Global trends in ultraprocessed food and drink product sales and their association with adult body mass index trajectories

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.

Is a voluntary healthy food policy effective? evaluating effects on foods and drinks for sale in hospitals and resulting policy changes

BACKGROUND

Healthy food and drink guidelines for public sector settings can improve the healthiness of food environments. This study aimed to assess the implementation and impact of the voluntary National Healthy Food and Drink Policy (the Policy) introduced in New Zealand in 2016 to encourage provision of healthier food and drink options for staff and visitors at healthcare facilities.

METHODS

A customised digital audit tool was used to collate data on foods and drinks available for sale in healthcare organisations and to systematically classify items as green ('healthy'), amber ('less healthy'), or red ('unhealthy') according to Policy criteria. On-site audits were undertaken between March 2021 and June 2022 at 19 District Health Boards (organisations responsible for providing public health services) and one central government agency. Forty-three sites were audited, encompassing 229 retail settings (serviced food outlets and vending machines). In total, 8485 foods/drinks were classified according to Policy criteria. The primary outcome was alignment with Policy guidance on the availability of green, amber, and red category food/drink items (≥ 55% green and 0% red items). Secondary outcomes were proportions of green, amber, and red category items, promotional practices, and price. Chi-square tests were used to compare results between categorical variables.

RESULTS

No organisation met the criteria for alignment with the Policy. Across all sites, 38.9% of food/drink items were rated red (not permitted), 39.0% were amber, and 22.1% were green. Organisations that adopted the voluntary Policy offered more healthy foods/drinks than those with their own organisational policy, but the proportion of red items remained high: 32.3% versus 47.5% (p < 0.0001). About one-fifth (21.3%) of all items were promoted, with red (24.6%) and amber (22.2%) items significantly more likely to be promoted than green items (14.0%) (p < 0.001). Green items were also significantly more costly on average (NZ$6.00) than either red (NZ$4.00) or amber (NZ$4.70) items (p < 0.0001).

CONCLUSIONS

Comprehensive and systematic evaluation showed that a voluntary Policy was not effective in ensuring provision of healthier food/drink options in New Zealand hospitals. The adoption of a single, mandatory Policy, accompanied by dedicated support and regular evaluations, could better support Policy implementation.

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.

Evaluation of Ireland's Sugar-Sweetened Beverage Tax (SSBT)

BACKGROUND

Ireland is experiencing high levels of overweight and obesity. The adverse health impacts of excess weight include cancer, cardiovascular disease, diabetes, and dental decay, as well as a host of other conditions. In response, the Irish Government introduced a Sugar-Sweetened Beverage Tax (SSBT) in 2018.

AIMS

This research sought to explore the impact of Ireland's Sugar-Sweetened Beverage Tax.

METHOD

Euromonitor International Ltd data for the years 2010 - 2022 detailing carbonated drinkrelated sugar consumption in Ireland was examined.

RESULTS

A gradual decline in sugar consumption via carbonated soft drinks was evident before the introduction of the SSBT in Ireland. However, in the first full year since the introduction of the SSBT, there was a marked 30.2% reduction in sugar intake via carbonates through retailers and a 19.8% reduction in sugar intake via carbonates via food service venues.

CONCLUSIONS

The reduction in sugar intake via carbonates in the aftermath of the introduction of the SSBT was dramatic. However, it is unclear how much of this reduction was caused by industry reformulation of soft drinks and how much by consumers choosing lower-sugar or sugar-free soft beverages. Whatever the precise contribution of either factor, these results suggest that the SSBT has effectively reset national sugar consumption via soft drinks at a lower level.

Association of ultra-processed foods with phenotypic age acceleration in US adults: a mediation analysis of body mass index in the NHANES

Background

The rising intake of ultra-processed foods (UPFs) has been linked to adverse health outcomes, yet its impact on aging acceleration remains unclear.

Objective

This study aimed to examine the association between the percentage of total daily calories (%Kcal) and grams (%Gram) from UPFs and phenotypic age acceleration (PhenoAgeAccel).

Methods

Data from 12,079 adults in the NHANES 2005-2010 cycles were analyzed. The relationship between UPFs intake and PhenoAgeAccel was assessed using multivariable linear regression and restricted cubic splines, with adjustments for relevant covariates. The mediating role of body mass index (BMI) was also explored.

Results

A significant positive linear association was observed between UPFs intake (%Gram) and PhenoAgeAccel, with the highest quartile showing an increase of 0.60 (95% CI: 0.15, 1.05; p for trend = 0.039), but no association was found between UPFs intake (%Kcal) and PhenoAgeAccel. Mediation analysis indicated that BMI mediated 27.5% of the association between UPFs intake (%Gram) and PhenoAgeAccel. Sensitivity analyses confirmed the robustness of the results.

Conclusion

Higher intake of UPFs intake (%Gram) is positively associated with PhenoAgeAccel, with BMI playing a significant mediating role.

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.

Associations between dietary diversity and self-rated health in a transverse study of four local food systems (French Guiana, Guadeloupe, Portugal and Senegal)

BACKGROUND

The nutrition transition is linked to the double-burden of malnutrition worldwide, and its impact on the quality of life is considerable. The dietary diversity score and self-rated health are two proxies that have been used to assess, for the former, nutrient adequacy and overall diet quality, and for the latter, health from a sociological, epidemiological and economical lens. The general aim of this study was to evaluate the relation between food and subjective health, and to test the hypothesis that greater dietary diversity is positively associated with a better perception of health.

METHODS

A transverse comparison of foods consumed in four highly contrasted local socio-ecosystems (i.e., two French oversea territories: French Guiana, Guadeloupe, Portugal and Senegal) was conducted using 24-hour dietary recalls. Dietary diversity was calculated using 18 food groups based on classifications provided by WHO and FAO. Binary logistic regressions were used to assess the relationship between dietary diversity scores and answers to the question assessing self-rated health.

RESULTS

Overall, 465 individuals, 18 years and older, from Senegal, Guiana, Guadeloupe and Portugal were interviewed using a 24-hour dietary recall. Participants were selected via a combination of non-probability sampling methods. The mean dietary diversity score for all regions combined was 9.22. Over one-third of participants reported their health as 'good' (39.8%), whereas 'bad' and 'excellent' health were the least reported, at 6.45% and 9.03%, respectively. Multiple binary logistic regression notably found that dietary diversity score (OR = 0.88, 95% CI [0.79, 0.99], p = 0.010) and at-home meal preparation, specifically with the reference category 'all the time' compared to 'never' (OR = 3.31, 95% CI [1.55, 7.07], p = 0.002) were statistically significant predictors of self-rated health (i.e., declaring overall bad health).

CONCLUSIONS

This study demonstrates a positive association between dietary diversity and self-rated health across distinct cultural contexts. The findings reinforce the importance of diverse diets for subjective well-being, regardless of differences in food systems. Public health messaging should continue to promote dietary diversity and home-cooked meals as effective strategies for improving health. Self-rated health could serve as a useful tool for quickly assessing the outcomes of nutrition therapy.

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.

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.

GroceryDB: Prevalence of Processed Food in Grocery Stores

The offering of grocery stores is a strong driver of consumer decisions, shaping their diet and long-term health. While highly processed food like packaged products, processed meat, and sweetened soft drinks have been increasingly associated with unhealthy diet, information on the degree of processing characterizing an item in a store is not straight forward to obtain, limiting the ability of individuals to make informed choices. Here we introduce GroceryDB, a database with over 50,000 food items sold by Walmart, Target, and Wholefoods, unveiling how big data can be harnessed to empower consumers and policymakers with systematic access to the degree of processing of the foods they select, and the potential alternatives in the surrounding food environment. The extensive data gathered on ingredient lists and nutrition facts enables a large-scale analysis of ingredient patterns and degrees of processing, categorized by store, food category, and price range. Our findings reveal that the degree of food processing varies significantly across different food categories and grocery stores. Furthermore, this data allows us to quantify the individual contribution of over 1,000 ingredients to ultra-processing. GroceryDB and the associated http://TrueFood.Tech/ website make this information accessible, guiding consumers toward less processed food choices while assisting policymakers in reforming the food supply.

