Consumers' conceptualization of ultra-processed foods

"Warning: ultra-processed": an online experiment examining the impact of ultra-processed warning labels on consumers' product perceptions and behavioral intentions

BACKGROUND

Nutrient content and degree of processing are complementary but distinct concepts, and a growing body of evidence shows that ultra-processed foods (UPFs) can have detrimental health effects independently from nutrient content. 10 + countries currently mandate front-of-package labels (FOPL) to inform consumers when products are high in added sugars, saturated fat, and/or sodium. Public health advocates have been calling for the addition of ultra-processed warning labels to these FOPLs, but the extent to which consumers would understand and be influenced by such labels remains unknown. We examined whether the addition of ultra-processed warning labels to existing nutrient warning labels could influence consumers' product perceptions and purchase intentions.

METHODS

In 2023, a sample of adults in Brazil (n = 1,004) answered an open-ended question about the meaning of the term "ultra-processed," followed by an online experiment where they saw four ultra-processed products carrying warning labels. Participants were randomly assigned to view either only nutrient warning labels or nutrient plus ultra-processed warning labels. Participants then answered questions about their intentions to purchase the products, product perceptions, and perceived label effectiveness.

RESULTS

Most participants (69%) exhibited a moderate understanding of the term "ultra-processed" prior to the experiment. The addition of an ultra-processed warning label led to a higher share of participants who correctly identified the products as UPFs compared to nutrient warning labels alone (Cohen's d = 0.16, p = 0.02). However, the addition of the ultra-processed warning label did not significantly influence purchase intentions, product healthfulness perceptions, or perceived label effectiveness compared to nutrient warning labels alone (all p > 0.05). In exploratory analyses, demographic characteristics and prior understanding of the concept of UPF did not moderate the effect of ultra-processed warning labels.

CONCLUSIONS

Ultra-processed warning labels may help consumers better identify UPFs, although they do not seem to influence behavioral intentions and product perceptions beyond the influence already exerted by nutrient warning labels. Future research should examine how ultra-processed warning labels would work for products that do and do not require nutrient warnings, as well as examine the benefits of labeling approaches that signal the health effects of UPFs.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT05842460. Prospectively registered March 15th, 2023.

Is the Term "Food Consistency" Used Consistently in Consumer Science? An Exploratory Study of Consumer Association and Conceptualization

The post-pandemic context has changed the modes for collecting data in sensory and consumer science. The objectives of this research were to analyze consumers' associations of food consistency and to study two virtual modes of the Free Word Association test (FWA). This test was administered to 209 consumers (180 women, 29 men, 18-45 years old) asynchronously (i.e. self-administered) and synchronously (i.e. face to face interviews). The Cognitive Salience Index (CSI) was calculated, and the structure of the social representation was analyzed. Correspondence analysis showed that food consistency was a mixture of concepts related to structure, hardness and several aspects of auditory (e.g., Crunchy, Crispy), tactile (e.g. Smooth, Spreadable) and oral texture (e.g., Creamy, Gummy). Slightly consistent food was associated with something soft, liquid or semisolid, and very consistent food to something hard and resistant. Consistent food was more related to "very" than to "slightly consistent." The CSI depended on the stimulus presented (p < 0.05). Regarding the social representation structure, the central core had the highest CSI for all stimuli (CSI ≥ 0.13, p < 0.05). Consumers defined "very consistent, consistent and slightly consistent food" by naming more foods in the synchronous mode than in the asynchronous one. In the asynchronous mode, consumers took more time to complete the test. The virtual FWA test (asynchronous or synchronous) showed some differences in the associations of term consistency, due to the lack of spontaneity in the first minute. It is important to adjust the methodologies to standardize the times in both modes.

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.

Vegetarians' and vegans' experiences with and attitudes towards ultra-processed foods (UPF): a qualitative study

BACKGROUND

The consumption of ultra-processed foods (UPF) is increasing in many countries. Simultaneously, there is a growing number of consumers that follow a vegetarian or vegan diet, many due to its possible positive impact on sustainability and food waste. However, little is known about attitudes towards and experiences with UPF among vegetarians and vegans. Thus, this study investigates vegetarians' and vegans' experiences with and attitudes towards UPFs.

METHODS

We conducted semi-structured, individual interviews with 14 participants between September and December 2021. The participants were from different areas in Norway. The data were analysed using a thematic analysis by Braun and Clarke.

RESULTS

In general, participants appeared to have diverse knowledge of and divergent attitudes towards UPFs. However, participants mainly associated substitute products (e.g. meat substitutes, dairy substitutes) as UPFs. They appreciated the increased availability of vegetarian and vegan UPF which made it easier for them to follow a plant-based diet. They enjoyed the taste and consistency of vegetarian and vegan UPF. However, participants expressed concerns about the effects that industrial processing has on the products' nutritional content.

CONCLUSION

This study indicated that there was a diverse knowledge of and various attitudes towards UPFs among the participating vegetarians and vegans. Public information and guidelines about using UPF (e.g. meat substitutes, dairy substitutes) in vegetarian and vegan diets are needed, as well as information about their possible impact on health and sustainability.

Consumer Awareness, Perceptions and Avoidance of Ultra-Processed Foods: A Study of UK Adults in 2024

BACKGROUND

Ultra-processed food (UPF) is currently not included in most countries' dietary guidance. However, there may be growing public interest and consumer avoidance of UPF due to media reporting of studies on the negative health outcomes associated with UPFs.

METHODS

We surveyed 2386 UK adults (M age = 45 years, 50% female) during February-April 2024. Participants completed measures on awareness of the term UPF, whether the UPF status of foods affects their dietary decision-making, and confidence in identifying UPFs. Participants categorised a list of 10 foods (5 UPFs and 5 non-UPFs) as UPF vs. not, before rating whether information about studies linking UPF to worse health impacts on their negative affect and acts as a deterrent to consuming UPFs.

RESULTS

Most participants (73%) were aware of the term UPF and 58% reported that their food choices are determined by whether they believe a food is ultra-processed or not. Participants with the highest income and education levels were most likely to report both being aware of, and, avoiding consuming UPFs. Most participants could not accurately categorise whether foods were UPFs. Some sociodemographic groups (e.g., higher education levels) were more likely to accurately categorise UPFs but were also more likely to incorrectly believe that non-UPFs were UPFs. Participants tended to report that UPF-health risk information increases negative affect and acts as a deterrent to consuming UPFs.

