Ultra-processed food intake and animal-based food intake and mortality in the Adventist Health Study-2

Joint analysis of diet quality, inflammatory potential of diet and ultra-processed food exposure in relation to chronic respiratory diseases and lung cancer mortality

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.

Biological properties of vitamin B12

Vitamin B12, cobalamin, is indispensable for humans owing to its participation in two biochemical reactions: the conversion of l-methylmalonyl coenzyme A to succinyl coenzyme A, and the formation of methionine by methylation of homocysteine. Eukaryotes, encompassing plants, fungi, animals and humans, do not synthesise vitamin B12, in contrast to prokaryotes. Humans must consume it in their diet. The most important sources include meat, milk and dairy products, fish, shellfish and eggs. Due to this, vegetarians are at risk to develop a vitamin B12 deficiency and it is recommended that they consume fortified food. Vitamin B12 behaves differently to most vitamins of the B complex in several aspects, e.g. it is more stable, has a very specific mechanism of absorption and is stored in large amounts in the organism. This review summarises all its biological aspects (including its structure and natural sources as well as its stability in food, pharmacokinetics and physiological function) as well as causes, symptoms, diagnosis (with a summary of analytical methods for its measurement), prevention and treatment of its deficiency, and its pharmacological use and potential toxicity.

Premature Mortality Attributable to Ultraprocessed Food Consumption in 8 Countries

INTRODUCTION

Ultraprocessed foods are becoming dominant in the global food supply. Prospective cohort studies have consistently found an association between high consumption of ultraprocessed foods and increased risk of several noncommunicable diseases and all-cause mortality. The study aimed to (1) estimate the risk of all-cause mortality for ultraprocessed foods consumption and (2) estimate the attributable epidemiologic burden of ultraprocessed food consumption in 8 select countries.

METHODS

First, a dose-response meta-analysis of observational cohort studies was performed to assess the association between ultraprocessed food consumption and all-cause mortality and estimated the pooled RR for all-cause mortality per each 10% increment in the percentage ultraprocessed food. Then, the population attributable fractions for premature all-cause mortality attributable to the ultraprocessed foods in consumption were estimated in 8 select countries with relatively low (Colombia and Brazil), intermediate (Chile and Mexico), and high (Australia, Canada, United Kingdom, and the U.S.) ultraprocessed food consumption. Analysis was conducted in November 2023-July 2024.

RESULTS

The meta-analysis showed a linear dose-response association between the ultraprocessed food consumption and all-cause mortality (RR for each 10% increase in percentage ultraprocessed food=1.03; 95% CI=1.02, 1.04). Considering the magnitude of the association between ultraprocessed foods intake and all-cause mortality and the ultraprocessed food dietary share number (percentage ultraprocessed food) in each of the 8 selected countries, estimations varied from 4% (Colombia) to 14% (United Kingdom and U.S.) of premature deaths attributable to ultraprocessed food intake.

CONCLUSIONS

The findings support that ultraprocessed food intake contributes significantly to the overall burden of disease in many countries, and its reduction should be included in national dietary guideline recommendations and addressed in public policies.

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.

Mediterranean and standard American diet consumption in psychosis and non-psychosis affective disorders groups: Symptoms and cognition

Research supports an association between diet and health, and emerging evidence suggests that diet is associated with neuropsychiatric symptoms. However, no human study has examined an anti-inflammatory diet across rigorously defined psychiatric diagnoses and its associations with symptom severity and cognition. As inflammation is implicated in mental illness, we investigated adherence to the Mediterranean diet (MD), an anti-inflammatory diet, and the standard American diet (SAD), and examined cross-sectional relationships with psychiatric symptoms and cognition.

METHOD

Participants included 54 individuals with psychotic disorders, 30 with non-psychosis affective disorders and 40 healthy controls. Participants underwent diagnostic interviews, PANSS symptom ratings, and MATRICS cognitive assessments. The self-report GBAQ was used to assess adherence to the MD versus SAD.

RESULTS

The psychosis group was significantly more likely to consume the SAD than healthy controls (p = 0.007), with MD adherence predicting better working memory (r = 0.461, p < 0.001). In the non-psychosis affective disorders group, MD adherence predicted slower processing speed (r = -0.376, p = 0.049). In the non-psychosis affective disorders group, MD predicted reduced PANSS General Psychopathology scale (r = -0.449, p = 0.013), as well as the Activation (r = -0.362, p = 0.049), and Dysphoric Mood factors (r = -0.403, p = 0.027).

DISCUSSION

This first-of-its kind study identified poor dietary choices in persons with psychosis, showing significantly lower symptoms and better cognition in association with the MD in transdiagnostic analyses. It supports the study of dietary interventions for prevention and treatment of psychiatric conditions.

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

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

Ultra-processed foods and risk of all-cause mortality: an updated systematic review and dose-response meta-analysis of prospective cohort studies

BACKGROUND

Ultra-processed food (UPF) consumption has been steadily increasing globally, yet the associated risk of all-cause mortality remains unclear. We aimed to assess the risk of all-cause mortality of UPFs via an updated systematic review and dose-response meta-analysis.

METHODS

A comprehensive literature search was conducted in PubMed, Embase, and Cochrane Library for studies published until July 2, 2024, in addition to referred studies included in the previous systematic review. Prospective cohort studies assessing the association between NOVA classification-defined UPF consumption and all-cause mortality were included. Dose-response meta-analysis via a random-effect model was used to combine the results with hazard ratio (HR) as an effect measure.

