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Fardet A. Ultra-processing should be understood as a holistic issue, from food matrix, to dietary patterns, food scoring, and food systems. J Food Sci 2024. [PMID: 38829743 DOI: 10.1111/1750-3841.17139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 06/05/2024]
Abstract
The ultra-processed food (UPF) concept first emerged 15 years ago, and is now studied worldwide in different contexts, for example, human health, food behavior, socio-economic, food consumption, food scoring, and food system sustainability. Briefly, UPFs are defined as containing at least one marker of ultra-processing (MUP). MUPs are (1) cosmetic additives, (2) aromas, (3) some highly processed carbohydrates, proteins, fats, and/or fiber, and (4) drastic processes directly applied to food such as extrusion cooking or puffing. The first three categories of MUPs are on the food packaging in the list of ingredients, and are extracted, then purified, from raw foods or coming from artificial syntheses, leading to a-matrix/a-cellular compounds. Therefore, the core paradigm to define MUP is extreme food matrix degradation, and for UPF, matrix artificialization. Besides, UPFs are more than just junk food, encompassing numerous industrialized foods, falsely presented as healthy, for example, animal-based food analogs, but also organic, vegan, gluten-free, micronutrient-enriched, and/or light foods. In this way, UPFs are "high-quality junk foods." Otherwise, UPF being a holistic and indivisible concept by essence, we propose in this review to analyze ultra-processing at four holistic levels corresponding to four important scientific issues: the food matrix, the dietary pattern, food system, and food scoring. We reached the main conclusion that UPFs should be first studied with a holistic and scientifically based approach, not a reductionist one. Otherwise, we take the risk of performing greenwashing and create still more new health threats at a global level.
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Affiliation(s)
- Anthony Fardet
- INRAE, UMR 1019, UNH, CRNH Auvergne, F-63000 Clermont-Ferrand & Clermont Auvergne Université, Unité de Nutrition Humaine, Clermont-Ferrand, France
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2
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Agostoni C, Boccia S, Graffigna G, Slavin J, Abodi M, Szajewska H. What should I eat today? Evidence, guidelines, dietary patterns and consumer's behavior. Eur J Intern Med 2024:S0953-6205(24)00233-4. [PMID: 38821785 DOI: 10.1016/j.ejim.2024.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/10/2024] [Accepted: 05/21/2024] [Indexed: 06/02/2024]
Abstract
Over the past century, dietary recommendations emphasizing food patterns as means to deliver essential nutrients have garnered widespread acceptance. The necessity for foods supplying vital nutrients and energy throughout various life stages requires the involvement of local resources and cultural practices to prevent nutrient deficiency diseases. Since the 1980s, dietary guidelines aimed at adverting chronic diseases have relied on epidemiological research to predict which dietary patterns correlate with reduced risk of chronic disease or links to health outcomes. Dietary guidelines have been broad, typically recommending avoiding excess or deficiency of single nutrients. Efforts to fine-tune these recommendations face challenges due to a scarcity of robust scientific data supporting more specific guidance across the life cycle. Consumers have become skeptical of dietary guidelines, because media coverage of new studies is often in conflict with accepted nutrition dogma. Indications to align individual and planet's health have been issued supporting the concept of sustainable dietary patterns. Whether we really have a science-based databank to support dietary guidelines is still a matter of ongoing debate, as presented in this paper.
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Affiliation(s)
- Carlo Agostoni
- Pediatric Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Stefania Boccia
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Guendalina Graffigna
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy; EngageMinds HUB, Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Cremona, Italy
| | - Joanne Slavin
- Department of Food Science and Nutrition, University of Minnesota - Twin Cities, St. Paul, United States
| | - Martina Abodi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Hania Szajewska
- The Medical University of Warsaw, Department of Paediatrics, Warsaw, Poland
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Nees S, Lutsiv T, Thompson HJ. Ultra-Processed Foods-Dietary Foe or Potential Ally? Nutrients 2024; 16:1013. [PMID: 38613046 PMCID: PMC11013700 DOI: 10.3390/nu16071013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
The prevalence of non-communicable diseases (NCDs) has steadily increased in the United States. Health experts attribute the increasing prevalence of NCDs, in part, to the consumption of ultra-processed foods (UPFs) based on epidemiological observations. However, no definitive evidence of causality has been established. Consequently, there is an ongoing debate over whether adverse health outcomes may be due to the low nutrient density per kilocalorie, the processing techniques used during the production of UPFs, taste preference-driven overconsumption of calories, or unidentified factors. Recognizing that "the science is not settled," we propose an investigative process in this narrative review to move the field beyond current controversies and potentially identify the basis of causality. Since many consumers depend on UPFs due to their shelf stability, affordability, availability, ease of use, and safety from pathogens, we also suggest a paradigm for guiding both the formulation of UPFs by food designers and the selection of UPFs by consumers.