CONCLUSIONS

In this study, a large number of UK adults reported avoiding consuming UPFs. This was particularly pronounced among those with the highest education and income levels.

Proposal and Validation of a Measurement Scale of the Acceptance of Ultra-Processed Food Products

Today, there is an increasing consumption of ultra-processed food products (UPFs), while more healthy options are available; however, there is no scale available that can adequately measure this phenomenon. In this context, the present study aims to develop and validate a measurement scale of the consumers' acceptance of ultra-processed food products. Research data (n = 478) were analyzed using Exploratory Factor Analysis (EFA), followed by a Confirmatory Factor Analysis (CFA). The results confirm the validity of the proposed measurement scale comprising nine factors: the quality of ultra-processed food products, ability to save time, low affordable price, effortless preparation, convenience, hedonic nature, marketing strategies, satisfaction and purchase intention. The present study makes a noticeable contribution to food marketing, and food companies could consider these factors to design and commercialize ultra-processed foods.

How Promising Are "Ultraprocessed" Front-of-Package Labels? A Formative Study with US Adults

High levels of food processing can have detrimental health effects independent of nutrient content. Experts and advocates have proposed adding information about food processing status to front-of-package labeling schemes, which currently exclusively focus on nutrient content. How consumers would perceive "ultraprocessed" labels has not yet been examined. To address this gap, we conducted a within-subjects online experiment with a convenience sample of 600 US adults. Participants viewed a product under three labeling conditions (control, "ultraprocessed" label, and "ultraprocessed" plus "high in sugar" label) in random order for a single product. The "ultraprocessed" label led participants to report thinking more about the risks of eating the product and discouraging them from wanting to buy the product more than the control, despite not grabbing more attention than the control. The "ultraprocessed" plus "high in sugar" labels grabbed more attention, led participants to think more about the risks of eating the product, and discouraged them from wanting to buy the product more than the "ultraprocessed" label alone. "Ultraprocessed" labels may constitute promising messages that could work in tandem with nutrient labels, and further research should examine how they would influence consumers' actual intentions and behaviors.

Exploring the role of the general interest in health on the perceptions of Healthy, Industrialized, and Ultra-processed foods among Brazilians

Food processing includes operations that transform raw materials into new products, ensuring the preservation and supply of safe food; however, this view is not always understood by consumers who tend to associate any type of processing with something negative and harmful to health. Given this, the objective of this study was to explore the associations of Brazilian consumers in relation to healthy foods, industrialized foods, and ultra-processed foods, as well as to evaluate the role of socio-demographic characteristics and interest in health in these associations. To this end, 512 Brazilians completed a word association task on these three concepts and then answered a questionnaire about interest in health and socio-demographic issues. In general, participants associated "Healthy food" mainly with "Unprocessed products." Conversely, "Industrialized foods" and "Ultra-processed foods" were associated with "Processed products," "Negative perceptions," "Health harm," and "Industry". Despite this, it was found that "Industrialized foods" were also perceived positively, mainly due to convenience. Consumer associations were influenced (p ≤ 0.05) both by interest in health and by socio-demographic profile. Individuals with a high interest in health mainly associated "Industrialized foods" and "Ultra-processed foods" with the presence of preservatives, additives, and pesticides, and with diseases. As for those with low interest in health, there was a greater lack of knowledge of the concepts. Doubts and lack of knowledge were observed for "Industrialized foods" and "Ultra-processed foods," mainly among consumers with low educational level. The results indicate the need to develop communication strategies that reach consumers to facilitate understanding and, in this way, help them to make more conscious food choices.

Associations Between Ultra-processed Food Consumption and Cardiometabolic Health Among Older US Adults: Comparing Older Asian Americans to Older Adults From Other Major Race-Ethnic Groups

Using data from the National Health and Nutrition Examination Survey (2001-2018; N = 19,602), this study examined whether ultra-processed food (UPF) consumption is associated with cardiometabolic health (obesity, hypertension, high cholesterol, and diabetes), among White, Black, Hispanic, and Asian Americans (AA) US adults 50 or older. Diet was assessed using 24 hour dietary recall. NOVA dietary classification system was used to calculate the percentage of caloric intake derived from UPFs. Cardiometabolic information was assessed through physical examination, blood tests, and self-reported medication information. A median of 54% (IQR: 40%, 68%) of caloric intake was attributed to UPFs and was lowest for AAs (34%, IQR: 20%, 49%) and highest for White adults (56%; IQR: 42, 69%). In multivariable adjusted models, UPF consumption was associated with greater odds of obesity, high cholesterol, and diabetes. UPF consumption is associated with poor cardiometabolic health among all US older adults. For AAs, UPFs may be particularly obesogenic.

The Human Interference Scoring System (HISS): A New Tool for Quantifying Food Quality Based on Its Level of Processing

The Human Interference Scoring System (HISS) is a novel food-based diet-quality-classification system based on the existing NOVA method. HISS involves food and fluid allocation into categories from digital imagery based on food processing levels, followed by meal plan analysis using food-servings quantification. The primary purpose of this work was to evaluate the reliability of HISS. Trained nutrition professionals analyzed digital photographs from five hypothetical 24 h food recalls and categorized foods into one of four HISS categories. A secondary purpose was to assess the nutrient composition of the food recalls and other selected foods from the HISS categories. Participants effectively categorized foods into HISS categories, with only minor discrepancies noted. High inter-rater reliability was observed in the outer HISS categories: unprocessed and ultra-processed foods. Ultra-processed items consistently displayed elevated energy, carbohydrates, and sugar compared to unprocessed foods, while unprocessed foods exhibited notably higher dietary fiber. This study introduces the HISS as a potentially useful tool for quantifying a food-quality-based system using digital-photography-based assessments. Its high inter-rater reliability and ability to capture relationships between food processing levels and nutrient composition make it a promising method for assessing dietary habits and food quality.

How Do Brazilian Consumers Understand Food Groups in the Food-based Dietary Guidelines?

In the Food-based Dietary Guidelines (FBDGs), food classification is based on food groups and nutrient sources. Much research has already investigated multiple aspects of consumer understanding of the information described in these documents. However, no study has evaluated consumer understanding of all food items contained in the groups described in the FBDGs. This study aimed to assess Brazilian consumers' understanding of food classification according to food groups in the concepts of the FBDGs. Therefore, an instrument, Consumer Understanding of Food Groups (UFG), was constructed and validated to assess consumer understanding of food groups. The instrument comprised 44 items approved by experts (agreement > 80%). A total of 894 Brazilians from all regions participated in this study. The results suggest that 48.9% of the participants believe it is easier to classify food according to food groups. The classification of food groups is based on the origin of the food (animal and vegetable). Although consumers easily recognize foods according to their origin, we still identify asymmetries regarding including food items from the animal kingdom and species from the plant kingdom. This exploratory study highlights important information that can contribute to improving the FBDGs. It is essential to consider consumers' understanding and guide them regarding choices from a technical point of view.