RESULTS

Overall, 18 studies with 1,148,387 participants (173,107 deaths) were identified. Compared to the lowest, participants with the highest UPF consumption had a 15% increased risk of all-cause mortality (HR = 1.15, 95% CI 1.09-1.22; I2 = 83.0%). Furthermore, a 10% higher risk of all-cause mortality was detected with each 10% increment in UPF consumption (HR = 1.10, 95% CI 1.04-1.16; I2 = 91.0%). Dose-response analysis showed a positive linear association (Pdose-response < 0.001). Moreover, subgroups and sensitivity analyses indicated consistent findings, while meta-regression analyses suggested sex distributions partially explained heterogeneity, with a higher risk of all-cause mortality in males.

CONCLUSIONS

Our updated meta-analysis, incorporating a greater number of newly published cohort studies using NOVA classification with the largest sample size to date, strengthens the evidence linking higher UPF consumption to increased all-cause mortality risk. Strategies such as dietary guidelines and policies for limiting UPF consumption worldwide should be encouraged.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42023467226.

The Effect of a Lecture-Based Educational Intervention to Improve the Nutrition Knowledge and Behavior of Plant-Based Seventh-Day Adventists Living in the United Kingdom

Background and Aims

The Adventist lifestyle, which encourages the consumption of a vegetarian or vegan diet, has been associated with several health benefits; however, the nutrition knowledge of Adventists about essential nutrients in the context of plant-based diets has not yet been assessed, therefore, this study evaluated the efficacy of an expert-led lecture-based educational intervention on the nutrition knowledge and habits of plant-based Seventh-day Adventists.

Methods

The intervention, delivered in the form of an online lecture by a clinical nutrition expert, comprised a 30-min lecture emphasizing the role of essential nutrients for vegans and vegetarians, the role of dietary supplements in COVID-19 prevention. Nutritional knowledge was assessed by using a 25-item questionnaire before and after the lecture, with a follow-up survey administered 4 weeks after the lecture to examine changes in dietary behaviors and supplement use.

Results

Thirty-seven participants completed the study. The mean test scores significantly improved from 8.49 (SD 3.75) pre-lecture to 20.03 (SD 2.99) post-lecture (p < 0.001). Subsequent behavioral changes were reported, including increased supplement use and dietary modifications, underscoring the intervention's impact.

Conclusion

This study highlights the effectiveness of a targeted educational interventions in improving nutritional knowledge among plant-based Seventh-day Adventists. Health promotion activities conducted by the church should aim to inform church members of the need for well-planned plant-based diets and of the importance of appropriate supplementation.

Ultra-processed food consumption, plasma metabolite profile, and risk of all-cause and cause-specific mortality in a population-based cohort

BACKGROUND & AIMS

Epidemiological evidence on ultra-processed food (UPF) and cause-specific mortality remains limited and mixed. Molecular mechanisms underlying UPF intake and mortality remain unexplored. This study aimed to evaluate the associations between UPF consumption, metabolic signatures, and all-cause, premature, and cause-specific mortality.

METHODS

This study included 27670 participants (mean age 58.1 years) from the Malmö Diet and Cancer (MDC) cohort study. Consumption of UPF was assessed using a food frequency questionnaire and a 7-day food diary. In a subset of the MDC (n = 879), the associations of UPF with 991 plasma metabolites were investigated. An elastic net regression model was used to establish the metabolic signature of UPF. Cox proportional hazards regression model was used to determine the association between UPF intake, metabolic signature, and mortality risk.

RESULTS

During a median follow-up of 23.3 years, a total of 11333 participants died. UPF intake showed a nonlinear positive association with all-cause mortality, with more pronounced associations found in females (Pinteraction = 0.044); in females, UPF was linked to a higher mortality risk in a linear manner, while the association was J-shaped in males. Each standard deviation (SD) increment in UPF intake was associated with an increased risk of premature mortality (HR, 1.06; 95 % CI, 1.03-1.09), cardiovascular disease (CVD) mortality (HR, 1.05; 95 % CI, 1.01-1.08) or respiratory disease mortality (HR, 1.08; 95 % CI, 1.01-1.15), but not cancer mortality. The metabolic signature for UPF consumption (with 93 metabolites) was positively associated with all-cause mortality risk (HR per 1 SD, 1.23; 95 % CI, 1.06-1.42).

CONCLUSIONS

Our results suggest that higher UPF intake is associated with increased risk of all-cause, premature, CVD, and respiratory disease mortality, with the association varying across sex for all-cause mortality. The plasma metabolic signature of UPF showed a positive association with all-cause mortality.

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

BACKGROUND

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

OBJECTIVE

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

DESIGN

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

PARTICIPANTS/SETTING

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

MAIN OUTCOME MEASURES

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

STATISTICAL ANALYSIS PERFORMED

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

RESULTS

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

CONCLUSIONS

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

Future perspectives: Current trends and controversies of meat alternatives classified as ultra-processed foods

This study reviewed the current state of meat alternatives including plant-based or cell-based ingredients and discussed the contentious factor surrounding the classification of meat alternatives as ultra-processed foods (UPFs). The term UPFs refers to foods undergoing extensive industrial processing and containing additives such as flavors, colors, emulsifiers, and preservatives. There is growing concern regarding the potential adverse effects of UPF consumption on health, nutrition, and sociodemographic factors. Additionally, this study examined the market potential, drivers, and barriers associated with different types of meat alternatives. In light of barriers focused on UPFs, meat alternatives can be disputed in that they undergo extensive processing and are highly processed, including numerous ingredients, while meat alternatives offer potential solutions to the environmental, ethical, and health issues associated with animal meat consumption. Consequently, it is important to distinguish them from other UPFs, which are known to have detrimental effects on health. Therefore, this paper proposed a reassessment of the UPF classification system, the establishment of uniform nutritional profiles for meat alternatives, and the dissemination of their beneficial impacts. These measures are necessary to validate the exclusion of meat alternatives from the UPF category and to promote their development and adoption.