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Affiliation(s)
- Sabrina Nees
- Graduate Program in Horticulture and Human Health, Colorado State University, Fort Collins, CO 80523, USA;
| | - Tymofiy Lutsiv
- Cancer Prevention Laboratory, Colorado State University, Fort Collins, CO 80523, USA;
- Graduate Program in Cell and Molecular Biology, Colorado State University, Fort Collins, CO 80523, USA
| | - Henry J. Thompson
- Graduate Program in Horticulture and Human Health, Colorado State University, Fort Collins, CO 80523, USA;
- Cancer Prevention Laboratory, Colorado State University, Fort Collins, CO 80523, USA;
- Graduate Program in Cell and Molecular Biology, Colorado State University, Fort Collins, CO 80523, USA
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Walton J, Kehoe L. Current perspectives and challenges in the estimation of fruit juice consumption across the lifecycle in Europe. Nutr Res Rev 2024:1-12. [PMID: 38356367 DOI: 10.1017/s095442242400009x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Fruit juice (FJ) is typically low in energy, contains natural sugars, important amounts of micronutrients and is not permitted to have added sugars/sweeteners. However, its role in a healthy diet is under scrutiny partly due to the wider adoption of the definition for free sugars in nutrition policy. This review aimed to identify data on FJ consumption from national food consumption surveys across Europe, to examine current intakes, percent consumers and its contribution to intakes of energy, total sugars, free sugars, vitamin C, folate and potassium. Data were extracted on the population mean intake of FJ and its contribution to nutrient intakes across the lifecycle and crude estimates of population mean intakes across countries were reported for the total population and for consumers only. This review highlighted significant gaps/challenges regarding the availability of country-specific national food consumption surveys across Europe and specifically data on FJ consumption (including complexities surrounding categorisations). Nonetheless, using a comparable/homogenous definition, the mean intake of FJ among consumers was approximately 1 × 150 ml glass/day for adults/older adults, with lower intakes among infants (86 g/d), children (108 g/d) and teenagers (112 g/d). FJ made important contributions to intakes of vitamin C while making little contribution to energy intakes but also contributed 2-14 % of free sugars intake (which may be considered modest compared to other sources). The complexity of collating and interpreting data on FJ intake as elucidated in this review raises questions surrounding the categorisation of FJ in research and presents significant challenges for policymakers with respect to dietary guidance for FJ.
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Affiliation(s)
- Janette Walton
- Department of Biological Sciences, Munster Technological University, Cork, Republic of Ireland
| | - Laura Kehoe
- Department of Biological Sciences, Munster Technological University, Cork, Republic of Ireland
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Saguy IS, Silva CLM, Cohen E. Emerging challenges and opportunities in innovating food science technology and engineering education. NPJ Sci Food 2024; 8:5. [PMID: 38216591 PMCID: PMC10786934 DOI: 10.1038/s41538-023-00243-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/08/2023] [Indexed: 01/14/2024] Open
Abstract
Progress in science, technology, innovation, and digital capabilities call for reassessing food science, technology, and engineering (FST&E) education and research programs. This survey targeted global professionals and students across food disciplines and nutrition. Its main objectives included assessing the status of FST&E higher education, identifying challenges and opportunities, and furnishing recommendations. Seven topics affecting the future of the FST&E curricula were evaluated by the panel as 'High' to 'Very high', namely: 'Critical thinking', followed by 'Problem-solving projects', 'Teamwork/collaboration', 'Innovation/Open innovation' and 'Multidisciplinary'. The importance of academic partnership/collaboration with the Food Industry and Nutrition Sciences was demonstrated. Significant positive roles of the food industry in collaboration and partnerships were found. Other essential food industry attributes were related to internships, education, strategy, and vision. Collaboration between FST&E and nutrition sciences indicated the high standing of this direction. The need to integrate or converge nutrition sciences and FST&E is emphasized, especially with the growing consumer awareness of health and wellness. The study provides insights into new education and learning opportunities and new topics for future curricula.
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Affiliation(s)
- I S Saguy
- The Robert H. Smith Faculty of Agriculture, Food & Environment, The Hebrew University of Jerusalem, Rehovot, Israel.
| | - C L M Silva
- Universidade Católica Portuguesa, CBQF-Centro de Biotecnologia e Química Fina-Laboratório Associado, Escola Superior de Biotecnologia, Rua Diogo Botelho 1327, 4169-005, Porto, Portugal
| | - E Cohen
- Gilford Glazer Faculty of Business Administration, Ben-Gurion University of the Negev Beer-Sheva, Be'er Sheva, Israel
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Visioli F, Marangoni F, Fogliano V, Del Rio D, Martinez JA, Kuhnle G, Buttriss J, Da Costa Ribeiro H, Bier D, Poli A. The ultra-processed foods hypothesis: a product processed well beyond the basic ingredients in the package. Nutr Res Rev 2023; 36:340-350. [PMID: 35730561 DOI: 10.1017/s0954422422000117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The NOVA classification of food items has become increasingly popular and is being used in several observational studies as well as in nutritional guidelines and recommendations. We propose that there is a need for this classification and its use in the formulation of public health policies to be critically discussed and re-appraised. The terms 'processing' and 'ultra-processing', which are crucial to the NOVA classification, are ill-defined, as no scientific, measurable or precise reference parameters exist for them. Likewise, the theoretical grounds of the NOVA classification are unclear and inaccurate. Overall, the NOVA classification conflicts with the classic, evidence-based evaluation of foods based on composition and portion size because NOVA postulates that the food itself (or how much of it is eaten) is unimportant, but rather that dietary effects are due to how the food is produced. We contend that the NOVA system suffers from a lack of biological plausibility so the assertion that ultra-processed foods are intrinsically unhealthful is largely unproven, and needs further examination and elaboration.
