow-up of 13.3 years, there were 8745 deaths. In the multivariable Cox regression analysis, worsening CKM severity was associated with all-cause mortality (P<0.001 for both sexes), with greater magnitudes of risk seen in women (hazards ratio, 1.24-3.33) compared with men (hazards ratio, 0.85-2.60) across all stages (likelihood ratio test χ2, 19.0; Pinteraction<0.001); results were similar for cardiovascular mortality (likelihood ratio test χ2, 22.3; Pinteraction<0.001).

CONCLUSIONS

Women, compared with men, exhibited a lower prevalence of CKM stage 3 but experienced excess mortality risk across the spectrum of multisystem CKM dysfunction. These findings underscore the importance of identifying mechanisms underlying joint cardiovascular, kidney, and metabolic system pathophysiology to close a potentially widening sex disparities gap in multiorgan disease risk.

Nutritional Dermatology: Optimizing Dietary Choices for Skin Health

BACKGROUND/OBJECTIVES

Youthful, smooth skin is highly desired in modern society. Individuals invest in cosmetics, plastic surgeons, and dermatologists in pursuit of perfect skin. However, many do not seek out dietary changes to improve skin health. Although research has been conducted on the role of nutrition and select nutrients and phytonutrients on skin health, there is a lack of healthy food recommendations for clear skin.

METHODS

The literature was assessed to determine which nutrients and phytonutrients play a significant role in the protection and maintenance of skin health. Key compounds were highlighted as there is evidence to suggest they have a significant role in skin health: vitamin A, vitamin C, vitamin D, vitamin E, zinc, omega-6 and omega-3 fatty acids, polyphenols/flavonoids, copper, selenium, and silicon. USDA FoodData Central and FooDB (food database), were utilized to select foods and food groups containing the key nutrients and phytonutrients.

RESULTS

A skin-healthy dietary pattern is proposed in addition to a scoring system to assess diet. A sample skin-healthy daily diet was designed, using only whole foods, that met the Daily Values for vitamins and minerals and contained key compounds for skin health.

CONCLUSIONS

There is a clear link between nutrition and skin health, or nutritional dermatology; however, more research needs to be done to find the intersection between both disciplines.

Home-made vs industry-made: Nutrient composition and content of potentially harmful compounds of different food products

Many consumers perceive industrially processed foods as lower in quality and potentially harmful to health, with concerns about poor nutrition, additives, and harmful compounds formed during processing. Epidemiological studies have highlighted risks associated with "ultra-processed foods," but empirical comparisons between industrial (IND) and home-made (HM) foods are scarce. This study aimed to compare nutritional values and harmful compounds in IND vs. HM versions of four common foods: plumcake, fish sticks, tomato sauce, and cereal bars. The HM foods were prepared using similar recipes to their industrial counterparts, avoiding technologies and ingredients not available at home. The analysis revealed identical nutritional compositions between the IND and HM versions. Acrylamide (AA) and Maillard reaction (MR) products, considered potentially harmful, showed comparable levels across the food pairs, though HM versions showed slightly higher levels in some cases. AA was undetectable in IND plumcake and HM cereal bars, while HM fish sticks had higher AA content than the industrial version. These findings indicate that homemade foods do not necessarily offer superior nutritional quality or lower levels of harmful compounds compared to industrial products. The classification of food products quality based on processing or industrial ingredients alone is not a reliable indicator of their healthiness.

Has the two decades of research on the gut microbiome resulted in making healthier choices?

The gut microbiome is widely recognized for its significant contribution to maintaining human health across all life stages, from infancy to adulthood and beyond. This perspective article focuses on the impacts of well-supported microbiome research on global caesarean delivery rates, breastfeeding practices, and antimicrobial use. The article also explores the impact of dietary choices, particularly those involving ultra-processed foods, on the gut microbiota and their potential contribution to conditions like obesity, metabolic syndrome, and inflammatory diseases. This perspective aims to emphasize the need for updated guidelines and policy interventions to address the increasing global trends of caesarean deliveries, reduced breastfeeding, overuse of antibiotics, and consumption of highly processed foods to counter their adverse effects on gut health.

Higher socioeconomic status is associated with higher ultra-processed food intake: a cross-sectional analysis

OBJECTIVE

To explore the differences in ultra-processed food (UPF) consumption across different socioeconomic status (SES) levels.