An unbiased, sustainable, evidence-informed Universal Food Guide: a timely template for national food guides

BACKGROUND

Although national food guides are designed, ostensibly, to translate scientific evidence with respect to food, dietary patterns, and health, their development has increasingly become a corporate/political process as well as scientific one; often with corporate/political influences overriding science. Our aim was to construct an unbiased, sustainable, evidence-informed Universal Food Guide to serve as a template for countries to develop their unique guides, thereby, provide a valid resource for health professionals, health authorities, and the public.

METHODS

To address our aim, we conducted an integrative review of multiple evidence-informed sources (e.g., established databases, evidence syntheses, scholarly treatises, and policy documents) related to four areas: 1. Food guides' utility and conflicts of interest; 2. The evidence-based healthiest diet; 3. Constituents of the Universal Food Guide template; and 4. Implications for population health; regulation/governance; environment/climate/planetary health; and ethics.

RESULTS

The eating pattern that is healthiest for humans (i.e., most natural, and associated with maximal health across the life cycle; reduced non-communicable disease (NCD) risk; and minimal end-of-life illness) is whole food, low fat, plant-based, especially vegan, with the absence of ultra-processed food. Disparities in national food guide recommendations can be explained by factors other than science, specifically, corporate/political interests reflected in heavily government-subsidized, animal-sourced products; and trends toward dominance of daily consumption of processed/ultra-processed foods. Both trends have well-documented adverse consequences, i.e., NCDs and endangered environmental/planetary health. Commitment to an evidence-informed plant-based eating pattern, particularly vegan, will reduce risks/manifestations of NCDs; inform healthy food and nutrition policy regulation/governance; support sustainable environment/climate and planetary health; and is ethical with respect to 'best' evidence-based practice, and human and animal welfare.

CONCLUSION

The Universal Food Guide that serves as a template for national food guides is both urgent and timely given the well-documented health-harming influences that corporate stakeholders/politicians and advisory committees with conflicts of interest, exert on national food guides. Such influence contributes to the largely-preventable NCDs and environmental issues. Policy makers, health professionals, and the public need unbiased, scientific evidence as informed by the Universal Food Guide, to inform their recommendations and choices.

The share of ultra-processed foods determines the overall nutritional quality of diet in British vegetarians

The aim of this study was to describe the dietary intake of British vegetarians according to the Nova classification and to evaluate the association between the consumption of ultra-processed foods and the nutritional quality of the diet. We used data from the UK national survey (2008/2019). Food collected through a 4-d record were classified according to the Nova system. In all tertiles of the energy contribution of ultra-processed foods, differences in the average nutrient intake, as well as in the prevalence of inadequate intake, were analysed, considering the values recommended by international authorities. Ultra-processed foods had the highest dietary contribution (56·3 % of energy intake), followed by fresh or minimally processed foods (29·2 %), processed foods (9·4 %) and culinary ingredients (5 %). A positive linear trend was found between the contribution tertiles of ultra-processed foods and the content of free sugars (β 0·25, P < 0·001), while an inverse relationship was observed for dietary fibre (β -0·26, P = 0·002), potassium (β -0·38, P < 0·001), Mg (β -0·31, P < 0·001), Cu (β -0·22, P < 0·003), vitamin A (β -0·37, P < 0·001) and vitamin C (β -0·22, P < 0·001). As the contribution of ultra-processed foods to total energy intake increased (from the first to the last tertile of consumption), the prevalence of inadequate intake of free sugars increased (from 32·9 % to 60·7 %, respectively), as well as the prevalence of inadequate fibre intake (from 26·1 % to 47·5 %). The influence of ultra-processed foods on the vegetarian diet in the UK is of considerable magnitude, and the consumption of this food was associated with poorer diet quality.

Implications of food ultra-processing on cardiovascular risk considering plant origin foods: an analysis of the UK Biobank cohort

Background

Comprehensive research evidence is lacking on the role of ultra-processed foods (UPF) in the relationship between the consumption of plant-sourced foods and their impact on cardiovascular disease (CVD) outcomes. This study aims to assess CVD risk associated with the dietary contribution of food groups that consider both plant or animal origin and food processing categories, within a large cohort of British adults.

Methods

Data from the UK Biobank participants (40-69 y) who completed at least two 24-h dietary recalls between 2009 and 2012 (n = 126,842; median follow-up: 9 y), with subsequent data linkage to hospital and mortality records, were used. Food groups were classified as either plant-sourced or non-plant/animal-sourced foods. These groups were further divided into non-UPF and UPF, and expressed as a percentage of total energy intake.

Findings

Every 10 percentage points increase in plant-sourced non-UPF consumption was associated with a 7% lower risk of CVD (95% CI 0.91-0.95) and a 13% lower risk of CVD mortality (0.80-0.94). Conversely, plant-sourced UPF consumption was associated with a 5% increased risk (1.03-1.07) and a 12% higher mortality (1.05-1.20). The contribution of all UPF was linked to higher CVD risk and mortality, and no evidence for an association between contribution of all plant-sourced foods and CVD incidence and mortality was observed.

Interpretation

The dietary contribution of plant-sourced non-UPF inversely linked to CVD risk, while plant-sourced UPF contribution showed a positive association. Recognizing the role of food processing is crucial for favourable CVD outcomes, even in plant-sourced diets.

Funding

World Cancer Research Fund.