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Affiliation(s)
- Francesco Visioli
- Department of Molecular Medicine, University of Padova, Padova, Italy
- IMDEA-Food, CEI UAM+CSIC, Madrid, Spain
| | | | - Vincenzo Fogliano
- Food Quality and Design Group, Wageningen University and Research, Wageningen, The Netherlands
| | - Daniele Del Rio
- Department of Food and Drugs, Human Nutrition Unit, University of Parma, Parma, Italy
| | | | - Gunter Kuhnle
- Department of Food and Nutritional Sciences, University of Reading, UK
| | | | - Hugo Da Costa Ribeiro
- Department of Pediatrics, Federal University of Bahia School of Medicine, Salvador, Bahia, Brazil
| | - Dennis Bier
- Department of Pediatrics, Children's Nutrition Research Center, Baylor College of Medicine, Houston, USA
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Touvier M, da Costa Louzada ML, Mozaffarian D, Baker P, Juul F, Srour B. Ultra-processed foods and cardiometabolic health: public health policies to reduce consumption cannot wait. BMJ 2023; 383:e075294. [PMID: 37813465 PMCID: PMC10561017 DOI: 10.1136/bmj-2023-075294] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Affiliation(s)
- Mathilde Touvier
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Nutritional Epidemiology Research Team (EREN), Center of Research in Epidemiology and StatisticS (CRESS), Bobigny, France
| | | | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Phillip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Filippa Juul
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY, USA
| | - Bernard Srour
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Nutritional Epidemiology Research Team (EREN), Center of Research in Epidemiology and StatisticS (CRESS), Bobigny, France
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Lasschuijt M, Camps G, Mars M, Siebelink E, de Graaf K, Bolhuis D. Speed limits: the effects of industrial food processing and food texture on daily energy intake and eating behaviour in healthy adults. Eur J Nutr 2023; 62:2949-2962. [PMID: 37452167 PMCID: PMC10469122 DOI: 10.1007/s00394-023-03202-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 06/30/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Frequent consumption of industrially processed foods has been associated with obesity. However, it is unknown what drives this association. Food textures of industrially processed foods that stimulate energy overconsumption may be an important driver of this association. Therefore, this study aimed to determine the independent and combined effects of food texture and level of industrial food processing (based on the NOVA classification) on daily energy intake and eating behaviour. METHODS Eighteen healthy adults (F/M: 11/7, 23 ± 3 y, 22.1 ± 2.0 kg/m2) participated in a 2 × 2 randomized crossover dietary intervention with four conditions (total of 288 meals): hard unprocessed, hard (ultra-)processed, soft unprocessed and soft (ultra-)processed. Daily diets were offered ad libitum and were equal in energy density (1 kcal/g). Food Intake (g) was measured by pre- and post-consumption weighing of the plates. Eating behaviour parameters were derived from video annotations. RESULTS Daily energy intake and food intake were, respectively, 33% (571 ± 135 kcal) and 14% (247 ± 146 g) lower in the hard compared to the soft conditions (main texture p < 0.001). Energy intake was lower in both hard conditions compared to the (ultra)processed soft condition (Tukey p < 0.04). Eating rate (g/min) was on average 85% slower (P < 0.001) in the hard compared to the soft conditions (p < 0.001). Level of processing did not affect food intake. CONCLUSION Consumption of hard-textured foods reduces daily energy intake of (ultra-) processed foods. This preliminary investigation shows that there is great variability in food properties that affect energy and food intake beyond industrial food processing. However, findings should be interpreted with precaution considering the limited sample size of this trial. Future classification systems for public health messaging should include energy intake rate to help reduce overconsumption. CLINICAL TRIAL REGISTRY NCT04280146, https://www. CLINICALTRIALS gov , February 21st 2020.