Ultraprocessed Food Consumption and Obesity Development in Canadian Children

Importance

Ultraprocessed foods (UPF), characterized as shelf-stable but nutritionally imbalanced foods, pose a public health crisis worldwide. In adults, UPF consumption is associated with increased obesity risk, but findings among children are inconsistent.

Objectives

To examine the associations among UPF intake, anthropometric adiposity indicators, and obesity status in Canadian children.

Design, Setting, and Participants

In the CHILD Cohort Study, one of the largest prospective, multicenter, population-based pregnancy cohorts in Canada, diet was assessed during the 3-year visit (September 2011 to June 2016), and anthropometric measurements were assessed at the 5-year visit (December 2013 to April 2018). Data analysis was performed between July 1, 2023, and June 30, 2024.

Exposure

Diet intake was assessed using a semiquantitative food frequency questionnaire at 3 years of age. UPFs were identified using the NOVA classification system.

Main Outcomes and Measures

Anthropometric adiposity indicators were measured at 5 years of age and used to calculate age- and sex-standardized z scores for body mass index (BMI), waist to height ratio, and subscapular and triceps skinfold thicknesses, and obesity, which was defined using BMI z score cutoffs. Multivariable-adjusted regression analyses were used to examine the associations of UPF with adiposity and obesity development, accounting for parental, birth, and early-childhood factors.

Results

Among 2217 participants included in this study, median age at the outcome assessment was 5.0 (IQR, 5.0-5.1) years, and 1175 (53.0%) were males. At 3 years of age, UPF contributed 45.0% of total daily energy intake. UPF energy contribution was higher in males vs females (46.0% vs 43.9%; P < .001). Among all participants, higher UPF intake at 3 years of age was associated with higher anthropometric adiposity indicators at 5 years of age, primarily driven by males. In males, every 10% UPF energy increase was associated with higher adiposity indicator z scores for BMI (β, 0.08; 95% CI, 0.03-0.14), waist to height ratio (β, 0.07; 95% CI, 0.01-0.12), and subscapular (β, 0.12; 95% CI, 0.06-0.18) and triceps (β, 0.09; 95% CI, 0.03-0.15) skinfold thickness and higher odds of living with overweight or obesity (odds ratio, 1.19; 95% CI, 1.03-1.36). No significant associations were observed among females.

Conclusions and Relevance

In this cohort study of Canadian children, high UPF consumption during early childhood was associated with obesity development, primarily in males. These findings can inform targeted public health initiatives for early childhood centers and caregiver education programs to reduce UPF intake and prevent obesity.

The global and regional burden of diabetic peripheral neuropathy

Diabetic peripheral neuropathy (DPN) is length-dependent peripheral nerve damage arising as a complication of type 1 or type 2 diabetes in up to 50% of patients. DPN poses a substantial burden on patients, who can experience impaired gait and loss of balance, predisposing them to falls and fractures, and neuropathic pain, which is frequently difficult to treat and reduces quality of life. Advanced DPN can lead to diabetic foot ulcers and non-healing wounds that often necessitate lower-limb amputation. From a socioeconomic perspective, DPN increases both direct health-care costs and indirect costs from loss of productivity owing to neuropathy-related disability. In this Review, we highlight the importance of understanding country-specific and region-specific variations in DPN prevalence to inform public health policy and allocate resources appropriately. We also explore how identification of DPN risk factors can guide treatment and prevention strategies and aid the development of health-care infrastructure for populations at risk. We review evidence that metabolic factors beyond hyperglycaemia contribute to DPN development, necessitating a shift from pure glycaemic control to multi-targeted metabolic control, including weight loss and improvements in lipid profiles.

The Impact of Economic Income on BMI Trajectory Groups in Chinese Elderly Individuals: A Population-Based Longitudinal Study

OBJECTIVE

The objective of this study is to gain insights into the influence of income on the body mass index (BMI) locus in the elderly population.

METHODS

The Chinese Longitudinal Healthy Longevity and Happy Family Study (CLHLS-HF) was included at baseline (2008) for participants aged 65 years and older. The total number of participants analyzed in this study was 7555. A population-based trajectory model (GBTM) was used. The economic income level was an independent variable and adjusted for age, gender, ethnicity, education, marriage, and physical activity (Model 1), and the baseline BMI value was added in Model 2, with a quadratic of the income added in Model 3. A sensitivity analysis was adopted.

RESULTS

Three BMI trajectory groups were identified using GBTM and were labeled as "overweight", "normal", and "obesity". After adjusting for covariates (Model 1), with the increase in economic income, the risk of the elderly transitioning into the overweight trajectory group and the obesity trajectory group was relatively increased. When the baseline BMI values were adjusted for Model 2, the effect of economic income on the overweight and obesity trajectories was enhanced. A sensitivity analysis was performed, and it was found that the result of the positive impact of economic income on the BMI trajectory group was robust.

CONCLUSIONS

The higher the income, the greater the risk of Chinese elderly individuals developing the overweight or obesity trajectory. It is suggested that elderly individuals with higher economic income especially need interventions and nutrition education to help them acquire nutrition knowledge for a healthy lifestyle. The positive impact of economic income on the BMI trajectories of the elderly provides further directions for preventing and controlling obesity in the elderly.

Association between gut microbiota and ultra-processed foods consumption among the patients with type 2 diabetes: a cross-sectional study

BACKGROUND

This study aimed to explore the relationship between ultra-processed foods (UPFs) consumption and gut microbiota in patients with type 2 diabetes (T2D).

METHODS

This cross-sectional study included 362 participants with T2D. UPFs consumption was assessed using a brief-type self-administered diet history questionnaire, quantified as the density of UPFs intake (g/1000 kcal). Gut microbial composition was evaluated via 16S rRNA gene sequencing. We investigated the association between gut microbiota, previously identified as relevant to T2D, and the density of UPFs intake using Spearman rank correlation coefficients. Multiple regression analysis, adjusting for age, sex, BMI, smoking status, exercise, and medication use, was conducted to further investigate these associations.

RESULTS

The mean age of participants was 68 (63-74) years. The density of UPFs intake showed significant associations with Bifidobacterium (r = 0.11, p = 0.031), Lactobacillus (r = 0.11, p = 0.046), Ruminococcus (r = -0.12, p = 0.019), Roseburia (r = 0.11, p = 0.045). After adjusting for covariates in multiple regression analysis, Ruminococcus and Roseburia showed modest negative (β = -0.11, p = 0.038) and positive (β = 0.12, p = 0.033) correlations, with the density of UPFs intake among participants with T2D, respectively.

CONCLUSIONS

The density of UPFs intake was modestly inversely associated with Ruminococcus among patients with T2D and modestly positively associated with Roseburia.

Who consumes ultra-processed food? A systematic review of sociodemographic determinants of ultra-processed food consumption from nationally representative samples

Ultra-processed food (UPF) intake is associated with increased non-communicable disease risks. However, systematic reports on sociodemographic predictors of UPF intake are lacking. This review aimed to understand UPF consumption based on sociodemographic factors, using nationally representative cohorts. The systematic review was pre-registered (PROSPERO:CRD42022360199), following PRISMA guidelines. PubMed/MEDLINE searches (‘ultra-processed/ultraprocessed’ and ‘ultra-processing/ultraprocessing’) until 7 September 2022 retrieved 1131 results. Inclusion criteria included: observational, nationally representative adult samples, in English, in peer-reviewed journals, assessing the association between sociodemographics and individual-level UPF intake defined by the NOVA classification. Exclusion criteria included: not nationally representative, no assessment of sociodemographics and individual-level UPF intake defined by NOVA. Risk of bias was assessed using the Newcastle–Ottawa Scale (NOS). Fifty-five papers were included, spanning thirty-two countries. All thirteen sociodemographic variables identified were significantly associated with UPF intake in one or more studies. Significant differences in UPF intake were seen across age, race/ethnicity, rural/urbanisation, food insecurity, income and region, with up to 10–20% differences in UPF intake (% total energy). Higher UPF intakes were associated with younger age, urbanisation and being unmarried, single, separated or divorced. Education, income and socioeconomic status showed varying associations, depending on country. Multivariate analyses indicated that associations were independent of other sociodemographics. Household status and gender were generally not associated with UPF intake. NOS averaged 5·7/10. Several characteristics are independently associated with high UPF intake, indicating large sociodemographic variation in non-communicable disease risk. These findings highlight significant public health inequalities associated with UPF intake, and the urgent need for policy action to minimise social injustice-related health inequalities.