"Food faddists and pseudoscientists!": Reflections on the history of resistance to ultra-processed foods

The term 'ultra-processed food' emerged in the 1980s, mostly used in reference to highly-processed convenience foods and snacks, often energy-dense, poor in nutrients, and inclusive of various synthetic additives such as emulsifiers, colors, artificial sweeteners, and/or flavor enhancers. Concern over such foods was part of the growing holistic and environmental health movements of the 1970-80s; yet, those who raised alarm about the encroachment of ultra-processed foods were often labeled, especially by industry and their powerful allies, as 'food faddists' and 'pseudoscientists'. Today, the topic of ultra-processed foods is generating massive personal, public, and planetary health interest. However, other than discussing the history of the NOVA food classification system, a useful tool that has allowed researchers to more accurately separate foods based on processing, most lay media and academic articles are ahistorical. That is, there is a tendency to present the term ultra-processed food(s) as a relatively new entrance into the lexicon, and by default, the idea that health-related pushback on ultra-processed foods is a relatively new phenomenon. This omission overlooks decades of determined advocacy and clinical work, much of it by pioneers within the holistic medicine (now integrative, functional, and lifestyle medicine) movement. Here in this reflection paper, the authors will use historical research and reporting to fill in the historical gap and articulate the saliency of why it matters.

Dismantling the myth of "all foods fit" in eating disorder treatment

We call for a reevaluation of the long-standing dogmatic nutritional principle that "all foods fit" for all cases of eating disorders (EDs) and its corollary, "there are no bad foods" (for anyone ever) during ED treatment. Based on accumulated scientific research, we challenge these ideologies as outdated, confusing, and potentially harmful to many patients. We review the evidence that indicates the folly of these assumptions and show there are a variety of exceptions to these rules, including (1) food allergies, sensitivities, and intolerances, (2) religious and spiritual preferences or doctrines, and (3) the ubiquitous emergence and widespread availability of ultra-processed foods leading to the potential development of addiction-like eating and a higher prevalence of various medical and psychiatric comorbidities, as well as higher mortality. This evidence supports a nutritional psychiatry approach that should be integrated into (rather than dissociated from) ED treatment research and practice.

The intake of solid fat and cheese may be associated with a reduced risk of Helicobacter pylori infection status: a cross-sectional study based on NHANES 1999-2000

BACKGROUND

Diet plays an important role in Helicobacter pylori (HP) infection, and our objective was to investigate potential connections between dietary patterns, specific food groups, and HP infection status in U.S. adults.

METHODS

The data for this study was obtained from the NHANES (National Health and Nutrition Survey) database for the year 1999-2000. This cross-sectional study involved the selection of adults aged 20 years and older who had undergone dietary surveys and HP testing. Factor analysis was employed to identify dietary patterns, and logistic regression models were utilized to assess the association between these dietary patterns and specific food groups with HP infection status.

RESULT

Based on the inclusion and exclusion criteria, our final analysis included 2,952 individuals. The median age of participants was 51.0 years, and 48.7% were male. In the study population, the overall prevalence of HP infection was 44.9%. Factor analysis revealed three distinct dietary patterns: High-fat and high-sugar pattern (including solid fats, refined grains, cheese, and added sugars); Vegetarian pattern (comprising fruits, juices, and whole grains); Healthy pattern (encompassing vegetables, nuts and seeds, and oils). Adjusted results showed that the high-fat and high-sugar pattern (OR = 0.689, 95% CI: 0.688-0.690), vegetarian pattern (OR = 0.802, 95% CI: 0.801-0.803), and healthy pattern (OR = 0.717, 95% CI: 0.716-0.718) were all linked to a lower likelihood of HP infection. Further analysis of the high-fat and high-sugar pattern revealed that solid fats (OR = 0.717, 95% CI: 0.716-0.718) and cheese (OR = 0.863, 95% CI: 0.862-0.864) were protective factors against HP infection, while refined grains (OR = 1.045, 95% CI: 1.044-1.046) and added sugars (OR = 1.014, 95% CI: 1.013-1.015) were identified as risk factors for HP infection.

CONCLUSION

Both the Vegetarian pattern and the Healthy pattern are associated with a reduced risk of HP infection. Interestingly, the High-fat and High-sugar pattern, which is initially considered a risk factor for HP infection when the score is low, becomes a protective factor as the intake increases. Within this pattern, animal foods like solid fats and cheese play a protective role, while the consumption of refined grains and added sugars increases the likelihood of HP infection.

Ultra-processed food consumption and mortality among patients with stages I-III colorectal cancer: a prospective cohort study

Background

Ultra-processed foods (UPFs) are emerging as a risk factor for colorectal cancer (CRC), yet how post-diagnostic UPF intake may impact CRC prognosis remains unexplored.

Methods

Data collected from food frequency questionnaires were used to estimate intakes of total UPFs and UPF subgroups (serving/d) at least 6 months but less than 4 years post-diagnosis among 2498 patients diagnosed with stages I-III CRC within the Nurses' Health Study and Health Professionals Follow-up Study during 1980-2016. Hazard ratios (HR) and 95% confidence intervals (CIs) of all-cause, CRC- and cardiovascular disease (CVD)-specific mortality in association with UPF consumption were estimated using an inverse probability weighted multivariable Cox proportional hazards regression model, adjusted for confounders.

Findings

The mean (SD) age of patients at diagnosis was 68.5 (9.4) years. A total of 1661 deaths were documented, including 321 from CRC and 335 from CVD. Compared to those in the lowest quintile (median = 3.6 servings/d), patients in the highest quintile (median = 10 servings/d) of post-diagnostic UPF intake had higher CVD mortality (HR = 1.65, 95% CI = 1.13-2.40) but not CRC or all-cause mortality. Among UPF subgroups, higher consumption of fats/condiments/sauces was associated with a higher risk of CVD-specific mortality (highest vs. lowest quintile of intake, HR = 1.96, 95% CI = 1.41-2.73), and higher intake of ice cream/sherbet was associated with an increased risk of CRC-specific mortality (highest vs. lowest quintile, HR = 1.86, 95% CI: 1.33-2.61). No statistically significant association was found between UPF subgroups and overall mortality.