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Affiliation(s)
- Marlou Lasschuijt
- Division of Human Nutrition and Health, Wageningen University & Research, Stippeneng 4, 6708 WE, Wageningen, The Netherlands.
| | - Guido Camps
- Division of Human Nutrition and Health, Wageningen University & Research, Stippeneng 4, 6708 WE, Wageningen, The Netherlands
| | - Monica Mars
- Division of Human Nutrition and Health, Wageningen University & Research, Stippeneng 4, 6708 WE, Wageningen, The Netherlands
| | - Els Siebelink
- Division of Human Nutrition and Health, Wageningen University & Research, Stippeneng 4, 6708 WE, Wageningen, The Netherlands
| | - Kees de Graaf
- Division of Human Nutrition and Health, Wageningen University & Research, Stippeneng 4, 6708 WE, Wageningen, The Netherlands
| | - Dieuwerke Bolhuis
- Food Quality and Design Group, Wageningen University & Research, Bornse Weilanden 9, 6708 WG, Wageningen, The Netherlands
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Calvo MS, Dunford EK, Uribarri J. Industrial Use of Phosphate Food Additives: A Mechanism Linking Ultra-Processed Food Intake to Cardiorenal Disease Risk? Nutrients 2023; 15:3510. [PMID: 37630701 PMCID: PMC10459924 DOI: 10.3390/nu15163510] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
The consumption of ultra-processed food (UPF) keeps rising, and at the same time, an increasing number of epidemiological studies are linking high rates of consumption of UPF with serious health outcomes, such as cardiovascular disease, in the general population. Many potential mechanisms, either in isolation or in combination, can explain the negative effects of UPF. In this review, we have addressed the potential role of inorganic phosphate additives, commonly added to a wide variety of foods, as factors contributing to the negative effects of UPF on cardiorenal disease. Inorganic phosphates are rapidly and efficiently absorbed, and elevated serum phosphate can lead to negative cardiorenal effects, either directly through tissue/vessel calcification or indirectly through the release of mineral-regulating hormones, parathyroid hormone, and fibroblast growth factor-23. An association between serum phosphate and cardiovascular and bone disease among patients with chronic kidney disease is well-accepted by nephrologists. Epidemiological studies have demonstrated an association between serum phosphate and dietary phosphate intake and mortality, even in the general American population. The magnitude of the role of inorganic phosphate additives in these associations remains to be determined, and the initial step should be to determine precise estimates of population exposure to inorganic phosphate additives in the food supply.
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Affiliation(s)
- Mona S. Calvo
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - Elizabeth K. Dunford
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2042, Australia;
- Department of Nutrition, Gillings Global School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Jaime Uribarri
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
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Lee JJ, Srebot S, Ahmed M, Mulligan C, Hu G, L'Abbé MR. Nutritional quality and price of plant-based dairy and meat analogs in the Canadian food supply system. J Food Sci 2023; 88:3594-3606. [PMID: 37458282 DOI: 10.1111/1750-3841.16691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/15/2023] [Accepted: 06/21/2023] [Indexed: 08/05/2023]
Abstract
There has been an increased consumer interest and public health emphasis on plant-based protein foods, resulting in a rise in the availability of highly processed plant-based analogs. The objectives of this study were to assess the nutritional quality and the price of plant-based dairy and meat analogs compared to their respective animal-derived products and to examine the association between processing levels and the nutritional quality among these products. Using a branded food composition database, products in cheese, yogurt, milk, and meat categories were examined (n = 3231). Products were categorized as plant-based analogs versus animal-derived products using the ingredient list. Products were examined for their nutrient content, overall nutritional quality using the Food Standards Australia New Zealand nutrient profiling model, price, and processing levels using the NOVA classification. All plant-based analogs had lower protein and higher total carbohydrate, sugar, and fiber content compared to their respective animal-derived products. Compared to their respective animal-derived products, plant-based milk and meat analogs had lower energy, total fat, and saturated fat content; plant-based yogurt and meat analogs had lower sodium content; and all plant-based dairy analogs had lower calcium content. Plant-based cheese and yogurt analogs were more expensive than animal-based products; however, there was no significant difference among milk and meat products. There was no association between processing levels and overall nutritional quality among dairy and meat products. Plant-based analogs may be part of a healthy and affordable diet to reduce the intakes of nutrients of concern; however, additional compositional guidelines and/or labeling may be needed to highlight the differences in the levels of nutrients to encourage.
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Affiliation(s)
- Jennifer J Lee
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sophia Srebot
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mavra Ahmed
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Joannah & Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, Ontario, Canada
| | - Christine Mulligan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Guanlan Hu
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mary R L'Abbé
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Calvo MS, Uribarri J. Food Additive Use in Ultraprocessed Foods: Can Processing Use of Industrial Additives Contribute to Adverse Health Outcomes in Children? J Acad Nutr Diet 2023; 123:861-864. [PMID: 36682684 DOI: 10.1016/j.jand.2023.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Affiliation(s)
- Mona S Calvo
- The Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Jaime Uribarri
- The Icahn School of Medicine at Mount Sinai, New York, New York.
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Monteiro CA, Astrup A. Does the concept of "ultra-processed foods" help inform dietary guidelines, beyond conventional classification systems? YES. Am J Clin Nutr 2022; 116:1476-1481. [PMID: 35670127 DOI: 10.1093/ajcn/nqac122] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The recommendation to prefer unprocessed/minimally processed foods and freshly made meals instead of ultra-processed foods (following the Nova food classification system) is being increasingly adopted in new official dietary guidelines issued by national governments and international health associations. This recommendation is supported by systematic reviews and meta-analyses of nationally representative dietary surveys and long-term cohort studies. These data show that increased intake of ultra-processed foods is associated with poor-quality diets and with increased morbidity and mortality from several chronic diseases. Various attributes of ultra-processed foods acting through known, plausible, or suggested physiologic and behavioral mechanisms relate them to ill health, and it is likely that different combinations of attributes and mechanisms affect different health outcomes. Although more research should be done to identify these mechanisms, existing evidence is sufficient to recommend the avoidance of ultra-processed foods to optimize health and policies to support and make feasible this recommendation.