From harmful nutrients to ultra-processed foods: exploring shifts in 'foods to limit' terminology used in national food-based dietary guidelines

OBJECTIVE

The choice of terms used to describe 'foods to limit' (FTL) in food-based dietary guidelines (FBDG) can impact public understanding, policy translation and research applicability. The choice of terms in FBDG has been influenced by available science, values, beliefs and historical events. This study aimed to analyse the terms used and definitions given to FTL in FBDG around the world, including changes over time and regional differences.

DESIGN

A review of terms used to describe FTL and their definitions in all current and past FBDG for adults was conducted, using a search strategy informed by the FAO FBDG website. Data from 148 guidelines (96 countries) were extracted into a pre-defined table and terms were organised by the categories 'nutrient-based', 'food examples' or 'processing-related'.

SETTING

National FBDG from all world regions.

PARTICIPANTS

None.

RESULTS

Nutrient-based terms (e.g. high-fat foods) were the most frequently used type of term in both current and past dietary guidelines (91 %, 85 %, respectively). However, food examples (e.g. cakes) and processing-related terms (e.g. ultra-processed foods) have increased in use over the past 20 years and are now often used in conjunction with nutrient-based terms. Regional differences were only observed for processing-related terms.

CONCLUSION

Diverse, and often poorly defined, terms are used to describe FTL in FBDG. Policymakers should ensure that FTL terms have clear definitions and can be integrated with other disciplines and understood by consumers. This may facilitate the inclusion of the most contemporary and potentially impactful terminology in nutrition research and policies.

Dietary Guidelines Meet NOVA: Developing a Menu for A Healthy Dietary Pattern Using Ultra-Processed Foods

BACKGROUND

A proposed topic for the 2025 Dietary Guidelines for Americans (DGA) Scientific Advisory Committee to address is the relationship between dietary patterns with ultra-processed foods (UPF) and body composition and weight status. Implementing the NOVA system, the most commonly applied framework for determining whether a food is "ultra-processed," in dietary guidance could omit several nutrient-dense foods from recommended healthy diets in the DGA.

OBJECTIVE

The purpose of this proof-of-concept study was to determine the feasibility of building a menu that aligns with recommendations for a healthy dietary pattern from the 2020 DGA and includes ≥80% kcal from UPF as defined by NOVA.

DESIGN

To accomplish this objective, we first developed a list of foods that fit NOVA criteria for UPF, fit within dietary patterns in the 2020 DGA, and are commonly consumed by Americans. We then used these foods to develop a 7-d, 2000 kcal menu modeled on MyPyramid sample menus and assessed this menu for nutrient content as well as for diet quality using the Healthy Eating Index-2015 (HEI-2015).

RESULTS

In the ultra-processed DGA menu that was created, 91% of kcal were from UPF, or NOVA category 4. The HEI-2015 score was 86 out of a possible 100 points. This sample menu did not achieve a perfect score due primarily to excess sodium and an insufficient amount of whole grains. This menu provided adequate amounts of all macro- and micronutrients except vitamin D, vitamin E, and choline.

CONCLUSIONS

Healthy dietary patterns can include most of their energy from UPF, still receive a high diet quality score, and contain adequate amounts of most macro- and micronutrients.

Oxidative Stress and Inflammatory Biomarkers Are Related to High Intake of Ultra-Processed Food in Old Adults with Metabolic Syndrome

In the last few decades the consumption of ultra-processed foods (UPFs) worldwide has substantially augmented. Increasing evidence suggests that high UPF consumption is associated with an increase in non-communicable diseases, being overweight, and obesity. The aim of this study was to assess how UPF consumption affects oxidative and inflammatory status in the plasma, neutrophils, and urine of old adults with metabolic syndrome. Participants (n = 92) were classified into two groups according to UPF consumption. Dietary intakes were measured by a validated semi-quantitative 143-item food frequency questionnaire and UPF consumption was determined according to the NOVA classification system. Low UPF consumers showed higher adherence to the Mediterranean diet than high UPF consumers. A high intake of fiber and a high concentration of polyphenols in urine were also observed in subjects with low UPF consumption. Despite the absence of differences in biochemical profile, oxidative and inflammatory biomarkers showed some significant changes. Catalase and superoxide dismutase activities were lower in high UPF consumers, whereas myeloperoxidase activity was higher. ROS production in neutrophils stimulated with zymosan was higher in high UPF consumers than in low UPF consumers. Biomarkers such as xanthine oxidase, tumor necrosis factor α (TNFα), interleukin (IL)-6, IL-15, and leptin levels were higher in participants with high intake of UPF. No differences were found in malondialdehyde and other inflammatory cytokines. The current study evidenced that MetS participants with high UPF consumption have a more pro-oxidant and inflammatory profile than those with low UPF consumption, despite showing similar blood biochemical profiles.

Different levels of ultra-processed food and beverage consumption and associations with environmental sustainability and all-cause mortality in EPIC-NL

BACKGROUND

The adverse health effects of high ultra-processed food and drink consumption (UPFD) are well documented. However, its environmental impact remains unclear and the separate effects of ultra-processed foods (UPF) and drinks (UPD) on all-cause mortality are not previously studied.

OBJECTIVES

To assess the association between levels of UPFD, UPF and UPD consumption with diet-related environmental impacts and all-cause mortality in Dutch adults.

METHODS

Habitual diets were assessed by FFQ in 1993-1997 among 38,261 participants of the EPIC-NL cohort. The mean follow-up time was 18.2 years (SD 4.1), 4,697 deaths occurred. FFQ-items were categorized according to the NOVA classification. Associations with quartiles of UPFD, UPF, and UPD consumption and environmental impact indicators were analyzed using general linear models and with all-cause mortality by Cox proportional hazard models. The lowest UPFD, UPF, UPD consumption quartiles were used as comparator.