Interpretation

Higher post-diagnostic intake of total UPFs and fats/condiments/sauces in CRC survivors is associated with higher CVD mortality, and higher ice cream/sherbet intake is linked to higher CRC mortality.

Funding

US National Institutes of Health and the American Cancer Society.

Ultra-Processed Food Consumption and Mortality: Three Cohort Studies in the United States and United Kingdom

INTRODUCTION

Given the increase in ultra-processed food (UPF) consumption, their potential health effects have aroused concern. Whether UPF consumption is associated with cancer and cardiovascular disease mortality is debatable. This study evaluates the association of UPF consumption with mortality.

METHODS

A total of 108,714 U.S. adults from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (1993-2001), 208,051 UK adults from UK Biobank (2006-2010), and 41,070 U.S. adults from National Health and Nutrition Examination Survey (1999-2018) were included. Dietary data were collected by dietary questionnaire and classified using the NOVA classification. UPF consumption was expressed as the weight proportion of UPFs in total foods consumed. Cox proportional hazard models were used to calculate hazard ratios and 95% CIs. Mediation analysis was used to evaluate whether multiple metabolic pathways mediated the associations in UK Biobank. Analyses were performed in 2022-2023.

RESULTS

Combined analyses of the three cohorts showed that those with the highest quartile of UPF consumption had higher risks of all-cause mortality (hazard ratio, 1.16; 95% CI, 1.11-1.20) and cardiovascular disease mortality (hazard ratio, 1.17; 95% CI, 1.06-1.28) compared to the lowest quartile of UPF consumption. UPF consumption was not associated with cancer mortality risk. Biomarkers of liver function have the greatest mediating effects on all-cause mortality (20.3%), and biomarkers of inflammation have the greatest mediating effects on cardiovascular disease mortality (29.2%).

CONCLUSIONS

Higher UPF consumption was associated with increased all-cause and cardiovascular disease mortality risk, with multiple metabolic pathways playing mediating roles.

Nutritional Criminology: Why the Emerging Research on Ultra-Processed Food Matters to Health and Justice

There is mounting concern over the potential harms associated with ultra-processed foods, including poor mental health and antisocial behavior. Cutting-edge research provides an enhanced understanding of biophysiological mechanisms, including microbiome pathways, and invites a historical reexamination of earlier work that investigated the relationship between nutrition and criminal behavior. Here, in this perspective article, we explore how this emergent research casts new light and greater significance on previous key observations. Despite expanding interest in the field dubbed 'nutritional psychiatry', there has been relatively little attention paid to its relevancy within criminology and the criminal justice system. Since public health practitioners, allied mental health professionals, and policymakers play key roles throughout criminal justice systems, a holistic perspective on both historical and emergent research is critical. While there are many questions to be resolved, the available evidence suggests that nutrition might be an underappreciated factor in prevention and treatment along the criminal justice spectrum. The intersection of nutrition and biopsychosocial health requires transdisciplinary discussions of power structures, industry influence, and marketing issues associated with widespread food and social inequalities. Some of these discussions are already occurring under the banner of 'food crime'. Given the vast societal implications, it is our contention that the subject of nutrition in the multidisciplinary field of criminology-referred to here as nutritional criminology-deserves increased scrutiny. Through combining historical findings and cutting-edge research, we aim to increase awareness of this topic among the broad readership of the journal, with the hopes of generating new hypotheses and collaborations.

Consumption of Ultra-Processed Food and Drink Products in a Greek Christian Orthodox Church Fasting Population

The positive effects of the Mediterranean diet on healthy living are widely known, while the health effects of religious fasting have received increased attention during the last decade. However, no study has focused on the consumption of ultra-processed foods (UPFs) in such populations. Therefore, our aim was to investigate UPF intake and its association with metabolic syndrome (MetS) in a Christian Orthodox church (COC) religious fasting population in Greece. In this cross-sectional study, 400 individuals who follow the Mediterranean diet were included, stratified as COC fasters and non-fasters. Dietary intake data were collected via three 24 h diet recalls and a monthly food frequency questionnaire (FFQ). The NOVA food classification system was used to identify the level of processing and categorize all food items. Fasters consumed significantly less chicken, turkey, and beef and significantly more seafood, fish, snails, soy products, and fresh fruits, in terms of unprocessed or minimally processed foods, as well as significantly more fried potatoes and olives in terms of processed foods when compared with non-fasters. Regarding UPFs, a significantly lower intake of pork sausages, ketchup, and mustard as well as a significantly higher consumption of margarine and tarama dip were recorded in fasters compared with non-fasters. Fasters with MetS more frequently consumed UPFs (such as cheese pastries, biscuits, and cakes) than fasters without MetS (p < 0.05 for all comparisons). Similarly, non-fasters with MetS had an increased intake of UPFs (such as Cypriot bread and Coco Pops breakfast cereals) than non-fasters without MetS. Future research should focus on UPF consumption and its associations with clinical outcomes in such populations, thus providing further data for the potential health effects of COC fasting.

Substitution of animal-based with plant-based foods on cardiometabolic health and all-cause mortality: a systematic review and meta-analysis of prospective studies

BACKGROUND

There is growing evidence that substituting animal-based with plant-based foods is associated with a lower risk of cardiovascular diseases (CVD), type 2 diabetes (T2D), and all-cause mortality. Our aim was to summarize and evaluate the evidence for the substitution of any animal-based foods with plant-based foods on cardiometabolic health and all-cause mortality in a systematic review and meta-analysis.