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Affiliation(s)
- Carlos A Monteiro
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Arne Astrup
- Obesity and Nutrition Science, Novo Nordisk Foundation, Hellerup, Denmark
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Astrup A, Monteiro CA. Does the concept of "ultra-processed foods" help inform dietary guidelines, beyond conventional classification systems? NO. Am J Clin Nutr 2022; 116:1482-1488. [PMID: 35670128 DOI: 10.1093/ajcn/nqac123] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The Nova classification of ultra-processed foods (UPFs) rests on poorly defined food processes and the presence of food additives from a chemically heterogeneous group, easily leading to misclassification. UPFs are claimed to promote overconsumption of energy and obesity due to high palatability, but little evidence supports effects beyond those that can be accounted for by nutrient composition, energy density, and food matrices. Observational studies link dietary intake of UPFs with obesity, but none have demonstrated independent associations after controlling for likely confounders. A highly cited randomized controlled feeding study that compared a UPF diet with an unprocessed diet showed a rapidly weaning effect on energy intake that can be entirely explained by more conventional and quantifiable dietary factors, including energy density, intrinsic fiber, glycemic load, and added sugar. Clearly, many aspects of food processing can affect health outcomes, but conflating them into the notion of ultra-processing is unnecessary, because the main determinants of chronic disease risk are already captured by existing nutrient profiling systems. In conclusion, the Nova classification adds little to existing nutrient profiling systems; characterizes several healthy, nutrient-dense foods as unhealthy; and is counterproductive to solve the major global food production challenges.
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Affiliation(s)
- A Astrup
- Obesity and Nutrition Science, Novo Nordisk Foundation, Hellerup, Denmark
| | - C A Monteiro
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
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Kelsey PT, Papadopoulou E, Borge TC, Dahl C, Brantsæter AL, Erlund I, Meltzer HM, Haug LS, Caspersen IH. Ultra-processed food consumption and associations with biomarkers of nutrition and inflammation in pregnancy: The Norwegian Environmental Biobank. Front Nutr 2022; 9:1052001. [PMID: 36570121 PMCID: PMC9772468 DOI: 10.3389/fnut.2022.1052001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/18/2022] [Indexed: 12/13/2022] Open
Abstract
Background A high consumption of ultra-processed foods (UPFs) is often associated with low nutritional quality, but data on associations with biomarkers are scarce. We aimed to explore associations between UPF intake, diet quality, and concentrations of biomarkers of nutrition and inflammation measured in mid-pregnancy. Methods This cross-sectional study included n = 2,984 pregnant women recruited during 2002-2008 in the Norwegian Mother, Father, and Child Cohort Study (MoBa). Concentrations of C-reactive protein (CRP) and 21 nutritional biomarkers including carotenes (α-carotene, β-carotene, γ-carotene, α-cryptoxanthin, β-cryptoxanthin, lutein, lycopene), vitamins [α-tocopherol, γ-tocopherol, 25-hydroxyvitamin D (25-OH-D), retinol], creatinine, elements (K, Na, Co, Cu, Mn, Mo, Se, Zn), and ferritin (Fe) were measured in blood and urine collected in mid-pregnancy. Habitual diet in pregnancy was assessed using a validated semi-quantitative food frequency questionnaire. We calculated the relative (%) energy contribution of UPF to overall intake according to the NOVA classification. We also applied a diet quality index (DQI) adapted to assess adherence to Norwegian dietary guidelines (DQI; min-max: 0-110, higher score meaning higher adherence). We present summary statistics for biomarker concentrations and explored associations between UPF intake or the DQI and measured biomarkers using adjusted linear, logistic, and generalized additive regression models. Results Ultra-processed food intake was positively associated with biomarker concentrations of vitamin E (γ-tocopherol), creatinine, K, and Na [βs: 5.6 to 17% increase in biomarker concentration per interquartile range (IQR) increase in UPF intake] and negatively associated with carotenoids (α-carotene, β-carotene, γ-carotene, α-cryptoxanthin, β-cryptoxanthin, lutein, lycopene), vitamin A, Mo, and Se (βs: -2.1 to -18%). Inversely, high diet quality (i.e., the DQI) was positively associated with concentrations of carotenoids, vitamins [vitamin A (retinol) and D (25-OH-D)], and Se (β: 1.5 to 25%) and negatively associated with vitamin E (γ-tocopherol), creatinine, and Na (β: -4.8 to -8.3%). A weak, positive association was found between UPF and CRP (β: 5.4%, 95% CI 0.12-11%). Conclusion High UPF intake was associated with reduced concentrations of nutrition biomarkers in mid-pregnancy. Associations in the opposite direction were found with high adherence to the Norwegian dietary guidelines, suggesting that the two dietary scoring systems capture diet quality in a mirrored manner in this population.