RESULTS

The average UPFD consumption was 181 (SD 88) g per 1000 kcal. High UPF consumption was statistically significantly inversely associated with all environmental impact indicators (_Q4vsQ1: -13.6% to -3.0%) whereas high UPD consumption was, except for land use, statistically significant positively associated with all environmental impact indicators (_Q4vsQ1: 5.9% to 1.2%). High UPFD consumption was heterogeneously associated with environmental impacts (_Q4vsQ1: 2.6% to -4.0% ). After multivariable adjustment, the highest quartiles of UPFD and UPD consumption were significantly associated with all-cause mortality (HR_Q4vsQ1 1.20, 95%CI 1.10,1.30 and HR_Q4vsQ1 1.19, 95%CI 1.09,1.29, respectively). UPF consumption of Q2 and Q3 were associated with a borderline significant lower risk of all-cause mortality (HR_Q2vsQ1 0.93, 95% CI 0.85,1.00; HR_Q3vsQ1 0.91, 95% CI 0.84,0.99), while Q4 was not statistically significant (HR_Q4vsQ1 1.05, 95% CI 0.96,1.15).

CONCLUSIONS

Reducing UPD consumption could lower environmental impact and all-cause mortality risk, however this was not shown for UPF. When categorizing foods consumption by their degree of processing trade-offs are observed for human and planetary health aspects.

Challenges around Child-Feeding Practices with ‘Comida Chatarra’: A Qualitative Study to Understand the Role of Sociocultural Factors in Caregiver Feeding Decisions

A massive incorporation of ultra-processed products into young children’s diets worldwide and in Mexico has been documented. The aim of this study is to understand the role of sociocultural factors in principal caregivers’ decisions to give a type of ultra-processed food to children under age five, called ‘comida chatarra’ (‘junk food’ in English), usually includes sugar-sweetened beverages, sweet and salty snacks, and sweet breakfast cereals. We conducted a descriptive, observational qualitative study. The research was conducted in urban and rural communities in two Mexican states. Twenty-four principal caregivers were equally distributed between the two states and types of communities. They were interviewed in person. Phenomenology underpinned this study. Results highlight the preponderant role of culture in food choices and feeding practices with junk food. Local culture influences child-feeding with ultra-processed products through social norms, knowledge, or socially constructed attitudes. These social norms, built in the context of abundant ultra-processed products and omnipresent marketing, ‘justify’ children’s consumption of junk food. They acquire these products from the principal caregivers, family members, and neighbors, among others, who reward and pamper them. These actors also define what amount (small amounts) and when (after meals as snacks) children are given these products. Cultural factors must be considered in the development of effective public policies and programs that aim to change the culture around ultra-processed products among children and avoid their consumption.

The Association between Vegan, Vegetarian, and Omnivore Diet Quality and Depressive Symptoms in Adults: A Cross-Sectional Study

Dietary patterns and depressive symptoms are associated in cross-sectional and prospective-designed research. However, limited research has considered depression risk related to meat-based and plant-based dietary patterns. This study explores the association between diet quality and depressive symptoms across omnivore, vegan, and vegetarian dietary patterns. A cross-sectional online survey utilised the Dietary Screening Tool (DST) and the Centre for Epidemiological Studies of Depression Scale (CESD-20) to measure diet quality and depressive symptoms, respectively. A total of 496 participants identified as either omnivores (n = 129), vegetarians (n = 151), or vegans (n = 216). ANOVA with Bonferroni post hoc corrections indicates that dietary quality was significantly different between groups F(2, 493) = 23.61, p < 0.001 for omnivores and vegetarians and omnivores and vegans. Diet quality was highest in the vegan sample, followed by vegetarian and omnivore patterns. The results show a significant, moderately negative relationship between higher diet quality and lower depressive symptoms (r = -0.385, p < 0.001) across groups. Hierarchical regression showed that diet quality accounted for 13% of the variability in depressive symptoms for the omnivore sample, 6% for vegetarians, and 8% for vegans. This study suggests that diet quality in a meat-based or plant-based diet could be a modifiable lifestyle factor with the potential to reduce the risk of depressive symptoms. The study indicates a greater protective role of a high-quality plant-based diet and lower depressive symptoms. Further intervention research is needed to understand the bi-directional relationship between diet quality and depressive symptoms across dietary patterns.

Representations of Ultra-Processed Foods: A Global Analysis of How Dietary Guidelines Refer to Levels of Food Processing

BACKGROUND

As evidence grows about negative health impacts of ultra-processed foods (UPFs), nutrient-centred advice is contested, and food-based dietary guidelines are increasingly utilised. Previous analyses of dietary guidelines evaluated their potential impact on health and sustainability, but little research has been conducted to examine how the concept of UPFs is reflected in dietary advice for consumers. This paper systematically analyses whether and how UPFs are represented in dietary guidelines internationally.

METHODS

Based on a systematic online search, the consumer-targeted key messages of 106 dietary guidelines were identified and a qualitative content analysis was conducted. A coding framework was developed to classify messages as 'eat more' or 'eat less' according to the language used (eg, 'choose' vs 'avoid') and to differentiate between a focus on nutrients or food processing. Specific foods mentioned in 'eat less' guidelines were classified according to their level of processing using the NOVA framework.

RESULTS

99% of guidelines utilised some type of nutrient-based message, either promoting 'positive' nutrients (eg, vitamins) or discouraging the consumption of 'negative' nutrients (mainly salt, sugar and fat). Explicit references to food processing were present in 45% of 'eat less' guidelines and 5% of 'eat more' guidelines. Implicit references (eg, promoting 'raw' or discouraging 'packaged' foods) were found in 43% of 'eat less' and 75% of 'eat more' guidelines. 53% of the specific foods referred to in 'eat less' advice were UPFs.

CONCLUSION

Overall, nutrient-based messages were more common than messages about processing levels. The majority of discouraged foods were UPFs, however some minimally processed foods were discouraged, which points to tensions and contradictions between nutrient- and processing-based dietary advice. As dietary guidelines begin to include advice about food processing, it is important to consider both consumer understanding of the terms used and their capacity to act on the advice.