METHODS

We systematically searched MEDLINE, Embase, and Web of Science to March 2023 for prospective studies investigating the substitution of animal-based with plant-based foods on CVD, T2D, and all-cause mortality. We calculated summary hazard ratios (SHRs) and 95% confidence intervals (95% CI) using random-effects meta-analyses. We assessed the certainty of evidence (CoE) using the GRADE approach.

RESULTS

In total, 37 publications based on 24 cohorts were included. There was moderate CoE for a lower risk of CVD when substituting processed meat with nuts [SHR (95% CI): 0.73 (0.59, 0.91), n = 8 cohorts], legumes [0.77 (0.68, 0.87), n = 8], and whole grains [0.64 (0.54, 0.75), n = 7], as well as eggs with nuts [0.83 (0.78, 0.89), n = 8] and butter with olive oil [0.96 (0.95, 0.98), n = 3]. Furthermore, we found moderate CoE for an inverse association with T2D incidence when substituting red meat with whole grains/cereals [0.90 (0.84, 0.96), n = 6] and red meat or processed meat with nuts [0.92 (0.90, 0.94), n = 6 or 0.78 (0.69, 0.88), n = 6], as well as for replacing poultry with whole grains [0.87 (0.83, 0.90), n = 2] and eggs with nuts or whole grains [0.82 (0.79, 0.86), n = 2 or 0.79 (0.76, 0.83), n = 2]. Moreover, replacing red meat for nuts [0.93 (0.91, 0.95), n = 9] and whole grains [0.96 (0.95, 0.98), n = 3], processed meat with nuts [0.79 (0.71, 0.88), n = 9] and legumes [0.91 (0.85, 0.98), n = 9], dairy with nuts [0.94 (0.91, 0.97), n = 3], and eggs with nuts [0.85 (0.82, 0.89), n = 8] and legumes [0.90 (0.89, 0.91), n = 7] was associated with a reduced risk of all-cause mortality.

CONCLUSIONS

Our findings indicate that a shift from animal-based (e.g., red and processed meat, eggs, dairy, poultry, butter) to plant-based (e.g., nuts, legumes, whole grains, olive oil) foods is beneficially associated with cardiometabolic health and all-cause mortality.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Vegan diet: nutritional components, implementation, and effects on adults' health

Vegan diet has emerged as a popular dietary choice for people worldwide in recent times, due to concerns such as health issues, animal rights and welfare, and the sustainability of the environment. The purpose of this literature review was to explain how a vegan diet may affect the health of adults and to point out beneficial components found in it as well as any difficulties associated with its implementation. Evidence supports that a vegan diet can reduce the risk of chronic diseases, such as type 2 diabetes, hypertension, and certain types of cancer. A well-planned vegan diet must include adequate calories and nutrients, as well as the necessary supplements, such as vitamin B12, vitamin D and EPA/DHA. Given the current growing interest in plant-based diets among the general population, it is crucial to understand both the barriers, risks, and benefits of the vegan diet among physicians, policy makers, and the general population.

Ultraprocessed foods and chronic kidney disease-double trouble

High energy intake combined with low physical activity generates positive energy balance, which, when maintained, favours obesity, a highly prevalent morbidity linked to development of non-communicable chronic diseases, including chronic kidney disease (CKD). Among many factors contributing to disproportionately high energy intakes, and thereby to the obesity epidemic, the type and degree of food processing play an important role. Ultraprocessed foods (UPFs) are industrialized and quite often high-energy-dense products with added sugar, salt, unhealthy fats and food additives formulated to be palatable or hyperpalatable. UPFs can trigger an addictive eating behaviour and is typically characterized by an increase in energy intake. Furthermore, high consumption of UPFs, a hallmark of a Western diet, results in diets with poor quality. A high UPF intake is associated with higher risk for CKD. In addition, UPF consumption by patients with CKD is likely to predispose and/or to exacerbate uraemic metabolic derangements, such as insulin resistance, metabolic acidosis, hypertension, dysbiosis, hyperkalaemia and hyperphosphatemia. Global sales of UPFs per capita increased in all continents in recent decades. This is an important factor responsible for the nutrition transition, with home-made meals being replaced by ready-to-eat products. In this review we discuss the potential risk of UPFs in activating hedonic eating and their main implications for health, especially for kidney health and metabolic complications of CKD. We also present various aspects of consequences of UPFs on planetary health and discuss future directions for research to bring awareness of the harms of UPFs within the CKD scenario.

Consumption of ultra-processed foods and all-cause and cause-specific mortality in the Southern Community Cohort Study

BACKGROUND & AIMS

Higher intake of ultra-processed foods (UPF) has been linked with higher risks of cancer, cardiovascular disease, and diabetes, as well as all-cause mortality. However, studies on UPF and cause-specific mortality remain limited, especially among disadvantaged populations. We aimed to examine associations of UPF intake with all-cause and cause-specific mortality among low-income Americans.

METHODS

In the Southern Community Cohort Study (SCCS), a prospective cohort of mostly low-income Black and White Americans, we included 77,060 participants who completed a food frequency questionnaire (FFQ) at baseline (2002-2009) and had at least 1 year follow-up. All 89 items in the FFQ were categorized using the Nova classification. UPF intake was calculated as % of daily foods intake by weight (grams). Cox regression was used to estimate HR (95% CI) for the association of UPF intake (quartile or per 10% increase) with total and cause-specific mortality (cancer, coronary heart disease [CHD], stroke, and diabetes) after adjusting for sociodemographics, lifestyles, and disease history.