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Affiliation(s)
- Pieta Tasnim Kelsey
- Division of Climate and Environmental Health, Department of Food Safety, Norwegian Institute of Public Health, Oslo, Norway,Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Eleni Papadopoulou
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Tiril Cecilie Borge
- Cluster for Reviews and Health Technology Assessments, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Cecilie Dahl
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Anne Lise Brantsæter
- Division of Climate and Environmental Health, Department of Food Safety, Norwegian Institute of Public Health, Oslo, Norway
| | - Iris Erlund
- Department of Government Services, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Helle Margrete Meltzer
- Division of Climate and Environmental Health, Department of Food Safety, Norwegian Institute of Public Health, Oslo, Norway
| | - Line Småstuen Haug
- Division of Climate and Environmental Health, Department of Food Safety, Norwegian Institute of Public Health, Oslo, Norway
| | - Ida Henriette Caspersen
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway,*Correspondence: Ida Henriette Caspersen,
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15
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Moreira PR, Nunes LM, Giugliani ERJ, Gomes E, Führ J, Neves RO, Belin CHS, Bernardi JR. Complementary feeding methods and introduction of ultra-processed foods: A randomized clinical trial. Front Nutr 2022; 9:1043400. [PMID: 36570172 PMCID: PMC9767977 DOI: 10.3389/fnut.2022.1043400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Complementary feeding (CF) is defined as a period when foods, other than milk, are introduced to the infant's diet. Unfortunately, frequent consumption of ultra-processed foods (UPF) has become highly prevalent early in an infant's life. The aim was to verify the association of CF methods with the introduction of UPF in early childhood. Methods This randomized clinical trial involved pairs of mother-infants, allocated in groups receiving different CF interventions: strict Parent-Led Weaning (PLW); strict Baby-Led Introduction to SolidS (BLISS), or mixed-method. The intervention consisted of a counseling session on healthy eating at the child's 5.5 months of age. A structured questionnaire was created based on the NOVA classification for the definition of UPF and applied at 9 and 12 months. The effect of the CF method intervention was measured by a survival curve for UPF offered for the first time in early childhood between groups. Cox regression was used to estimate its magnitude. The primary analysis was done in three groups (PLW, BLISS, and Mixed) and the secondary analysis was done in two groups (PLW, and BLISS + Mixed). Results A total of 139 mother-infant pairs were eligible and 129 followed the study. The prevalence of infants who were exposed to UPF in early childhood was 58.9% (n = 76), being 71.4% in the PLW group, 53.3% in the BLISS group, and 52.4% in the Mixed group, without differences between them (p = 0.133). The PLW group intervention had a greater chance of exposure to ice cream or popsicles (p = 0.032) and sweet crackers (p = 0.009), compared with the other two CF groups. The Cox regression did not find significant differences between the three groups. However, the regression with two groups estimated a 38% reduction in the offer of UPF in the BLISS + Mixed group intervention (p = 0.049). Discussion The CF intervention promoting greater infant autonomy (BLISS and Mixed) was associated with a reduction in the offer of UPF in early childhood. This knowledge may contribute to supporting strategies aimed at reducing UPF consumption by the young infant. Brazilian registry of clinical trials ReBEC [https://ensaiosclinicos.gov.br/rg/RBR-229scm], identifier [RBR-229scm U1111-1226-9516].
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Affiliation(s)
- Paula Ruffoni Moreira
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil,Graduate Program in Food, Nutrition, and Health, Department of Nutrition, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil,Graduate Program in Child and Adolescent Health, Department of Pediatrics, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Leandro Meirelles Nunes
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil,Graduate Program in Child and Adolescent Health, Department of Pediatrics, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Elsa Regina Justo Giugliani
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil,Graduate Program in Child and Adolescent Health, Department of Pediatrics, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Erissandra Gomes
- School of Dentistry, Department of Surgery and Orthopedics, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Jordana Führ
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil,Graduate Program in Child and Adolescent Health, Department of Pediatrics, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Renata Oliveira Neves
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil,Graduate Program in Child and Adolescent Health, Department of Pediatrics, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Christy Hannah Sanini Belin
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil,Graduate Program in Child and Adolescent Health, Department of Pediatrics, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Juliana Rombaldi Bernardi
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil,Graduate Program in Food, Nutrition, and Health, Department of Nutrition, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil,Graduate Program in Child and Adolescent Health, Department of Pediatrics, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil,*Correspondence: Juliana Rombaldi Bernardi,
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16
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Mookerjee A, Tanaka T. Influence of enzymatic treatments on legume proteins for improved functional and nutritional properties: Expansion of legume protein utilization as food ingredients. Curr Opin Food Sci 2022. [DOI: 10.1016/j.cofs.2022.100974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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17