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.

Virtual dentistry strategy to enhance knowledge, attitudes, and practices in selecting sweetened ultra-processed foods

Education on the selection of low-sugar ultra-processed foods (UPF) plays a crucial role in promoting good oral health. This study aimed to assess the impact of a virtual educational strategy, developed in the field of dentistry, on improve Knowledge, Attitudes, and Practices (KAPs) related to oral health and the appropriate selection of sweet-tasting UPF. A quasi-experimental study with a pre-test and post-test design was conducted, involving parents and caregivers of children and pre-adolescents. Thirteen virtual learning objects (VLO) were delivered via Facebook. To measure the impact of the strategy, a validated instrument was used before the intervention, immediately after, and again six months later to assess Knowledge, Attitudes, and Practices (KAPs) on the subject. The median scores before and after the intervention were compared using the Friedman test for related samples, followed by multiple comparisons with Dunn's test. Participants' KAP levels were analyzed using Pearson's Chi-square test and multiple comparisons of column proportions with Bonferroni correction. Finally, a satisfaction and applicability survey was conducted. A significant improvement (p < 0.01) was observed in the participants' median KAP scores both immediately after the intervention and six months later. A greater number of participants reached the highest level in knowledge (Before (B): 43.8%, Immediately After (IA): 86%, After six months (A6): 81.3%), attitudes (B: 34.2%, IA: 69.4%, A6: 65.2%), and practices (B: 22.5%, IA: 53.7%, A6: 47.3%). Most participants described the course as consistently dynamic, well-organized, and appropriate timing. They also expressed their intention to apply the knowledge in their daily lives. The implemented strategy improved participants' KAPs concerning oral health and the appropriate selection of sweet-tasting UPF. It also resulted in participants' children consuming fewer sweet bakery products, candies, and flavored milk. Additionally, more participants reported consistently reading food labels after the intervention, although this behavior was not adopted by the majority.

Dietary intake, obesity, and physical activity in association with biliary tract cancer risk: Results from meta-analyses of individual-level data from prospective cohort studies of 723,326 adults

Biliary tract cancer (BTC) is a rare and aggressive malignancy with increasing incidence. Most BTC cases are diagnosed with metastatic disease which carries a 5-year survival rate of <5%. Physical activity, diet, and obesity might be associated with BTC risk, but studies have been limited particularly in African descendants. We addressed this knowledge gap by evaluating associations of BTC risk with obesity, physical activity, and dietary intakes in 723,326 adult participants in four cohort studies conducted in China, the United Kingdom, and the United States. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) in each cohort; results were combined using meta-analysis. All cohorts had ≥11 median follow-up years with 839 incident BTC cases combined. BTC risk was positively associated with body mass index (BMI) and waist-to-hip ratio (WHR) whereas physical activity, fruit intake, and fish intake were inversely associated. HR and (95% CI) comparing BMI >35.0 to 18.5-24.9: 1.71 (1.26, 2.31), p-trend <.0001; comparing BMI-adjusted WHR top to bottom quartile: 1.20 (0.94, 1.53), p-trend = .05; comparing ≥15-0 metabolic equivalent task-hours/week 0.76 (0.61, 0.94), p-trend = .009; comparing highest to lowest intake tertile for fruit and fish 0.79 (0.66, 0.95), p-trend = .01; 0.82 (0.68, 0.98), p-trend = .04, respectively. Associations were, in general, similar across ancestry groups. Our study provides strong evidence for important roles of obesity, diet, and physical activity in BTC etiology and stresses the need for lifestyle modification to combat the rising incidence of this fatal malignancy.

Association Between Ultraprocessed Food Consumption and Metabolic Disorders in Children and Adolescents with Obesity

BACKGROUND/OBJECTIVES

We investigated the effects of ultraprocessed food (UPF) consumption on metabolic disorders (e.g., adiposity, metabolic associated steatotic liver disease [MASLD], and insulin resistance) in children and adolescents with obesity to improve dietary guidelines and public health strategies.

METHODS

The dietary intake of 149 participants (aged 8-17 years) was assessed with food diaries. The NOVA classification system was used to classify food according to the degree of processing. Metabolic outcomes, including the fat mass index (FMI), hepatic fat percentage, and insulin resistance, were measured via dual-energy X-ray absorptiometry (DXA), magnetic resonance imaging proton density fat fraction (MRI-PDFF), and biochemical analysis, respectively.

RESULTS

Greater UPF consumption from baseline to the 6-month follow-up was significantly associated with increased insulin and decreased total cholesterol and LDL-cholesterol. UPF consumption was positively associated with the prevalence of MASLD (liver MRI-PDFF ≥ 5%; odds ratio T3 vs. T1 = 1.75; 95% confidence interval [CI] 1.03, 3.00), moderate-to-severe MASLD (liver MRI-PDFF ≥ 10%; OR T3 vs. T1 = 4.19; 95% CI 1.72, 10.22), and insulin resistance (OR T3 vs. T1 = 2.44; 95% CI 1.33, 4.48), after adjusting for covariates. A linear dose-response relationship was observed between UPF consumption and the odds of moderate-to-severe MASLD and insulin resistance.

CONCLUSIONS

Greater UPF consumption was strongly associated with MASLD and insulin resistance in children and adolescents with obesity, underscoring the importance of reducing UPF consumption through dietary guidelines and public health interventions to mitigate the risk of obesity-related metabolic conditions in young populations.

Factors influencing perceptions of processed baby foods and feeding practices among Indian mothers: a qualitative investigation

OBJECTIVE

To explore how professionally qualified, working Indian mothers conceptualize healthy foods in general, perceive processed infant and baby foods available commercially and what feeding practices they actually follow with their children at home.

DESIGN

Five focus groups with 8-12 participants were conducted around the participants' conceptualization of healthy food, their perceptions about commercially available processed baby and infant foods and their actual feeding practices that they routinely follow with their children. Discussion transcripts were analyzed using an inductive coding approach.

SETTING

India.

PARTICIPANTS

Fifty-one professionally qualified, working women with at least one child under 5 years of age.

RESULTS

Participants agreed that fresh food is healthiest. They also had favorable opinions about processed infant and baby foods with regards to healthfulness, hygiene and safety. Healthy foods were largely conceptualized in relation to nutrient claims, ingredients and discernible health outcomes. They use cues, such as health claims, brand, price, package design and others to determine healthfulness of the product. Perception was heavily influenced by these extrinsic cues rather than by participants' own nutrition knowledge. Despite having the knowledge, most participants admitted to using these foods on account of factors such as their own inability to lactate, social pressure, lack of time and convenience.

CONCLUSIONS

Most educated and well off people continue to use these products. While they rue the lack of stringent regulatory measures in India, they feel there is an urgent need to address this huge policy gap by way of legislation and regulation.

Association of ultra-processed food intake with severe non-alcoholic fatty liver disease: a prospective study of 143073 UK Biobank participants

BACKGROUND

Previous studies indicate a link between non-alcoholic fatty liver disease (NAFLD) and unhealthy dietary patterns or nutrient intake. However, it remains unclear whether ultra-processed foods (UPF) contribute to an increased risk of NAFLD. This study aimed to explore how ultra-processed food consumption correlates with severe NAFLD using the UK Biobank data.