RESULTS

Of 77,060 participants, 46,175 (59.9%) were women, 49,857 were Black (64.7%), and mean age was 52.4 (SD: 8.8) years at baseline. The mean intake of UPF was 41.0% (SD: 15.7%). UPF intake was inversely associated with Healthy Eating Index and intakes of fiber, minerals, and vitamins but positively associated with intakes of sugars and fats (all PFDR<0.0001). During an average follow-up of 12.2 years, we documented 17,895 total deaths, including 4267 from cancer, 2208 from CHD, 867 from stroke, and 997 from diabetes. In the fully adjusted model, higher UPF intake was not associated with all-cause, cancer, CHD, or stroke mortality but showed a significant association with increased diabetes mortality (HR [95% CI] = 1.32 [1.07, 1.62] for the highest versus lowest quartiles [>51.1% vs. <29.3%] and 1.09 [1.04, 1.15] per 10% increase). The adverse UPF-diabetes mortality association was noted regardless of sex, race, income, neighborhood deprivation, lifestyles, and cardiometabolic disease history, while particularly evident in participants with no more than high school education or a history of hypercholesterolemia (HR [95% CI] per 10% increase = 1.12 [1.05, 1.18] and 1.14 [1.07, 1.22], respectively; both Pinteraction<0.05).

CONCLUSIONS

Among predominantly low-income Black and White American adults, UPF intake was associated with increased diabetes mortality, especially for individuals with limited education or hypercholesterolemia. Our findings suggest the potential impact of increasing access and intake of un/minimally processed food to replace UPF on reducing diabetes-related mortality among populations facing socioeconomic and health disparities.

The Association between Vegan Dietary Patterns and Physical Activity-A Cross-Sectional Online Survey

A balanced diet and sufficient physical activity (PA) are known to have positive health effects. The relationship between a vegan diet and PA levels is understudied. This cross-sectional online survey aimed to analyze whether different vegan dietary patterns differ in PA. In total, 516 vegan participants were included (June to August 2022). Different dietary patterns were compiled through principal component analysis, while group differences were calculated using independent tests, or chi-squared tests as well as logistic regression analyses. The population had an average age of 28.0 (SD: 7.7) years and had been living vegan for 2.6 (95% CI: 2.5-3.0) years. Two dietary patterns, the "convenience" and the "health-conscious" group, were identified. People with a convenience dietary pattern had significantly higher odds of sitting more (OR 1.10, 95% CI 1.04-1.18) and not achieving aerobic PA (OR 1.81, 95% CI 1.18-2.79) or strength training recommendations (OR 1.81, 95% CI 1.26-2.61) than people with a health-conscious dietary pattern. This study suggests the heterogeneity of vegan diets and that dietary patterns must be differentiated, as they also differ in the level of PA. Additional studies involving complete dietary assessment with a focus on ultraprocessed foods, blood metabolite analysis, and objective PA assessment are required.

Dose-response meta-analysis of ultra-processed food with the risk of cardiovascular events and all-cause mortality: evidence from prospective cohort studies

Background: Previous meta-analyses included abundant cross-sectional studies, and/or only assessed high versus low categories of UPF consumption. We conducted this meta-analysis based on prospective cohort studies to estimate the dose-response associations of UPF consumption with the risk of cardiovascular events (CVEs) and all-cause mortality among general adults. Methods: PubMed, Embase, and Web of Science were searched for relevant articles published up to August 17, 2021, and newly published articles between August 17, 2021 and July 21, 2022 were re-searched. Random-effects models were used to estimate the summary relative risks (RRs) and confidence intervals (CIs). Generalized least squares regression was used to estimate the linear dose-response associations of each additional serving of UPF. Restricted cubic splines were used to model the possible nonlinear trends. Results: Eleven eligible papers (17 analyses) were finally identified. The pooled effect size for the highest versus lowest category of UPF consumption showed positive associations with the risk of CVEs (RR = 1.35, 95% CI, 1.18-1.54) and all-cause mortality (RR = 1.21, 95% CI, 1.15-1.27). For each additional daily serving of UPF, the risk increased by 4% (RR = 1.04, 95% CI, 1.02-1.06) for CVEs and 2% (RR = 1.02, 95% CI, 1.01-1.03) for all-cause mortality. With increasing UPF intake, the risk of CVEs reflected a linear upward trend (P_nonlinearity = 0.095), while all-cause mortality reflected a nonlinear upward trend (P_nonlinearity = 0.039). Conclusion: Our findings based on prospective cohorts suggested that any increased level of UPF consumption was linked to higher CVEs and mortality risk. Thus, the recommendation is to control the intake of UPF in daily diet.

Friend or Foe? The Role of Animal-Source Foods in Healthy and Environmentally Sustainable Diets

Scientific and political discussions around the role of animal-source foods (ASFs) in healthy and environmentally sustainable diets are often polarizing. To bring clarity to this important topic, we critically reviewed the evidence on the health and environmental benefits and risks of ASFs, focusing on primary trade-offs and tensions, and summarized the evidence on alternative proteins and protein-rich foods. ASFs are rich in bioavailable nutrients commonly lacking globally and can make important contributions to food and nutrition security. Many populations in Sub-Saharan Africa and South Asia could benefit from increased consumption of ASFs through improved nutrient intakes and reduced undernutrition. Where consumption is high, processed meat should be limited, and red meat and saturated fat should be moderated to lower noncommunicable disease risk-this could also have cobenefits for environmental sustainability. ASF production generally has a large environmental impact; yet, when produced at the appropriate scale and in accordance with local ecosystems and contexts, ASFs can play an important role in circular and diverse agroecosystems that, in certain circumstances, can help restore biodiversity and degraded land and mitigate greenhouse gas emissions from food production. The amount and type of ASF that is healthy and environmentally sustainable will depend on the local context and health priorities and will change over time as populations develop, nutritional concerns evolve, and alternative foods from new technologies become more available and acceptable. Efforts by governments and civil society organizations to increase or decrease ASF consumption should be considered in light of the nutritional and environmental needs and risks in the local context and, importantly, integrally involve the local stakeholders impacted by any changes. Policies, programs, and incentives are needed to ensure best practices in production, curb excess consumption where high, and sustainably increase consumption where low.