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Are all ultra‐processed foods created equal? FOOD SCIENCE AND TECHNOLOGY 2022. [DOI: 10.1002/fsat.3604_9.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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18
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Bolhuis D, Mosca AC, Pellegrini N. Consumer Awareness of the Degree of Industrial Food Processing and the Association with Healthiness-A Pilot Study. Nutrients 2022; 14:4438. [PMID: 36297121 PMCID: PMC9610034 DOI: 10.3390/nu14204438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
Consumption of ultraprocessed foods (UPFs) has been associated with lower diet quality, obesity, and adverse health effects. Not much is known about how consumers evaluate the degree of processing of a food product and how they relate this to healthiness. An online questionnaire was completed by a total of 277 Dutch, 204 Italian, and 181 Brazilian consumers. Consumers were aged 18-65 year, mean 38 ± 13 year, 31% were males, and 71% were highly educated. Pictures of several common food products were evaluated on the degree of industrial processing and healthiness. Thirteen food categories were included, each including one minimally processed food (MPF), one High NS_UPF (Nutri-Score A or B), and one Low NS_UPF (Nutri-Score D or E). Lastly, knowledge and attitude about UPFs were assessed. Ultraprocessing was perceived as unhealthy by the majority of consumers (Dutch, Italian: 55%; Brazilian: 75%) and contributed to weight gain according to: 38% Dutch, 51% Italian, and 70% Brazilian consumers. Low NS_UPFs were correctly rated toward "processed" and "not healthy" in all countries. High NS_UPF were rated as processed but showed large variations in healthiness scores. In conclusion, consumers rated UPFs relatively low in healthiness compared with MPFs with similar Nutri-Scores within the same food category. These preliminary findings suggest that consumers incorporate, to some extent, the degree of industrial processing while assessing the healthiness of food products.
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Affiliation(s)
- Dieuwerke Bolhuis
- Food Quality and Design, Wageningen University and Research, P.O. Box 17, 6700 AA Wageningen, The Netherlands
| | | | - Nicoletta Pellegrini
- Food Quality and Design, Wageningen University and Research, P.O. Box 17, 6700 AA Wageningen, The Netherlands
- Department of Agricultural, Food, Environmental and Animal Sciences, University of Udine, 3310 Udine, Italy
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19
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Abstract
Dramatically increasing trends in consumption of ultra-processed foods have been reported across the globe. Public concern about the health consequences of ultra-processed foods is high. This manuscript provides a comprehensive review of trends in global consumption of ultra-processed foods, dietary nutrient profile of ultra-processed foods, demographic, socioeconomic, psychological, and behavioral characteristics of ultra-processed food consumers, current evidence from longitudinal studies at the population level on the association between ultra-processed foods consumption and major health outcomes (including all-cause and cause-specific mortality, cardiovascular disease, overweight and obesity, body composition and fat deposition, diabetes, cancer, and gastrointestinal and other diseases), potential mechanisms linking ultra-processed foods with these outcomes (nutrient displacement, factors that influence adiposity, and processing), and challenges and future research directions. The global trends in consumption of ultra-processed foods, the generally unfavorable nutrient profile of ultra-processed foods, the characteristics of ultra-processed food consumers, the accumulating longitudinal studies associating ultra-processed foods with major health outcomes, and the uncertainties and complexities in putative mechanisms all highlight the need for future high-quality epidemiologic and mechanistic investigations on this topic. It is critical to interpret findings in the light of the totality of evidence.
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Affiliation(s)
- Yin Zhang
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Edward L Giovannucci
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
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20
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De Cosmi V, Mazzocchi A, Milani GP, Agostoni C. Dietary Patterns vs. Dietary Recommendations. Front Nutr 2022; 9:883806. [PMID: 35592632 PMCID: PMC9113217 DOI: 10.3389/fnut.2022.883806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/06/2022] [Indexed: 01/10/2023] Open
Abstract
Dietary Reference Values (DRVs) are important for developing labeling laws, identifying populations at risk of over- or under-consumption, and promoting public health interventions. However, the process of developing DRVs is quite complex, and they should not be viewed as recommendations ready to use or goals for individuals. Rather, they require interpretation by professionals and can form the basis of dietary advice. On the other hand, focusing on foods rather than macronutrients can assist individuals in understanding a healthy diet by taking into consideration many variables that may help compliance with a healthy dietary style. Evolution, tradition within specific geographical and historical contexts, taste, economic affordability, season-associated local dietary resources, and lifestyle may all explain the increasing popularity of dietary patterns that are highly successful today. Three models (the Mediterranean, New Nordic, and Japanese) have been recently characterized for geographical setting and food composition, as well as the associated lifestyle. Of note, all these three models rely on pyramids sharing a large basis made up of local vegetal resources and a top of red meats (allowed in many cases, but in limited amounts), thus allowing for the urgent demand of sustainability for the planet's health. This mini-review aimed to summarize the meaning of DRVs and to describe the dietary patterns that better contemplate health, diet diversity, and sustainability.