METHODS

This prospective cohort study included 143,073 participants from the UK Biobank. UPF consumption levels were determined using the NOVA classification and quantified from 24-h dietary recall data. The association between UPF consumption and severe NAFLD (hospitalization or death) was initially examined using Cox proportional hazards models with intake quartiles. Nonlinear associations were investigated using penalized cubic splines fitted in the Cox proportional hazards models. Adjustments were made for general characteristics, sociodemographic factors, body mass index (BMI), and lifestyle.

RESULTS

Throughout the median follow-up period of 10.5 years, 1,445 participants developed severe NAFLD. The adjusted models indicated a significant increase in severe NAFLD risk in higher UPF intake groups compared to the lowest quartile (HR: 1.26 [95% CI: 1.11-1.43]). Subgroup analysis revealed that individuals with a BMI of 25 or higher were at greater risk in the highest quartile of UPF consumption. Sensitivity analyses yielded results consistent with these findings.

CONCLUSION

Higher consumption of UPF is associated with an increased risk of severe NAFLD. Reducing the intake of UPF can be a potential approach to lower the risk of NAFLD.

Dutch consumers' attitude towards industrial food processing

Industrial food processing and its possible adverse effects on health are widely debated in scientific literature and media. There is not much known about consumers' attitudes towards the processing of foods. Therefore, a questionnaire (n = 463) was distributed and interviews (n = 11) were conducted with Dutch consumers to evaluate the attitudes and associations towards industrial food processing and to assess opinions about communications on food processing and health. The results showed that 51% of the respondents had a neutral, 23% had a positive, and 26% had a negative attitude towards food processing. Respondents with a background in food by profession or education (n = 159) had more frequently a positive attitude towards food processing (P = 0.008). Respondents and interviewees pointed out both positive and negative associations with industrial processing: additives, artificial, not fresh, low nutritional value, unnatural, but also palatability, food safety, shelf life, and convenience. The questionnaire showed that 70% of the respondents thought food processing had a (slightly) negative health effect. Most interviewees indicated that when doing groceries, food processing per se is not relevant in food choices, although some critically inspected the ingredients. Furthermore, interviewees indicated that communication about food and health is scattered and complex. They would like to gain easy and straightforward information from a central source. From the questionnaire respondents, 60% indicated that they would like to have more information about food processing. In conclusion, most Dutch consumers in this study have a neutral and nuanced attitude towards industrial food processing. A connection with food via profession or education showed a more positive attitude, which may indicate the importance of knowledge and the need for clear communication about nutrition, ingredients, and food processing.

Maternal Nutrition during Pregnancy and Offspring Brain Development: Insights from Neuroimaging

Maternal nutrition during pregnancy is known to be important for offspring growth and health and has also been increasingly recognized for shaping offspring brain development. On the other hand, recent advancements in brain imaging technology have provided unprecedented insights into fetal, neonatal, and pediatric brain morphometry and function. This review synthesizes the current literature regarding the impact of maternal nutrition on offspring brain development, with a specific focus on findings from neuroimaging studies. The diverse effects of maternal nutrients intake or status during pregnancy on neurodevelopmental outcomes in children are discussed. Neuroimaging evidence showed associations between maternal nutrition such as food categories, macronutrients, and micronutrients including vitamins and minerals during pregnancy and child brain imaging features measured using imaging techniques such as ultrasound, magnetic resonance imaging (MRI), electroencephalography (EEG), and magnetoencephalography (MEG). This review demonstrates the capability of neuroimaging in characterizing how maternal nutrition during pregnancy impacts structure and function of the developing brain that may further influence long-term neuropsychological, cognitive, and behavioral outcomes in children. It aims to inspire future research utilizing neuroimaging to deepen our understanding of the critical impacts of maternal nutrition during pregnancy on offspring brain development.

Ultra-processed foods intake and sex hormone levels among children and adolescents aged 6-19 years: a cross-sectional study

Background

Sex hormones are crucial for the development of children and adolescents. The increasing consumption of ultra-processed foods (UPFs) among children and adolescents in the United States (US) has raised concerns about their potential impact on health, including hormonal balance.

Methods

Data from 3,354 participants aged 6-19 years from the NHANES 2013-2016 were analyzed. UPF intake was categorized using the NOVA food classification system, and the percentage of total daily energy intake from UPFs was calculated. The serum levels of total testosterone (TT), sex hormone-binding globulin (SHBG), and estradiol (E2) were measured. The free androgen index (FAI) and TT/E2 ratio were calculated to estimate bioavailable testosterone levels and the balance between androgens and estrogens, respectively. Multiple linear regression models, adjusted for potential confounders, estimated the associations.

Results

Our results showed that higher intake of UPFs was marginally associated with decreased serum SHBG levels (quartile (Q) 2 vs. Q1: β = -5.3, 95% confidence interval (CI): -17.0, 8.1%; Q3 vs. Q1: β = -14.6, 95%CI: -25.1, -2.5%; Q4 vs. Q1: β = -9.0, 95%CI: -20.3, 3.8%; P trend = 0.081), and significantly associated with increased serum FAI in female adolescents (Q2 vs. Q1: β = 3.2, 95%CI: -3.3, 9.7; Q3 vs. Q1: β = 7.6, 95%CI: -0.7, 16.0; Q4 vs. Q1: β = 9.5, 95%CI: 1.5, 17.6; P trend = 0.019). Additionally, UPF intake showed a marginally positive association with increased serum SHBG levels (P trend = 0.057) in male children and FAI (P trend = 0.150) in male adolescents, respectively. Similar results were observed when participants were stratified by puberty status, except for the association between UPF intake and SHBG in male children. However, there were no associations between UPF consumption and TT, E2, or the TT/E2 ratio, both in males and females.

Conclusion

Higher UPF consumption is associated with increased FAI in adolescents, particularly in girls, indicating higher bioavailable testosterone levels. Future studies should validate these findings with direct free testosterone measurements and more precise dietary intake assessments.

Catalytic action of alternansucrase on sucrose under in vitro simulated gastric conditions

Alternansucrase, a glucosyltransferase, is currently used to produce slowly digestible alternan oligosaccharides or maltooligosaccharides from sucrose. These oligosaccharides are popular for food fortification to lower postprandial glucose levels. This study aimed to explore the enzymatic reaction of alternansucrase in simulated in vitro gastric reaction conditions. Under the studied conditions, SucroSEB (a model enzyme for alternansucrase) hydrolyzed the sucrose and transglycosylated the glucose to produce glucans, both in the absence and presence of acceptors. The preference of the acceptor was maltose˃ raffinose˃ lactose. The rate of sucrose hydrolysis was significantly higher in the presence of maltose (p = 0.024). The glucans formed during the reaction included oligomers (DP 3-10) and polymers (DP ≥ 11), both of which increased over time. These glucans contained α-1,3 and α-1,6 glycosidic linkages, confirmed by 1H and 13C NMR. They were slowly and partially digestible in the presence of rat intestinal extract in contrast to the complete and rapid digestion of starch. The glucans formed after a longer gastric reaction time exhibited higher dietary fiber potential (19.145 ± 4.77 %; 60 min) compared to those formed during the initial phase (2.765 ± 0.19 %; 15 min). Overall, this study demonstrated the efficacy of SucroSEB in converting sucrose to slowly and partially digestible glucans under simulated in vitro gastric conditions.

Ultraprocessing and presence of additives in commercially produced complementary foods in seven Southeast Asian countries: a cross-sectional study

BACKGROUND

There has been a dramatic shift in food systems, and the consumption of commercially processed and packaged foods has grown globally, including among older infants and young children. Many of these products are ultraprocessed and contain additives, with concerning implications for the health and nutrition of children.

OBJECTIVES

The study objectives were as follows: 1) to assess the levels of processing among different commercially produced complementary food product (CPCF) categories marketed in the Southeast Asia region, 2) to compare the nutrient content of CPCF products across levels of processing, and 3) to assess the types of additives present in different CPCF categories.