Conceptualizing a Product with the Food-Related Lifestyle Instrument

Product perception is important for consumers' acceptance, especially when it is associated with a geographical location. Consumers' food-related lifestyles (FRLs) have been used to better identify the role that beverages have in people lives. The present study was conducted to understand the conceptualization of mezcal according to consumers' FRLs. Four hundred mezcal consumers were surveyed in Mexico. Participants were asked to describe their experience with the product and consumption habits, to evaluate ten different FRL constructs, and to assess mezcal conceptualization using a check-all-that-apply test. A hierarchical cluster analysis was carried out on the composite variables of the evaluated constructs and their objective knowledge score to define segments. To visualize the relationships among FRL constructs and the terms used to describe mezcal, a multiple factorial analysis was carried out. The results showed four different mezcal clusters. The social and involved segment described the beverage with elements of traditional and food-related activities. The price-quality fixed segment was mainly associated with the product to handcraft process. Uninvolved consumers were not linked to specific terms and uninformed and unaware consumers were novice participants with mainly negative product connotations. Therefore, is important to consider consumers' FRLs to have a better understanding of product conceptualization.

Consumer Awareness of the Degree of Industrial Food Processing and the Association with Healthiness-A Pilot Study

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.

Acceptability Analysis of 3D-Printed Food in the Area of the Czech Republic Based on Survey

The aim of the research was to observe consumer perceptions of 3D food printing and to highlight possible applications of this production. The questionnaire survey took place in the Czech Republic and was attended by 1156 respondents. The questionnaire was divided into six sections: (1) Socio-Demographic Data; (2) 3D Common Printing Awareness; (3) 3D Food Printing Awareness; (4) 3D Food Printing, Worries and Understanding; (5) Application; (6) Investments. Although awareness of 3D food printing is increasing, a very small fraction of respondents had encountered printed food in person (1.5%; n = 17). Respondents expressed concerns about the health benefits and the reduced prices of novel foods, and they perceived printed foods as ultra-processed foods (56.0%; n = 647). Concerns have also been raised about job losses due to the introduction of new technology. On the contrary, they perceived that quality raw materials would be used to prepare printed foods (52.4%; n = 606). Most respondents believed that printed foods would be visually appealing and would find application in several food industry sectors. Most respondents believed that 3D food printing is the future of the food sector (83.8%; n = 969). The gained results can be helpful for 3D food printer producers, as well as for future experiments dealing with 3D food printing issues.

On how people deal with industrialized and non-industrialized food: A theoretical analysis

“Canned, frozen, processed, ultra-processed, functional” etc. Two hundred years after the beginning of the food industry, industrialized food has evolved with many labels. Every person in the world eats and has different experiences with food that are connected to culture and social relationships which permeate our daily lives in many kinds of situations. Food evokes feelings, beliefs, desires, and moral values. For many people, food not only satisfies hunger and sustains life, but it also brings a delicious pleasure that is with their history, culture, and ancestry. Today's food industry pushes products through its marketing, which promotes a plethora of claims that have now trended proportionally with neophobic dimensions. In reality, the general public lacks objective knowledge about the complex science of modern food technology because of its low transparency, and this has resulted in the appearance of misleading ideas that can prejudice the correct analysis of food values. Given this, education about food is an urgent need. Notably, food scientists, technologists, and engineers must look at eaters through the prism of consumers who are human beings in all their rich social/anthropological diversity. The objective of this article is to explore the elemental anthropologic aspects of foods and how they can affect consumer's trust in the food industry's role.

How Do Consumers Understand Food Processing? A Study on the Brazilian Population

Food guides are official documents that guide consumers’ food choices. They inform the qualitative classification of food groups and messages on how to adopt a healthy diet. The classifications and nomenclatures adopted in these documents vary according to cultural, nutritional, and scientific criteria. This study aimed to evaluate the understanding of Brazilian consumers regarding food classification according to the Food Guide for the Brazilian Population (FGBP) concepts. An instrument was constructed to assess consumer understanding. It was named “Understanding of the Level of Processing of Food” (ULPF) and validated according to the concepts of constructs presented by psychometrics such as the Delphi methodology. The instrument was composed of 36 items approved by experts (concordance > 80% and with good internal consistency). A total of 2333 Brazilians from all regions participated in the study. The results suggest that food classification according to the level of processing was difficult for participants to understand. About 85% of them did not understand or did not know the definitions and classification of food and preparations according to food and science technology (FST) and the FGBP. More than 50% of the participants believed that it was easier to classify food according to food groups.

The fourth industrial revolution in the food industry-part II: Emerging food trends

The food industry has recently been under unprecedented pressure due to major global challenges, such as climate change, exponential increase in world population and urbanization, and the worldwide spread of new diseases and pandemics, such as the COVID-19. The fourth industrial revolution (Industry 4.0) has been gaining momentum since 2015 and has revolutionized the way in which food is produced, transported, stored, perceived, and consumed worldwide, leading to the emergence of new food trends. After reviewing Industry 4.0 technologies (e.g. artificial intelligence, smart sensors, robotics, blockchain, and the Internet of Things) in Part I of this work (Hassoun, Aït-Kaddour, et al. 2022. The fourth industrial revolution in the food industry-Part I: Industry 4.0 technologies. Critical Reviews in Food Science and Nutrition, 1-17.), this complimentary review will focus on emerging food trends (such as fortified and functional foods, additive manufacturing technologies, cultured meat, precision fermentation, and personalized food) and their connection with Industry 4.0 innovations. Implementation of new food trends has been associated with recent advances in Industry 4.0 technologies, enabling a range of new possibilities. The results show several positive food trends that reflect increased awareness of food chain actors of the food-related health and environmental impacts of food systems. Emergence of other food trends and higher consumer interest and engagement in the transition toward sustainable food development and innovative green strategies are expected in the future.

Meat consumption and consumer attitudes - A Norwegian perspective

Norway has lower meat consumption than other North European countries. Meat is acknowledged as important for food security in Norway, as Norway's agricultural possibilities are best suited for free-ranging and self-foraging animals. Meat has a strong position in the Norwegian diet, particularly as a centrepiece for special occasions. Good taste, product variety, and affordable price make meat a convenient choice. Norwegian consumers are not worried about animal welfare in local production, nor highly driven by environmental motives for reducing their consumption. Meat analogues have a very small market share, and taste and processing level do not make it a primary replacement for meat reducers. Still, Norwegian consumers' attitudes towards meat have become more diverse in later years. More consumer segments display meat-reducing behaviours citing both health and sustainability reasons. Females are particularly interested in reducing meat consumption, young age and urban lifestyle are other characteristics of meat reducing segments.