Ultra-processed food consumption, cancer risk and cancer mortality: a large-scale prospective analysis within the UK Biobank

Background

Global dietary patterns are increasingly dominated by relatively cheap, highly palatable, and ready-to-eat ultra-processed foods (UPFs). However, prospective evidence is limited on cancer development and mortality in relation to UPF consumption. This study examines associations between UPF consumption and risk of cancer and associated mortality for 34 site-specific cancers in a large cohort of British adults.

Methods

This study included a prospective cohort of UK Biobank participants (aged 40-69 years) who completed 24-h dietary recalls between 2009 and 2012 (N = 197426, 54.6% women) and were followed up until Jan 31, 2021. Food items consumed were categorised according to their degree of food processing using the NOVA food classification system. Individuals' UPF consumption was expressed as a percentage of total food intake (g/day). Prospective associations were assessed using multivariable Cox proportional hazards models adjusted for baseline socio-demographic characteristics, smoking status, physical activity, body mass index, alcohol and total energy intake.

Findings

The mean UPF consumption was 22.9% (SD 13.3%) in the total diet. During a median follow-up time of 9.8 years, 15,921 individuals developed cancer and 4009 cancer-related deaths occurred. Every 10 percentage points increment in UPF consumption was associated with an increased incidence of overall (hazard ratio, 1.02; 95% CI, 1.01-1.04) and specifically ovarian (1.19; 1.08-1.30) cancer. Furthermore, every 10 percentage points increment in UPF consumption was associated with an increased risk of overall (1.06; 1.03-1.09), ovarian (1.30; 1.13-1.50), and breast (1.16; 1.02-1.32) cancer-related mortality.

Interpretation

Our UK-based cohort study suggests that higher UPF consumption may be linked to an increased burden and mortality for overall and certain site-specific cancers especially ovarian cancer in women.

Funding

The Cancer Research UK and World Cancer Research Fund.

Australian Consumers' Attitudes towards Sustainable Diet Practices Regarding Food Waste, Food Processing, and the Health Aspects of Diet: A Cross Sectional Survey

Environmentally sustainable diets are increasingly aspired to in food-based dietary guidelines across the world. However, little is known about consumer attitudes toward these diets when making food decisions. This study aimed to identify the demographic characteristics of Australian adults based on the level of attention they paid to the healthfulness of their diet, their consideration of the level of food processing, and their concern about household food waste and sustainable packaging disposal. Adults aged from 18 to over 75 years (n = 540) were surveyed online. Thirty-seven percent were concerned about sustainable food waste, 28% considered the level of food processing when making food decisions, and 23% paid attention to the healthfulness of the food they ate. Adults who had higher educational attainment (above Year 12) were twice as likely to be concerned about food waste and sustainable packaging disposal (odds ratio (OR) = 2.10, 95% confidence interval (CI) 1.29-3.4), and processing levels (OR = 2.04, 95% CI 1.23-3.42) (controlling for age and gender). Those earning an income over AUD$100,000 were twice as likely to pay attention to the healthfulness of their food choices than those earning less than AUD$50,000 (OR = 2.19, 95% CI 1.28-3.74). Only 9% percent were concerned about or paid attention to all three of the components of healthy sustainable diets investigated, and 45% paid no attention and were not concerned about all three components. These findings suggest there is a need to educate the public to raise awareness of and concern for healthy, minimally processed, and sustainable food choices.

A Heart-Healthy Diet for Cardiovascular Disease Prevention: Where Are We Now?

Purpose of Review

The relationship between cardiovascular health and diet is evolving. Lifestyle modifications including diet changes are the primary approach in managing cardiometabolic risk factors. Thus, understanding different diets and their impact on cardiovascular health is important in guiding primary and secondary prevention of cardiovascular disease (CVD). Yet, there are many barriers and limitations to adopting a heart healthy diet.

Recent Findings

Diets rich in fruits, vegetables, legumes, whole grains, and lean protein sources, with minimization/avoidance of processed foods, trans-fats, and sugar sweetened beverages, are recommended by prevention guidelines. The Mediterranean, DASH, and plant-based diets have all proven cardioprotective in varying degrees and are endorsed by professional healthcare societies, while other emerging diets such as the ketogenic diet and intermittent fasting require more long-term study. The effects of diet on the gut microbiome and on cardiovascular health have opened a new path for precision medicine to improve cardiometabolic risk factors. The effects of certain dietary metabolites, such as trimethylamine N-oxide, on cardiometabolic risk factors, along with the changes in the gut microbiome diversity and gene pathways in relation to CVD management, are being explored.

Summary

In this review, we provide a comprehensive up-to-date overview on established and emerging diets in cardiovascular health. We discuss the effectiveness of various diets and most importantly the approaches to nutritional counseling where traditional and non-traditional approaches are being practiced, helping patients adopt heart healthy diets. We address the limitations to adopting a heart healthy diet regarding food insecurity, poor access, and socioeconomic burden. Lastly, we discuss the need for a multidisciplinary team-based approach, including the role of a nutrition specialist, in implementing culturally-tailored dietary recommendations. Understanding the limitations and finding ways to overcome the barriers in implementing heart-healthy diets will take us miles in the path to CVD prevention and management.