METHODS

This cross-sectional study involved secondary analysis of a cross-sectional dataset of product label information from CPCF purchased in 2021 in Cambodia, Indonesia, Lao People's Democratic Republic, Malaysia, Philippines, Thailand, and Viet Nam. Ingredient lists were reviewed to determine the level of processing-based on the Nova classification-and the presence of additives. Nutrient declaration panels were reviewed to determine total sugar, sodium, and total fat.

RESULTS

Nearly half of all CPCF were ultraprocessed, with total sugar and sodium content significantly higher among ultraprocessed CPCF than unprocessed/minimally processed products. Almost half of CPCF contained additives, with a median of 6 per product. More than 30% of all CPCF made use of cosmetic additives to enhance the products' appearance, flavor, or texture, with emulsifiers, colors, and thickeners the most prevalent. Almost one-third of products contained additives not permitted in Codex Alimentarius standards and guidelines for CPCF.

CONCLUSIONS

Findings from this study should alert national governments to both adopt and ensure enforcement of Codex guidance on additives and regulations enacted to encourage lower levels of processing for CPCF.

The Potential Effectiveness of Front-of-Pack Nutrition Labeling for Improving Population Diets

Nutrition labeling on the front of food packages can support more healthful purchase decisions and encourage favorable reformulation. This systematic literature review applied Cochrane methods to synthesize and appraise the evidence on the effectiveness of front-of-pack labeling (FOPL) on diet-related outcomes and food reformulation to inform policy recommendations. The search was conducted on 11 academic and gray literature databases, from inception to July 2022. Evidence was synthesized using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation), vote counting, and meta-analyses, where appropriate. Overall, 221 articles were included in the review. The randomized controlled trial evidence suggested that, compared with when no FOPL was present, FOPL likely improved consumer understanding of the nutritional quality/content of foods (moderate certainty of evidence), and the healthfulness of food choices (moderate certainty) and purchases (moderate certainty). Interpretive FOPL had a greater effect on these outcomes compared with noninterpretive systems (moderate certainty). There was inconsistency in the best-performing interpretive FOPL system.

Sugar-Sweetened Beverages and Adverse Human Health Outcomes: An Umbrella Review of Meta-Analyses of Observational Studies

Our aim was to conduct an umbrella review of evidence from meta-analyses of observational studies investigating the link between sugar-sweetened beverage consumption and human health outcomes. Using predefined evidence classification criteria, we evaluated evidence from 47 meta-analyses encompassing 22,055,269 individuals. Overall, 79% of these analyses indicated direct associations between greater sugar-sweetened beverage consumption and higher risks of adverse health outcomes. Convincing evidence (class I) supported direct associations between sugar-sweetened beverage consumption and risks of depression, cardiovascular disease, nephrolithiasis, type 2 diabetes mellitus, and higher uric acid concentrations. Highly suggestive evidence (class II) supported associations with risks of nonalcoholic fatty liver disease and dental caries. Out of the remaining 40 meta-analyses, 29 were graded as suggestive or weak in the strength of evidence (classes III and IV), and 11 showed no evidence (class V). These findings inform and provide support for population-based and public health strategies aimed at reducing sugary drink consumption for improved health.

Exploring Maternal Socio-Demographic Factors Shaping Children's Dietary Patterns in Brazil: Results from the 2019 National Health Survey

This study aimed to identify the dietary patterns of Brazilian children aged 6-23 months and to investigate their association with maternal socio-demographic factors. Data from the 2019 Brazilian National Health Survey were used in this cross-sectional study. Mothers of 1616 children aged 6-23 months reported on their children's dietary intake. Dietary patterns were identified using principal component analysis, and their associations with maternal socio-demographic characteristics were assessed using linear regression models. The first consisted of healthy patterns and the second, unhealthy ones. Linear regression showed that adherence to a healthy dietary pattern was higher among children of mothers who were older (β = 0.02, p = 0.01), had more years of education (β = 0.49, p = 0.04), reported living with a partner (β = 0.29, p = 0.01), and resided in an urban area (β = 0.35, p = 0.01). Conversely, adherence to the unhealthy pattern was positively associated with mothers who declared themselves as black or brown (β = 0.25, p = 0.03). Our results show that older mothers with higher levels of education and paid work and who live with a partner are more likely to contribute to their children's healthy eating patterns. We conclude that socio-demographic factors may influence the quality of the food offered to children. Nevertheless, advocating for public policies promoting nutritious complementary diets emphasising fresh and minimally processed foods remains crucial for children whose mothers do not possess these favourable socio-demographic characteristics.

Environmental Sustainability of Food Environments: Development and Application of a Framework in 4 cities in South Asia

Background

Food environments, where people directly engage with broader food systems, may be an important contributor to the environmental sustainability of food systems.

Objectives

The primary objectives of this study were to establish a new food environment framework that considers environmental indicators and to assess data availability and gaps using data previously collected as part of a food systems survey in 4 South Asian cities.

Methods

The framework was developed by conducting a structured literature review of previous food environment frameworks and in-depth interviews with content experts (n = 6). The framework and indicators were then mapped to data collected by consumer and vendor surveys using the Urban Food Systems Assessment Tool (UFSAT) in Ahmedabad (India), Pune (India), Kathmandu (Nepal), and Pokhara (Nepal).

Results

We have expanded the sustainability domain within food environments to include consumer travel to food vendors, the presence of food delivery services, policies related to sustainability, vendor food waste, vendor plastic use, vendor utility usage, vendor recycling and waste management practices, and food packaging. Mapping the framework to existing data from 4 cities in South Asia, we found variations in food environment sustainability indicators, particularly regarding consumer transportation to food vendors, the presence of delivery services, and food waste.

Conclusions

Although the majority of food environment research focuses on the availability and affordability of healthy foods, there is an urgent need to understand better how aspects of food environments contribute to environmental goals. When mapping the framework to existing food systems data, we found gaps in data on environmental sustainability in food environments and variation in indicators across settings.

Ultra-Processed Food Consumption as a Risk Factor for Gastrointestinal Cancer and Other Causes of Mortality in Southern Italy: A Competing Risk Approach

BACKGROUND

Ultra-Processed Foods (UPFs) are increasingly consumed worldwide, even in regions with strong dietary traditions like the Mediterranean and can play a crucial role in the development of chronic diseases, including cancer. This population-based prospective cohort study investigates the association between UPF consumption and gastrointestinal cancers and other causes of mortality in Southern Italy.

METHODS

Data were collected from 4870 participants in the MICOL and NUTRIHEP cohorts. The EPIC questionnaire was used to elicit information on food and drink consumption and UPFs were categorized by degree of processing according to the NOVA classification. Cox proportional hazards regression and competing risk models were employed for statistical analysis.

RESULTS

UPF consumption was positively associated with all-cause mortality: participants in the 3rd UFP quartile, as compared to the lowest, had a 27% higher risk of death (SHR 1.27 95% CI, 1.03; 1.57), while in the highest quartile as compared to the lowest, the risk was 34% higher (SHR 1.34 95% CI, 1.00; 1.79). Higher UPFs intake was also correlated with an increased gastrointestinal cancers mortality risk, especially the 2nd (SHR 1.65, 95% CI: 1.01; 2.71) and 4th quartile (SHR 3.14 95% CI: 1.56; 6.32), with a dose-dependent effect. For the other cancers, a SHR 1.61 (95% CI 1.03; 2.54) was observed for the 3rd quartile.

CONCLUSIONS

Our results reinforce the link between UPF consumption and cancer risk, emphasizing the urgent need for interventions targeting dietary patterns.