Essential Factors for a Healthy Microbiome: A Scoping Review

Recent discoveries of the purpose and potential of microbial interactions with humans have broad implications for our understanding of metabolism, immunity, the host−microbe genetic interactions. Bioavailability and bioaccessibility of phytonutrients in foods not only enrich microbial diversity in the lower human gastrointestinal tract (GIT) but also direct the functioning of the metagenome of the microbiota. Thus, healthy choices must include foods that contain nutrients that satisfy both the needs of humans and their microbes. Physical activity interventions at a moderate level of intensity have shown positive effects on metabolism and the microbiome, while intense training (>70% VO2max) reduces diversity in the short term. The microbiome of elite endurance athletes is a robust producer of short-chain fatty acids. A lifestyle lacking activity is associated with the development of chronic disease, and experimental conditions simulating weightlessness in humans demonstrate loss of muscle mass occurring in conjunction with a decline in gut short-chain fatty acid (SCFA) production and the microbes that produce them. This review summarizes evidence addressing the relationship between the intestinal microbiome, diet, and physical activity. Data from the studies reviewed suggest that food choices and physical fitness in developed countries promote a resource “curse” dilemma for the microbiome and our health.

Consumers' Understanding of Ultra-Processed Foods

Food classification systems have been proposed to improve food quality criteria. Among these systems, "processing level" has been used as a criterion. NOVA classification, as the denotation "ultra-processed" food (UPF), has been widely used in different countries. However, even though some studies have pointed out some controversial aspects, no study has evaluated its comprehension by the population where it is used as reference. Therefore, this study explored the understanding of the term UPF for Brazilian consumers, where this denotation has been used in the last 8 years. A questionnaire was used, with questions referring to different aspects of self-assessment of knowledge about UPF. Altogether, 939 valid participants completed the questionnaire, and 81.9% of them declared to know the term UPF. For 78.2%, a better definition for UPF should be "foods that have gone through many processes in industry". Finally, it was concluded that the term UPF is still confusing for most Brazilians, indicating the risk of use and the urgent necessity to improve the classifications systems and consequently consumer understanding. Only when all parties interested in healthy food work together could this problem be solved.

Evaluation of foods, drinks and diets in the Netherlands according to the degree of processing for nutritional quality, environmental impact and food costs

OBJECTIVE

This study investigates nutritional quality, environmental impact and costs of foods and drinks and their consumption in daily diets according to the degree of processing across the Dutch population.

DESIGN

The NOVA classification was used to classify the degree of processing (ultra-processed foods (UPF) and ultra-processed drinks (UPD)). Food consumption data were derived from the Dutch National Food Consumption Survey 2012-2016. Indicators assessed were nutritional quality (saturated fatty acids (SFA), sodium, mono and disaccharides (sugar), fibre and protein), environmental impact (greenhouse gas (GHG) emissions and blue water use) and food costs.

SETTING

The Netherlands.

PARTICIPANTS

Four thousand three hundred thirteen Dutch participants aged 1 to 79 years.

RESULTS

Per 100 g, UPF were more energy-dense and less healthy than unprocessed or minimally processed foods (MPF); UPF were associated with higher GHG emissions and lower blue water use, and were cheaper. The energy and sugar content of UPD were similar to those of unprocessed or minimally processed drinks (MPD); associated with similar GHG emissions but blue water use was less, and they were also more expensive. In the average Dutch diet, per 2000 kcal, ultra-processed foods and drinks (UPFD) covered 29% (456 g UPF and 437 g UPD) of daily consumption and 61% of energy intake. UPFD consumption was higher among children than adults, especially for UPD. UPFD consumption determined 45% of GHG emissions, 23% of blue water use and 39% of expenses for daily food consumption. UPFD consumption contributed 54% to 72% to daily sodium, sugar and SFA intake.

CONCLUSIONS

Compared with unprocessed or minimally processed foods and drinks, UPF and UPD were found to be less healthy considering their high energy, SFA, sugar and sodium content. However, UPF were associated higher GHG emissions and with less blue water use and food costs. Therefore daily blue water use and food costs might increase if UPF are replaced by those unprocessed or minimally processed. As nutritional quality, environmental impacts and food costs relate differently to the NOVA classification, the classification is not directly applicable to identify win-win-wins of nutritional quality, environmental impact and costs of diets.

Modelling the Impact of Reducing Ultra-Processed Foods Based on the NOVA Classification in Australian Women of Reproductive Age

Women of reproductive age have a high proportion of overweight/obesity and an overall poor nutritional intake and diet quality. Nutritional modelling is a method to forecast potential changes in nutrition composition that may offer feasible and realistic changes to dietary intake. This study uses simulation modelling to estimate feasible population improvements in dietary profile by reducing ultra-processed food (UPF) consumption in Australian women of reproductive age. The simulation used weighted data from the most recent 2011-2012 National Nutrition and Physical Activity Survey. A total of 2749 women aged 19-50 years was included, and 5740 foods were examined. The highest daily energy, saturated fat, and added sugar and sodium came from UPF. Reducing UPF by 50% decreased energy intake by 22%, and saturated fat, added sugar, sodium, and alcohol by 10-39%. Reducing UPF by 50% and increasing unprocessed or minimally processed foods by 25% led to a lower estimated reduction in energy and greater estimated reductions in saturated fat and sodium. Replacement of 50% UPF with 75% of unprocessed or minimally processed foods led to smaller estimated reductions in energy and nutrients. Our results provide insight as to the potential impact of population reductions in UPF, but also increasing intake of unprocessed or minimally processed foods, which may be the most feasible strategy for improved nutritional intake.

Evolving Food Choices Among the Urban Indian Middle-Class: A Qualitative Study

One of the leading risk factors for an escalating obesity burden in India is non-nutritious choices. Underpinned by the nutrition transition theory, this qualitative inquiry was designed to understand the urban middle-class Indian consumers’ views about processed foods and rapidly changing food choices. The study consisted of two phases, the first phase consisted of focus group discussions pertaining to the definition and conception of processed foods and the second phase consisted of interviews regarding the changing food environment. A convenience sample of Indian consumers aged 40–65 years were recruited from Mumbai and Kochi to participate in focus group discussions (FGD1 – nine participants and FGD2 – seven participants) and semi-structured face-to-face interviews (N = 22). Both discussions and interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to analyze the transcribed data. Features of processed foods mentioned were chemical and physical processing, prolonged shelf life and poor nutritional quality. Factors influencing food choices and consumption of processed foods reported by participants could be categorized into changes in the socio-cultural environment and changes in the food environment. Changes in the socio-cultural environment included globalization and urbanization, long work days and sedentary living, rise in income levels and decrease in household cooking. Changes in the food environment included increased availability and accessibility of processed foods, replacement of traditional Indian diet with Western food, food as indicators of status, food advertisements and convenience. These results are consistent with nutrition transition theory and provide useful direction for public health policies aimed at promoting healthy diets.