METHODS

Data on UPF consumption (grams/day) were derived from the 2017-2018 National Health and Nutrition Examination Survey. The analysis controlled for age, marital status, race, and sex. A restricted cubic spline (RCS) model was applied to examine the nonlinear response curve.

RESULTS

UPF consumption increased with higher poverty income ratio (PIR), the ratio of household income to the established poverty line. Compared to the low PIR group, the medium group showed a non-significant increase (β = 34.23[95%CI: -28.81, 97.28], p = 0.287), while the high group exhibited a significant increase (β = 115.15[95%CI: 43.53, 186.76], p = 0.002). A linear positive correlation was observed in RCS analysis (p-nonlinear = 0.166, p-overall < 0.001).

CONCLUSIONS

The study highlights that higher SES is associated with greater consumption of UPF in the US. The findings suggest that policy interventions should take SES into consideration.

Exploring the correlation between dietary zinc intake and stroke risk in adults based on NHANES database

OBJECTIVE

To explore the relationship between dietary zinc intake and stroke.

METHODS

Subjects from the National Health and Nutrition Examination Survey (NHANES) database (2015 to 2020) were included. Zinc intake was determined using two 24-h dietary recall interviews, and stroke was determined using the Medical Condition Questionnaire (MCQ). Logistic analysis was used to analyze the association between zinc intake and stroke risk. 1:1 nearest neighbor propensity score matching (PSM) was used to reduce selection bias.

RESULTS

4705 subjects were included in the study. Multivariate logistic regression analysis before and after matching showed that increased zinc intake was associated with a reduced risk of stroke. And as zinc intake increases, the risk of stroke shows a gradually decreasing trend. Compared with the Q1 group, the risk of stroke in the Q2, Q3, and Q4 groups was reduced by approximately 0.27 times, 0.29 times, and 0.31 times respectively. And there is no interaction between dietary zinc intake and gender in stroke patients.

CONCLUSION

Dietary zinc intake may be a protective factor against stroke, and increasing its intake may prevent or reduce the symptoms of stroke and related diseases.

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

BACKGROUND

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

OBJECTIVE

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

DESIGN

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

PARTICIPANTS/SETTING

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

MAIN OUTCOME MEASURES

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

STATISTICAL ANALYSES PERFORMED

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

RESULTS

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

CONCLUSIONS

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

Trends in Plant-Based Diets among United States Adults, 1999-March 2020

BACKGROUND

Interest in plant-based eating has increased alongside increased variety and availability of highly processed plant-based meat and dairy alternatives. The impact of the shifting commercial landscape and public interest in plant-based eating on dietary intake is unknown.

OBJECTIVES

To examine trends in the consumption and composition of plant-based diets in the United States adults.

METHODS

Serial cross-sectional data from the National Health and Nutrition Examination Survey were used to assess trends in the proportion of United States adults aged ≥20 y consuming a plant-based diet (defined as ≥50% total protein from plants on a 24-h dietary recall) from 1999-2000 to 2017-March 2020 (n = 51,698). Trends in processing level (percentage energy intake from ultraprocessed foods) and diet quality [Healthy Eating Index (HEI)-2020 scores] were assessed in the subset of adults consuming plant-based diets (n = 8327).

RESULTS

The proportion of United States adults consuming plant-based diets increased from 14.4% (95% CI: 12.9%, 16.0%) to 17.2% (95% confidence interval [CI]: 15.5%, 19.1%; P = 0.005 for trend). In all survey cycles, ultraprocessed foods accounted for the majority of energy intake, and ultraprocessed food intake in plant-based diets did not significantly change over time [50.7% kcal (95% CI: 47.3%, 54.1%) in 1999-2000 compared with 52.7% kcal (95% CI: 49.7%, 55.6%) in 2017-March 2020; P for trend = 0.34]. The quality of plant-based diets, measured by HEI-2020 scores, improved from 52.1 (95% CI: 49.7, 54.6) to 55.8 (95% CI: 54.1, 57.5; P for trend <0.001).

CONCLUSIONS

Between 1999 and March 2020, the proportion of United States adults consuming a plant-based diet increased. Among people consuming plant-based diets, ultraprocessed foods contributed most to energy intake and there was no sustained change in intake over time. The mean diet quality was low but improved modestly.