Market-driven fortification of vitamins and minerals in packaged foods targeted at children in Brazil

This study aimed to characterise the market-driven fortification of vitamins and minerals in packaged foods targeted at children in Brazil. We analysed 535 food labels using data collected in a census-type method (n = 5620) of food labels in a Brazilian supermarket in 2013. Micronutrients declared in nutrition claims and the ingredients list (synthetic compounds) were considered to be added for commercial purposes. Analysis of the ingredients list and nutrition claims showed that market-driven fortification of vitamins and minerals was present in 27.1% of foods. The main vitamins and minerals were vitamins A, B complex, C, D, calcium, iron and zinc. The food groups 'Milk and dairy products' and 'Sugars, sugary foods and snacks' had the highest frequencies of micronutrients declared in the ingredients list. Calcium, iron, phosphorus, zinc and all vitamins, except B7, were found to be added for commercial purposes. Micronutrients were found to be commonly added to packaged foods as a marketing strategy directed at parents and their children. Future studies should assess the amount of vitamins and minerals added to packaged foods targeted at children and whether intakes of vitamins and minerals in children are potentially excessive.

Type and timing of ultra-processed foods consumption and its association with dietary intake and physical activity in women with obesity living in poverty

BACKGROUND

The present study aimed to investigate the type and timing of ultra-processed foods (UPF) consumption and its association with dietary intake (DI) and physical activity (PA) in women with obesity living in poverty.

METHODS

A cross-sectional study was employed. Obesity was defined by at least two criteria (body mass index, waist circumference or % fat mass). Poverty was defined as the three lowest classes of the Brazilian Economic Classification Criterion. PA was measured with triaxial accelerometers and DI was assessed with three 24-h dietary recalls. Foods were categorised according to the NOVA classification, with UPF classified into five subgroups, as well as the timing of consumption into six meals.

RESULTS

In total, 56 adult women were included. Overall energy intake was 1653.21 (503.22) kcal/day. UPF intake was 21.62% (11.94%) kcal/day, being higher at breakfast (4.91% kcal/day), afternoon snack (5.39% kcal/day) and dinner (5.01% kcal/day). Only UPF subgroup 4 (sandwich biscuits, sweets, or treats) showed a positive association with energy intake (β = 54.40 [27.6, 81.10] kcal/day) and a negative association with protein intake (β = -0.31% [-0.48%, -0.14%] kcal/day). UPF consumption in morning (β = -0.41% [-0.79%, -0.02%] kcal/day) and afternoon (β = -0.18% [-0.33%, -0.04%] kcal/day) snacks was associated with lower protein intake. Furthermore, lunchtime UPF consumption was positively associated with walking time (β = 0.16% [0.02%; 0.30%]) and steps/hour (β = 8.72 [1.50; 15.94] steps/h).

CONCLUSIONS

Women with obesity living in poverty consume more UPF during breakfast, afternoon snack and dinner. Physical activity is positively associated with UPF consumption at lunch. UPF, such as sandwich biscuits, sweets or treats, contribute to increasing energy intake and reducing protein intake.

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

BACKGROUND & AIMS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Psychosocial risk and protective factors for youth problem behavior are associated with food addiction in the Generation Z

Objective

Food Addiction (FA) and other well-known risk behavior as substance misuse tend to co-occur and may share similar risk and protective factors. The aim of this study was to assess the association between the diagnosis/severity of FA and psychosocial domains typically related to risk behavior syndrome in a large, nationally representative community sample of Generation Z underage Italian students.

Method

The sample consisted of 8,755 students (3,623 from middle schools, 5,132 from high schools). A short version of the Yale Food Addiction Scale 2.0 was administered to evaluate FA. Risk and protective factors related to demographic, personality, behavior, and family variables were examined. Stepwise multivariate logistic and linear regressions were conducted.

Results

The prevalence of FA was 30.8%. Female gender, social anxiety and depression symptoms, social withdrawal risk, Internet gaming disorder, social media addiction, current substance use, social challenge engagement and experienced doxing boosted the chance of FA diagnosis, whereas eating fruit and vegetables, playing competitive sports and an average sleep duration of 7-8 h per night reduced these odds. FA severity was significantly and positively associated with trait impulsiveness, social anxiety and depressive symptoms, risk of social withdrawal, recent substance use, social media, and gaming addiction, doxing suffered and risky social challenges participation. Negative associations between the severity of FA and fruit and vegetable diet habits were found.

Conclusion

Our findings confirm that FA is widespread among Italian adolescents. The associations between the diagnosis and severity of FA and psychosocial risk factors for health, including, addictive and deviant behaviors related to digital misuse, suggest its belonging to the risk behavior constellation. Health promotion schemes based on a multicomponent strategy of intervention should consider the inclusion of FA and its psychosocial correlates.

Trends in ultra-processed food availability and its association with diet-related non-communicable disease health indicators in the Portuguese population

Broad variations in dietary and physical activity patterns are part of nutritional transition concept. An additional nutritional transition has as main characteristic the change of consumption of processed foods for ultra-processed foods (UPF). This study aims to evaluate trends of UPF availability in Portuguese population and its association with diet-related non-communicable diseases (NCD) health indicators. This ecological study used data from the Household Budget Surveys conducted by the National Statistics Institute each 5 years within a national representative sample of households. The percentage of UPF was calculated based on the total daily amount of food and beverages available per capita (in grams). Data from the years 1990, 1995, 2000 and 2005 were used, which were retrieved from DAFNE-Anemos Software. NCD age-standardised mortality, prevalence and incidence were obtained from the Global Burden of Disease database, for the years 2000, 2005, 2010 and 2015. Between 1990 and 2005, the UPF availability increased from 3·9 % to 13·8 %. Over the years, almost all food and beverages categories increased the UPF availability contribution, mainly noticeable for milk, sugar, cereal and meat products. Positive correlations were observed between UPF availability and digestive diseases both in prevalence (r = 0·062; P = 0·037) and incidence (r = 0·005; P = 0·010) measures. Neoplasms incidence also showed positive correlation with UPF availability (r = 0·002; P = 0·012). Trends in UPF availability in Portugal increased exponentially. At the same time, there is a trend towards a decrease in unprocessed and processed food availability. The Portuguese population should be made aware of the health risks resulting from excessive consumption of UPF.

A policy approach to identifying food and beverage products that are ultra-processed and high in added salt, sugar and saturated fat in the United States: a cross-sectional analysis of packaged foods

Background

Governments globally aim to reduce the intake of unhealthy foods. Many policies exist that aim to address foods high in saturated fat, salt and sugar (HFSS) but the identification of ultra-processed foods (UPF) have presented a greater challenge due to the lack of an appropriate policy definition. To support policymakers, we provide approaches that can support governments to identify both HFSS foods and UPFs.

Methods

Four approaches combining elements of UPF definitions (i.e., presence of additives) and HFSS definitions were compared attempting to simplify and standardize the identification of less healthy products. Nationally representative food purchase data from NielsenIQ linked with nutrition facts label data were used to examine the mean proportion of product volume purchased by US households to be targeted. Differences between approaches were examined using Student t test; Bonferroni adjusted P value < 0.0001 was considered significant.

Findings

In 2020, 50% of 33,054,687 products purchased by US households were considered UPFs (65% of foods and 38% of beverages) and 43% HFSS (65% of foods and 26% of beverages), however there was not 100% agreement between the two definitions (P < 0.0001). By starting with HFSS criteria and adding elements of UPF (colors and flavors), we were able to provide a method with 100% agreement between the identification of UPFs and HFSS products.

Interpretation

Results demonstrated how combining HFSS criteria with UPF criteria can be used to identify less healthy foods and ensure policymakers have both a simple and accurate method to target products for policy intervention.

Funding

Bloomberg Philanthropies and the Global Food Research Program of UNC-Chapel Hill provided funds.

Inhibitors and Supporters of Policy Change in the Regulation of Unhealthy Food Marketing in Australia

BACKGROUND

Evidence on the impact of policies that regulate unhealthy food marketing demonstrates a need for a shift from pure industry self-regulation toward statutory regulation. Institutional rules, decision-making procedures, actor practices, and institutional norms influence the regulatory choices made by policy-makers. This study examined institutional processes that sustain, support, or inhibit change in the food marketing regulation in Australia using the three pillars of institutions framework - regulatory, normative, and cultural cognitive pillars.

METHODS

This was a qualitative study. Twenty-four in-depth semi-structured interviews were conducted with industry, government, civil society, and academic actors who are involved in nutrition policy in Australia.