Antiradical Potential of Food Products as a Comprehensive Measure of Their Quality

Antiradical potential (ARP) is an important measure of food safety. In addition, it directly or indirectly affects the rate of occurrence of a number of human pathologies. Using a photocolorimetric analysis of DPPH (2,2-diphenyl-1-picrylhydrazyl) solutions, we estimated the antiradical potential of food raw materials, food concentrates, biologically active substances, and wild plants. We conducted approximately 1500 analyses of almost 100 food products selected from 11 food groups: vegetables, milk, meat, fish, cereals and bread, drinks (including tea and coffee), etc. With a confidence interval (CI) of 95%, the average values for animal products range from 15.87 to 18.70 ascorbic acid equivalents per gram of dry matter. For plant materials, the range is 474.54-501.50 equivalents when wild herbs are included and 385.02-408.83 equivalents without taking herbs into account. The antiradical potential of the biologically active substances we studied ranged from 706.84 to 847.77 equivalents per gram of dry matter, which makes it possible to use some of the components to repair products with low ARP values, for example, bread and baked goods, confectionery, milk and dairy products, carbonated drinks, and juice. In this study, a low ARP value is associated with a reduction in the shelf life of products and a deterioration in their organoleptic properties; therefore, we propose using ARP as an important reference for describing the quality of food products and raw food materials.

What Do Consumers Think About Foods Processed by Ultraviolet Radiation and Ultrasound?

This study aimed to investigate Brazilian consumers' perception concerning foods processed by ultraviolet (UV) radiation and ultrasound (US) and define consumer segments considering their socioeconomic characteristics and eating habits towards industrialized products through free word association tasks answered by 1004 participants via an online platform. UV- and US-treated foods were more frequently related to unfamiliar words/terms (21.51 and 36.95%) and negative associations (36.25 and 26.70%) than positive ones (29.89 and 24.20%), respectively. Unfamiliarity and health risk concerns were more reported for US-treated foods by women aged 18-25 and ≥46 with low income, and low and frequent industrialized products consumption, as well as for UV-treated foods by consumers ≤35 years old with low and medium income, and low and frequent industrialized products consumption. This indicates that more clear and trustworthy information is needed before introducing these products in the Brazilian market, mainly for potential target consumer groups identified in this study.

Hunger, Obesity, Public Policies, and Food-Based Dietary Guidelines: A Reflection Considering the Socio-Environmental World Context

Nowadays, the world has been characterized by hunger, obesity, and food loss and waste (FLW). With the COVID-19 pandemic, the food issue became more intense, serious, and evident. Hunger demands urgent actions. Obesity levels have been raised and are removing health and quality of life from the population. Production planting practices and the food supply chain are not necessarily ecologically friendly. Sustainability issues greatly intensify social problems. As well as food loss (FL), food waste (FW), and sustainability concerns, obesity, and malnutrition are enhanced due to the lack of knowledge by the population. Processed food (PF), packaging, and additives, despite still needing improvement, are essential to food security control. Nowadays, hunger is not due to insufficient agricultural practices but rather to inequality and absence of adequate public policies. In the context of a certain abundance of food production and processing, the hunger scenario in contrast to FLW is an ethical, social, moral, and sustainable issue. In this context, a Food-Based Dietary Guideline (FBDG) can be an important public policy tool from the health, nutrition, environmental, and educational points of view. Despite the effort, the literature shows that FBDGs can be better used to fulfill healthiness and sustainability purposes. In this scenario, the elaboration/revision of the FBDG, adopting a clearer, simpler, and a better-suited communication strategy is essential. In this way, this article discusses the importance of the FBDG as a public policy tool, not only regarding health issues but also communication strategies, production sustainability, and humanitarian ones, which are crucial to FBDG's efficiency.

Decision flowchart for food classification by the extension and purpose of industrial processing: update and practical application

ABSTRACT Objective To describe the development and update of an instrument for food categorisation according to the extension and purpose of industrial processing, and to test its practical application. Methods After updating the instrument based on a recent publication on the NOVA classification, it was applied by five researchers to a database of 108 food items. These items are part of a database of foods announced in the health-related sections of supermarket promotional circulars. The Cohen’s weighted kappa coefficient was calculated to determine intra-rater agreement; Fleiss’ kappa and Kendall’s coefficient were applied to determine inter-rater agreement. Results In the updated version, two classes of additives and eight substances considered by the most recent publication as specific to ultra-processed foods were added. The intra-rater agreement was 100% (p<0.001), indicating an “almost perfect” agreement; Fleiss’ agreement among all raters ranged from 74% to 97% (p<0.001), which represents an agreement that ranged from “strong” to “almost perfect”; Kendall’s W was higher than 0.93 (p<0.001) among all raters. Conclusion The updated instrument showed high agreement and proved to be a methodologically sound and applicable tool for the purpose of classifying foods by the extension and purpose of industrial processing.

Food consumption in Tunisian university students and its association with sociodemographic characteristics and lifestyle behaviours

OBJECTIVE

This study aimed to characterise food consumption among students at the University of Carthage (Tunisia), assessing quality of diet and main dietary patterns, and their association with potential conditioning factors.

DESIGN

Cross-sectional study. Participants self-reported food consumption in two 24-h recalls and information about sociodemographic, anthropometric and lifestyle characteristics such as BMI, birthplace, physical activity, eating places or kitchen appliances. Mediterranean Diet Score (MDS) and the Nutrient Rich Foods (NRF) index (NRF9.3) were used to assess diet quality. Exploratory factor analysis was conducted to identify eating patterns. Linear regression models were used to test the association of dietary patterns with the diet quality markers.

SETTING

Students at the University of Carthage, Tunisia.

PARTICIPANTS

132 students.

RESULTS

Almost 96 % of participants need shifts towards healthier food. Four main food patterns were identified 'Traditional food', 'Transitional food', 'European breakfast' and 'Western food'. 'Traditional food' was the first dietary model, positively associated with MDS and NRF9.3. Women showed higher adherence to 'European breakfast' and higher quality of diet by NRF9.3. Students eating out of home showed higher adherence to 'Western food', those who never kept a regular schedule of meals consumed lower amount of vegetables and tubers, and sedentary or low active students had a higher intake of ready-to-eat products.