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Affiliation(s)
- Valentina De Cosmi
- Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Alessandra Mazzocchi
- Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
- *Correspondence: Alessandra Mazzocchi
| | - Gregorio P. Milani
- Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Agostoni
- Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
- Pediatric Intermediate Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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21
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Capozzi F. Food Innovation in the Frame of Circular Economy by Designing Ultra-Processed Foods Optimized for Sustainable Nutrition. Front Nutr 2022; 9:886220. [PMID: 35592637 PMCID: PMC9113194 DOI: 10.3389/fnut.2022.886220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/05/2022] [Indexed: 12/11/2022] Open
Abstract
Despite the large debate about the relationship between ultra-processed foods and the prevalence of some diet-related diseases, the innovative potential of various processing technologies has been evidenced in pathways that could lead to modifications of the food matrix with beneficial health effects. Many efforts have been directed toward the conjugation of a healthy diet and sustainable exploitation of natural resources for the preparation of accessible foods. This minireview highlights the possible links between processing, sustainability, and circular economy through the valorization of by-products that could be exploited to prepare nutrient-rich ingredients at lower economic and environmental costs. The assessment of the quality and safety of functional foods based on ingredients derived from food waste requires a more robust validation by means of the food-omics approach, which considers not only the composition of the final products but also the structural characterization of the matrix, as the bioaccessibility and the bioavailability of nutrients are strictly dependent on the functional characteristics of the innovative ingredients.
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Affiliation(s)
- Francesco Capozzi
- Interdepartmental Centre for Industrial Agrofood Research—CIRI Agrofood, Alma Mater Studiorum-University of Bologna, Cesena, Italy
- Department of Agricultural and Food Sciences (DISTAL), Alma Mater Studiorum-University of Bologna, Cesena, Italy
- *Correspondence: Francesco Capozzi,
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22
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Anti-Inflammatory and Active Biological Properties of the Plant-Derived Bioactive Compounds Luteolin and Luteolin 7-Glucoside. Nutrients 2022; 14:nu14061155. [PMID: 35334812 PMCID: PMC8949538 DOI: 10.3390/nu14061155] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/02/2022] [Accepted: 03/05/2022] [Indexed: 12/14/2022] Open
Abstract
Flavonoids are interesting molecules synthetized by plants. They can be found abundantly in seeds and fruits, determining the color, flavor, and other organoleptic characteristics, as well as contributing to important nutritional aspects. Beyond these characteristics, due to their biochemical properties and characteristics, they can be considered bioactive compounds. Several interesting studies have demonstrated their biological activity in different cellular and physiological processes in high-order organisms including humans. The flavonoid molecular structure confers the capability of reacting with and neutralizing reactive oxygen species (ROS), behaving as scavengers in all processes generating this class of molecules, such as UV irradiation, a process widely present in plant physiology. Importantly, the recent scientific literature has demonstrated that flavonoids, in human physiology, are active compounds acting not only as scavengers but also with the important role of counteracting the inflammation process. Among the wide variety of flavonoid molecules, significant results have been shown by investigating the role of the flavones luteolin and luteolin-7-O-glucoside (LUT-7G). For these compounds, experimental results demonstrated an interesting anti-inflammatory action, both in vitro and in vivo, in the interaction with JAK/STAT3, NF-κB, and other pathways described in this review. We also describe the effects in metabolic pathways connected with inflammation, such as cellular glycolysis, diabetes, lipid peroxidation, and effects in cancer cells. Moreover, the inhibition of inflammatory pathway in endothelial tissue, as well as the NLRP3 inflammasome assembly, demonstrates a key role in the progression of such phenomena. Since these micronutrient molecules can be obtained from food, their biochemical properties open new perspectives with respect to the long-term health status of healthy individuals, as well as their use as a coadjutant treatment in specific diseases.
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23
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Taren D, Akseer N, Davis CD, Miller JW, Moustaid-Moussa N, Novotny R, Slupsky CM, Saroja Voruganti V, Cameron JM. Eighty years of nutritional sciences, and counting. Nutr Rev 2021; 80:1-5. [PMID: 34891168 DOI: 10.1093/nutrit/nuab112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Douglas Taren
- Department of Pediatrics Nutrition Section, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nadia Akseer
- Modern Scientist Global and the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Cindy D Davis
- Agricultural Research Service, U.S. Department of Agriculture, Beltsville, Maryland, USA
| | - Joshua W Miller
- Department of Nutritional Sciences, School of Environmental and Biological Sciences, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Naima Moustaid-Moussa
- Department of Nutritional Sciences, College of Human Services and the Obesity Research Institute, Texas Tech University, Lubbock, Texas, USA
| | - Rachel Novotny
- Human Nutrition, Food and Animal Sciences Department, College of Tropical Agriculture and Human Resources, and the Children's Healthy Living Center of Excellence, University of Hawaii at Mānoa, Honolulu, Hawaii, USA
| | - Carolyn M Slupsky
- Department of Nutrition, University of California, Davis, California, USA
| | - V Saroja Voruganti
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Kannapolis, North Carolina, USA
| | - James M Cameron
- International Life Sciences Institute, Washington, District of Columbia, USA
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