RESULTS

The regulatory pillar was perceived to inhibit policy change through the co-regulation and self-regulation frameworks that assign rulemaking, monitoring and enforcement to industry bodies with minimal oversight by regulatory agencies and no involvement of health actors. The normative pillar was perceived to provide pathways for comprehensive statutory regulation through institutional goals and norms for collaboration that centre on a whole-of-government approach. The framing of food marketing policies to highlight the vulnerability of children is a cultural cognitive element that was perceived to be essential for getting support for policy change; however, there was a lack of shared understanding of food marketing as a policy issue. In addition, government ideologies that are perceived to be reluctant to regulate commercial actors and values that prioritize economic interest over public health make it difficult for health advocates to argue for statutory regulation of food marketing.

CONCLUSION

Elements of all three pillars (regulatory, normative, and cultural-cognitive) were identified as either inhibitors or pathways that support policy change. This study contributes to the understanding of factors that inhibit policy change and potential pathways for implementing comprehensive statutory regulation of unhealthy food marketing.

Nutrient profile of packaged foods according to the degree of processing

An increased consumption of ultra-processed foods (UPF) leads to a rising prevalence of chronic noncommunicable diseases. This study aims to characterise the nutrient profile of white-label pre-packaged foods and bakery products available in a market leader Portuguese food retail chain, according to the extent of processing proposed by NOVA classification system. The nutrient profile (energy, sugar, total fat, saturated fat and sodium) according to processing degree was analysed using non-parametric tests. UPF were the most energy dense (278 kcal/100 g, p < .001) and the highest in sugar (15.9 g/100 g, p < .001). Processed foods were the highest in sodium (538 mg/100 g, p < .001). Processed and UPF showed significantly higher total (12.4 and 10.8 g/100 g, respectively) and saturated fat content (6.10 and 4.61 g/100 g, respectively) than unprocessed/minimally processed foods (p < .001). Regarding the variation of the nutritional value across the extent of processing, different results were observed for some categories suggesting the importance of a stratified analysis. The consumption of less processed foods and the manufacture of processed/UPF with better nutrient profile should be promoted.

Higher ultra processed foods intake is associated with low muscle mass in young to middle-aged adults: a cross-sectional NHANES study

Design

Ultra-processed foods (UPFs) have become a pressing global health concern, prompting investigations into their potential association with low muscle mass in adults.

Methods

This cross-sectional study analyzed data from 10,255 adults aged 20-59 years who participated in the National Health and Nutritional Examination Survey (NHANES) during cycles spanning from 2011 to 2018. The primary outcome, low muscle mass, was assessed using the Foundation for the National Institutes of Health (FNIH) definition, employing restricted cubic splines and weighted multivariate regression for analysis. Sensitivity analysis incorporated three other prevalent definitions to explore optimal cut points for muscle quality in the context of sarcopenia.

Results

The weighted prevalence of low muscle mass was 7.65%. Comparing the percentage of UPFs calories intake between individuals with normal and low muscle mass, the values were found to be similar (55.70 vs. 54.62%). Significantly linear associations were observed between UPFs consumption and low muscle mass (P for non-linear = 0.7915, P for total = 0.0117). Upon full adjustment for potential confounding factors, participants with the highest UPFs intake exhibited a 60% increased risk of low muscle mass (OR = 1.60, 95% CI: 1.13 to 2.26, P for trend = 0.003) and a decrease in ALM/BMI (β = -0.0176, 95% CI: -0.0274 to -0.0077, P for trend = 0.003). Sensitivity analysis confirmed the consistency of these associations, except for the International Working Group on Sarcopenia (IWGS) definition, where the observed association between the highest quartiles of UPFs (%Kcal) and low muscle mass did not attain statistical significance (OR = 1.35, 95% CI: 0.97 to 1.87, P for trend = 0.082).

Conclusion

Our study underscores a significant linear association between higher UPFs consumption and an elevated risk of low muscle mass in adults. These findings emphasize the potential adverse impact of UPFs on muscle health and emphasize the need to address UPFs consumption as a modifiable risk factor in the context of sarcopenia.

Monitoring health and nutrition claims on food labels in Brazil

Introduction

The monitoring of nutrition and health claims on food and beverage labels has been proposed by international and national organizations because it can collaborate with the development of public policies to regulate food labeling and marketing strategies. One way of carrying out this monitoring is by using data collected by private companies.

Objective

To compare information on nutrition and health claims available in a commercial database of a private company that monitors the launch of new foods and beverages in Brazilian food retailers with information on those same claims manually coded by trained research assistants.

Methods

This is a cross-sectional observational study using a data sample of newly launched food and beverages available at a commercial database from 2018 to 2021. We compared the information on health and nutrition claims available on the commercial dataset with reliable information on the same nutrition and health claims manually coded by trained research assistants using a tested taxonomy to classify such claims. We used Gwet's Kappa AC1 with 95% CI and percentage agreement to compare both data sources and calculated sensitivity and specificity of the compared data.

Results

A total of 6,722 foods and beverages were analyzed. Mintel-GNPD presented 36.28% (n = 2,439) of nutrition claims, while in the trained researchers' coding, it was 33.73% (n = 2,267). We found a prevalence of 5.4% (n = 362) for health claims in Mintel-GNPD and 10.8% (n = 723) in the researchers' coding. All subcategories of nutrition and health claims showed high agreement (Kappa >0.81). Health claims presented kappa = 0.89 with 33.7% sensitivity and 98.0% specificity while nutrition claims showed kappa = 0.86 with 92.9% sensitivity and 92.5% specificity.

Conclusion

Nutrition and health claims showed high agreement, with great results in nutrition claims, indicating that Mintel-GPND is suitable for monitoring such claims on food and beverage packaging in Brazil. Additionally, our findings show a high prevalence of nutrition and health claims on food packages launched in the Brazilian food retail, highlighting the need to monitor these to develop public policies to regulate food marketing on packaging in Brazil.

Examining gender differences in adolescent exposure to food and beverage marketing through go-along interviews

This study explores how adolescents engage with unhealthy food and beverage marketing in online settings, from a gender perspective. Employing an online ethnography approach and using go-along interviews, we explored the experiences of adolescent boys and girls aged 13-17 as they navigated their online experiences with digital food and beverage marketing. Notable themes emerged, including the identification of predatory actions by food companies, the role of protective factors such as family, and the influence of social media influencers in shaping adolescent dietary preferences. Importantly, this research unearthed gender disparities in the participants' responses. Girls, in particular, exhibited a heightened awareness of the protective role played by their families, emphasized the influence of color in marketing strategies, recognized the significance of gender in marketing, and reported exposure to alcohol advertisements-findings that boys less frequently echoed. The study underscores the importance of adolescence as a critical phase in development, during which food companies target these impressionable individuals, driven by their independence and potential for brand loyalty. Moreover, it highlights the potential avenue of gender-specific marketing, offering valuable insights into the gendered dimensions of adolescents' food marketing experiences. By examining the interplay between digital food marketing and gender, this research addresses a critical gap in the literature, shedding light on how gender influences adolescents' perceptions, responses, and behaviors in the context of food marketing strategies. These findings have the potential to inform adolescents of the marketing techniques that target them and guide policymakers in developing and implementing evidence-based regulations aimed at safeguarding adolescents from exposure to unhealthy food marketing.

How and why ultra-processed foods harm human health

The analysis of food using a perspective centred on nutrients seems inadequate for understanding the dietary transition and its impact on the growth of obesity and chronic diseases. Industrial food processing is now proposed as the key to explain the relationship between food and health. The NOVA food classification considers the degree and the purpose of food processing, which includes physical, biological and chemical processes used after foods are separated from nature, and before being consumed or prepared as dishes and meals. NOVA has four food groups: (1) unprocessed and minimally processed foods; (2) processed culinary ingredients; (3) processed foods and (4) ultra-processed foods, which are formulations made mostly or entirely from substances derived from group 1 foods and additives, with little if any intact group 1 food. Many investigations linking high ultra-processed food consumption with deterioration of diets and adverse health outcomes are reinforced by prospective studies, systematic reviews and meta-analyses. There are various plausible explanations of why diets high in ultra-processed foods are harmful. Their production and consumption continue to rise worldwide. Efficient and effective public policies and actions that reduce production and consumption of ultra-processed products are needed, to protect human health now and in future.