CONCLUSIONS

Diet quality of the participating Tunisian students is inadequate, but traditional Mediterranean diet remains the main pattern in spite of the advanced transitional nutrition. Some lifestyle risk behaviours affecting quality of diet were identified in this work, which supports the youth's particular vulnerability.

Parental reward-based eating drive predicts parents' feeding behaviors and Children's ultra-processed food intake

Reward-based eating drive is associated with individual consumption, but there has been a paucity of research on the relationships between parental reward-based eating, child feeding behaviors, and child food consumption. Child feeding behaviors likely to be associated with parental reward-based eating drive include the provision of ultra-processed foods, as they are designed to be hyperpalatable and are associated with disordered food intake. The present study uses a virtual reality (VR) buffet restaurant environment to examine parents' food choice behaviors for their children and a food frequency assessment to measure the children's reported consumption over the course of a week. Results found that parental reward-based eating drive significantly predicted ultra-processed calories chosen by parents for their children in the VR Buffet, as well as the amount of ultra-processed food children ate according to the food frequency assessment. Both of these effects were significantly mediated by the healthfulness of the home food environment. This study is among the first to demonstrate associations between parental reward-based eating drive and child-focused food behavior and to elucidate a mediating effect of the home food environment on such relationships. These findings may be useful for the development of family-based interventions to improve child feeding and ultimately child health.

Perceptions of risk and benefit of different foods consumed in Brazil and the optimism about chronic diseases

This study aimed to assess consumers' perceptions about the impact of consumption of different foods on health and body weight, as well as to identify risk perceptions about food-related chronic diseases. Face-to-face questionnaires were conducted with 525 Brazilians. Individuals were asked about their perception of risks associated with the consumption of 50 food items on health and bodyweight. The unrealistic optimism was measured by asking participants about their risk and the risk of another person with similar body and health conditions of developing diabetes mellitus (DM), systemic arterial hypertension (SAH), and gaining 3 to 10 kg in the next 12 months. According to the principal component analysis, biased perception of food healthiness and weight gain was observed. Some UPF were perceived as healthy (e.g., gelatin, cereal bars, cream cracker), indicating a false healthy stereotype. Regarding the bodyweight effect, some typical Brazilian staple foods, such as rice, pasta, bread, and potatoes, were considered fattening foods. Optimistic bias was found for DM, SAH, and weight gain, and perceived control over health correlated negatively to risk perception of all hazards. Some motives for food choice and perceptions about foods affected the risk perception about chronic disease. Consumers with higher income, highly educated, and without children perceive higher health benefits in food than risks. These results indicate that health campaigns must be unbiased, clarifying the level of food processing and health effects, especially for the food stereotyped as healthy and fattening.

Ultra-Processed Food Consumption is Associated with Renal Function Decline in Older Adults: A Prospective Cohort Study

Ultra-processed food (UPF) consumption has been associated with increased risk of cardiovascular risk factors and mortality. However, little is known on the UPF effect on renal function. The aim of this study is to assess prospectively the association between consumption of UPF and renal function decline. This is a prospective cohort study of 1312 community-dwelling individuals aged 60 and older recruited during 2008-2010 and followed up to December 2015. At baseline, a validated dietary history was obtained. UPF was identified according to NOVA classification. At baseline and at follow-up, serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) levels were ascertained and changes were calculated. A combined end-point of renal decline was considered: SCr increase or eGFR decreased beyond that expected for age. Logistic regression with adjustment for potential confounders was performed. During follow-up, 183 cases of renal function decline occurred. The fully adjusted odds ratios (95% CI) of renal function decline across terciles of percentage of total energy intake from UPF were 1.56 (1.02-2.38) for the second tercile, and 1.74 (1.14-2.66) for the highest tercile; p-trend was 0.026. High UPF consumption is independently associated with an increase higher than 50% in the risk of renal function decline in Spanish older adults.

Are the recommendations of paediatricians about complementary feeding aligned with current guidelines in Uruguay?

OBJECTIVE

To explore Uruguayan paediatricians' personal recommendations about complementary feeding and to assess if they are aligned with current guidelines and scientific evidence.

DESIGN

A questionnaire composed of open-ended questions was used to explore foods recommended to start complementary feeding, foods regarded as the most important during the first meals, recommendations for delayed introduction of foods and foods that should be avoided. Reasons underlying the recommendations were also explored.

SETTING

Montevideo, the capital city of Uruguay (Latin America).

PARTICIPANTS

A total of 212 paediatricians were recruited during a National Pediatrics Conference, organised by the Uruguayan Society of Pediatrics.

RESULTS

The recommendations about complementary feeding provided by paediatricians to parents and caregivers in Uruguay seemed not to be fully aligned with the guidelines provided by the Ministry of Health. Paediatricians recommend a rigid food introduction sequence, characterised by the early introduction of soft pureed vegetables and fruits, followed by meat and the delayed introduction of allergenic foods. Food diversity and the concept of ultra-processed were not frequently identified in the responses.

CONCLUSIONS

Results stress the importance of developing educational and communication approaches targeted at paediatricians to contribute to the uptake of updated recommendations regarding complementary feeding.

Consumption of ultra-processed foods and health outcomes: a systematic review of epidemiological studies

Background

Consumption of ultra-processed foods (UPFs) plays a potential role in the development of obesity and other diet-related noncommunicable diseases (NCDs), but no studies have systematically focused on this. This study aimed to summarize the evidence for the association between UPFs consumption and health outcomes.

Methods

A comprehensive search was conducted in PubMed, Embase, and Web of Science to identify all relevant studies. Epidemiological studies were included, and identified studies were evaluated for risk of bias.A narrative review of the synthesized findings was provided to assess the association between UPFs consumption and health outcomes.

Results

20 studies (12 cohort and 8 cross-sectional studies) were included in the analysis, with a total of 334,114 participants and 10 health outcomes. In a narrative review, high UPFs consumption was obviously associated with an increased risk of all-cause mortality, overall cardiovascular diseases, coronary heart diseases, cerebrovascular diseases, hypertension, metabolic syndrome, overweight and obesity, depression, irritable bowel syndrome, overall cancer, postmenopausal breast cancer, gestational obesity, adolescent asthma and wheezing, and frailty. It showed no significant association with cardiovascular disease mortality, prostate and colorectal cancers, gestational diabetes mellitus and gestational overweight.

Conclusions

This study indicated a positive association between UPFs consumption and risk of several health outcomes. Large-scale prospective designed studies are needed to confirm our findings.