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Robles B, Mota-Bertran A, Saez M, Solans M. Association between ultraprocessed food consumption and excess adiposity in children and adolescents: A systematic review. Obes Rev 2024; 25:e13796. [PMID: 38956887 DOI: 10.1111/obr.13796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/17/2023] [Accepted: 06/12/2024] [Indexed: 07/04/2024]
Abstract
Ultraprocessed foods (UPF) consumption is associated with excess adiposity in adults, but this linkage remains unclear among children and adolescents. The present systematic review sought to address this research gap. Publications up to November 2023 were retrieved from PubMed, Web of Science, and Scopus databases. Outcomes included overweight/obesity anthropometric and body composition indicators; the exposure was UPF consumption based on the NOVA classification system. The review included 23 studies (i.e., 8 cohort and 15 cross-sectional); approximately half were carried out in Brazil. Inconclusive and heterogeneous evidence exists as few cohort studies found positive/mixed associations between UPF consumption and excess adiposity in pediatric populations, whereas most cross-sectional studies reported null associations. Such inconsistencies may be attributed to underlying methodological issues, especially heterogeneity in the outcomes assessed and UPF consumption operationalization and/or categorization. Future studies should adopt longitudinal designs with sufficiently extended follow-up periods, account for relevant confounding factors, employ validated and standardized measurement tools to assess dietary exposure, ensure consistent operationalization of variables, and encompass diverse geographic contexts. Ultimately, strengthening the quality of existing research evidence may better inform current and forthcoming policy and practice interventions aimed at mitigating the increasing prevalence of overweight/obesity in childhood and across the life course.
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Affiliation(s)
- Brenda Robles
- Department of Economics, University of Rovira i Virgili, Reus, Spain
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Anna Mota-Bertran
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Marc Saez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Solans
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
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Shinozaki N, Murakami K, Kimoto N, Masayasu S, Sasaki S. Highly Processed Food Consumption and its Association With Overall Diet Quality in a Nationwide Sample of 1,318 Japanese Children and Adolescents: A Cross-Sectional Analysis Based on 8-Day Weighed Dietary Records. J Acad Nutr Diet 2024:S2212-2672(24)00267-3. [PMID: 38852670 DOI: 10.1016/j.jand.2024.06.001] [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: 09/18/2023] [Revised: 05/31/2024] [Accepted: 06/04/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND There is limited evidence regarding the association between consumption of highly processed foods (HPFs) and overall diet quality in children and adolescents from Asian countries. OBJECTIVE This study aimed to examine the association between HPF consumption and overall diet quality in Japanese children and adolescents. DESIGN A cross-sectional analysis was conducted based on 8-day dietary record data collected from volunteers in 32 of 47 prefectures throughout Japan in 2016 to 2020. Foods were categorized into 1 of 4 processing levels using the framework developed by the University of North Carolina at Chapel Hill. Food classification was performed under a low-estimate scenario (classifying mixed dishes consumed outside the home after disaggregation into ingredients) and high-estimate scenario (classifying them into HPFs without food disaggregation). PARTICIPANTS/SETTING A total of 1318 Japanese children and adolescents aged 3 to 17 years participated in the study. MAIN OUTCOME MEASURES Diet quality was assessed using the Healthy Eating Index-2020 and Nutrient-Rich Food Index 9.3. STATISTICAL ANALYSIS Multiple regression models adjusted for sociodemographic and anthropometric characteristics and the survey cycle were used to examine the association between tertiles of the energy contribution of HPFs and diet quality. RESULTS The mean energy contribution of HPFs was 27.3% and 44.3% in the low- and high-estimate scenarios, respectively. The top contributors to total energy intake from HPFs were confectioneries in the low-estimate scenario and cereals and starchy foods in the high-estimate scenario. Irrespective of the scenarios, participants in higher tertiles of energy contribution of HPFs had lower total scores for Healthy Eating Index-2020 and Nutrient-Rich Food Index 9.3 (P for trend < .0001). CONCLUSIONS HPFs accounted for more than one-quarter of the energy intake of Japanese children and adolescents surveyed, and higher consumption of HPFs was associated with lower diet quality. Therefore, reducing HPF consumption may increase overall diet quality among Japanese children and adolescents. Further research is needed to explore the causal nature of this association.