Assessment of ultra processed foods consumption in Senegal: validation of the Nova-UPF screener

BACKGROUND

Ultra-processed foods (UPF), as proposed by the Nova food classification system, are linked to the development of obesity and several non-communicable chronic diseases and deaths from all causes. The Nova-UPF screener developed in Brazil is a simple and quick tool to assess and monitor the consumption of these food products. The aim of this study was to adapt and validate, against the 24-hour dietary recall, this short food-based screener to assess UPF consumption in the Senegalese context.

METHODS

The tool adaptation was undertaken using DELPHI methodology with national experts and data from a food market survey. Following the adaptation, sub-categories were renamed, restructured and new ones introduced. The validation study was conducted in the urban area of Dakar in a convenience sample of 301 adults, using as a reference the dietary share of UPF on the day prior to the survey, expressed as a percentage of total energy intake obtained via 24-hour recall. Association between the Nova-UPF score and the dietary share of UPF was evaluated using linear regression models. The Pabak index was used to assess the agreement in participants' classification according to quintiles of Nova-UPF score and quintiles of the dietary share of UPF.

RESULTS

The results show a linear and positive association (p-value < 0.001) between intervals of the Nova-UPF score and the average dietary share of UPF. There was a near perfect agreement in the distribution of individuals according to score's quintiles and UPF dietary share quintiles (Pabak index = 0.84).

CONCLUSION

The study concluded that the score provided by the Nova-UPF screener adapted to the Senegalese context is a valid estimate of UPF consumption.

One Health Perspectives on Food Safety in Minimally Processed Vegetables and Fruits: From Farm to Fork

While food markets and food production chains are experiencing exponential growth, global attention to food safety is steadily increasing. This is particularly crucial for ready-to-eat products such as fresh-cut salads and fruits, as these items are consumed raw without prior heat treatment, making the presence of pathogenic microorganisms quite frequent. Moreover, many studies on foodborne illnesses associated with these foods often overlook the transmission links from the initial contamination source. The prevention and control of the dissemination of foodborne pathogens should be approached holistically, involving agricultural production, processing, transport, food production, and extending to final consumption, all while adopting a One Health perspective. In this context, our objective is to compile available information on the challenges related to microbiological contamination in minimally handled fruits and vegetables. This includes major reported outbreaks, specific bacterial strains, and associated statistics throughout the production chain. We address the sources of contamination at each stage, along with issues related to food manipulation and disinfection. Additionally, we provide potential solutions to promote a healthier approach to fresh-cut fruits and vegetables. This information will be valuable for both researchers and food producers, particularly those focused on ensuring food safety and quality.

Synthesis of Effect Sizes on Dose Response from Ultra-Processed Food Consumption against Various Noncommunicable Diseases

Ultra-processed foods (UPFs), according to the NOVA classification food system, are food products that are processed using advanced processing technology, which improves palatability and sensory quality. However, UPFs increase the daily intake of energy, sodium, sugar, and total fat (including saturated fat), and decrease the intake of fiber. This might trigger overweight and obesity, the initial stages of noncommunicable diseases (NCDs). However, the effect of UPF consumption on NCDs remains under debate. This study aimed to synthesize the effect size of UPF dose response on various NCDs by using a meta-analysis method. The main output was a hazard ratio (HR) and a 95% confidence interval (CI). Using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) selection guidelines, 18 research articles were chosen for further effect size synthesis. The results showed that UPF consumption significantly increased the daily intake of carbohydrates, added sugar, saturated fat, sodium, energy, cholesterol, and total fat; increases of 49.64, 40.78, 30.00, 27.76, 26.67, 25.69, and 15.77%, respectively, were observed. Moreover, with UPF consumption, the fiber intake was way below the daily dietary recommendation (DR), at -38.55%. Further, a 10% increment in UPF consumption significantly affects diabetes, cardiovascular diseases, obesity, and cancer (HR ± 95% CI: 1.115 ± 0.044, 1.096 ± 0.053, 1.068 ± 0.050, and 1.020 ± 0.020, respectively). Thus, limiting daily UPF consumption could help prevent obesity and various NCDs.

Evaluation of food purchasing in the Brazilian School Feeding Programme: feasibility of the requirements and recommendations

OBJECTIVE

To analyse the purchase of food for school feeding, according to the extent and purpose of industrial processing and variety, exploring the feasibility of achieving the requirements and recommendations of the Brazilian School Feeding Programme, and the variety of unprocessed or minimally processed foods according to the purchase of ultra-processed foods.

DESIGN

Secondary data from 2016 from the Accountability Management System of the National Fund for Educational Development, concerning the food items purchased, were used to explore the feasibility of the requirements and recommendations. The foods were grouped according to the NOVA classification system. Variety was assessed by counting different types of unprocessed or minimally processed foods.

SETTING

Brazil.

PARTICIPANTS

3698 Brazilian municipalities.

RESULTS

Energy share from unprocessed or minimally processed foods was 44·1 % while that of ultra-processed foods was 29·9 %. The average of unprocessed or minimally processed food types purchased annually was 33·8 items. Of the municipalities, 35·8 % were within the limit established for the expenditure of funds for the purchase of processed and ultra-processed foods, while 8·7 % followed the recommendation for variety. The proportion of ultra-processed foods did not influence the variety of food items purchased.

CONCLUSIONS

The results showed the feasibility of achieving the requirements and recommendations and underscored the importance of continued efforts to promote the inclusion of unprocessed or minimally processed foods in the school feeding programme while addressing the challenges associated with expenditure limits of processed and ultra-processed foods and enhancing variety, which is strategic to promote adequate and healthy meals.

Upstream Determinants of Overweight and Obesity in Europe

PURPOSE OF REVIEW

To review the upstream determinants of overweight and obesity in Europe, including food and built environments, and political, commercial, and socioeconomic determinants.

RECENT FINDINGS

Overweight and obesity affect 60% of European adults, and one in three children, and are more common in individuals with low compared to high socioeconomic position (SEP). Individuals in low SEP groups are more exposed to unhealthy built and food environments, including higher exposure to unhealthy food marketing. Industries influencing the food system have much economic power, resulting in ignoring or silencing the role of ultra-processed foods and commercial practices in weight gain. Overall, effective policies to address overweight and obesity have been insufficiently implemented by governments. To accelerate implementation, strengthened political commitment is essential. Policies must also focus on the upstream, structural, and systemic drivers of overweight and obesity; be comprehensive; and target socioeconomic inequalities in diets and physical activity.

New insights in the mechanisms of weight-loss maintenance: Summary from a Pennington symposium

Obesity is a chronic disease that affects more than 650 million adults worldwide. Obesity not only is a significant health concern on its own, but predisposes to cardiometabolic comorbidities, including coronary heart disease, dyslipidemia, hypertension, type 2 diabetes, and some cancers. Lifestyle interventions effectively promote weight loss of 5% to 10%, and pharmacological and surgical interventions even more, with some novel approved drugs inducing up to an average of 25% weight loss. Yet, maintaining weight loss over the long-term remains extremely challenging, and subsequent weight gain is typical. The mechanisms underlying weight regain remain to be fully elucidated. The purpose of this Pennington Biomedical Scientific Symposium was to review and highlight the complex interplay between the physiological, behavioral, and environmental systems controlling energy intake and expenditure. Each of these contributions were further discussed in the context of weight-loss maintenance, and systems-level viewpoints were highlighted to interpret gaps in current approaches. The invited speakers built upon the science of obesity and weight loss to collectively propose future research directions that will aid in revealing the complicated mechanisms involved in the weight-reduced state.