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Affiliation(s)
- Nana Shinozaki
- Department of Social and Preventive Epidemiology, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kentaro Murakami
- Department of Social and Preventive Epidemiology, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Nana Kimoto
- Department of Social and Preventive Epidemiology, School of Public Health, The University of Tokyo, Tokyo, Japan
| | | | - Satoshi Sasaki
- Department of Social and Preventive Epidemiology, School of Public Health, The University of Tokyo, Tokyo, Japan
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Ramadas A, Rizal H, Rajakumar S, Mariapun J, Yasin MS, Armstrong MEG, Su TT. Dietary intake, obesity, and metabolic risk factors among children and adolescents in the SEACO-CH20 cross-sectional study. Sci Rep 2024; 14:11265. [PMID: 38760446 PMCID: PMC11101611 DOI: 10.1038/s41598-024-61090-7] [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: 08/04/2023] [Accepted: 04/30/2024] [Indexed: 05/19/2024] Open
Abstract
We investigated the association between dietary intake and metabolic risk factors in children and adolescents within a semi-rural Malaysian community. Using an interviewer-led questionnaire, we surveyed 623 participants aged 7-18 from the South East Asia Community Observatory (SEACO). Anthropometric and blood pressure data were collected from all participants, while a subset (n = 162) provided blood samples for biomarker analysis, including fasting blood glucose (FBG), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). Metabolic syndrome was determined using the International Diabetes Federation's Definition of Metabolic Syndrome in Children and Adolescents. Most participants were Malay (66.8%), with a median household income of MYR1,500 and a balanced sex distribution. Cereals, processed foods, beverages, fruits, and vegetables were commonly consumed. Obesity and abdominal obesity were prevalent, affecting more than a third of participants. Adherence to dietary recommendations was generally poor (ranging from 19.9 to 58.1%) and varied across age, sex, and ethnicity. Notably, some food groups displayed unexpected associations with health markers; for instance, fruit consumption was linked to abdominal obesity in children (abdominal obesity vs. normal: 2.4 servings/day vs. 1.6 servings/day). These findings emphasise the necessity of longitudinal studies to explore the complex relationship between diet and long-term health outcomes, including cardiometabolic diseases, while acknowledging the unique challenges posed by the COVID-19 pandemic on data collection and analysis.
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Affiliation(s)
- Amutha Ramadas
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500, Bandar Sunway, Malaysia.
| | - Hussein Rizal
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500, Bandar Sunway, Malaysia
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500, Bandar Sunway, Malaysia
| | - Sutha Rajakumar
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500, Bandar Sunway, Malaysia
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500, Bandar Sunway, Malaysia
| | - Jeevitha Mariapun
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 80100, Johor Bahru, Malaysia
| | - Mohamed Shajahan Yasin
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500, Bandar Sunway, Malaysia
| | - Miranda E G Armstrong
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, BS8 1TZ, UK
| | - Tin Tin Su
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500, Bandar Sunway, Malaysia
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500, Bandar Sunway, Malaysia
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Stefanovics EA, Potenza MN, Tsai J. Obesity in U.S. low-income veterans:Prevalence, clinical characteristics, and homelessness. J Psychiatr Res 2024; 173:317-325. [PMID: 38574595 DOI: 10.1016/j.jpsychires.2024.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/15/2024] [Accepted: 03/25/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE Obesity is associated with lower socioeconomic status. To date, however, scarce research has examined the prevalence, comorbidity, and incremental burden of obesity in relation to medical, psychiatric, functional, and homelessness measures among low-income veterans. METHODS A nationally representative sample of 1004 low-income U.S. veterans was examined. Bivariate and multivariable analyses were conducted to assess relationships between obesity and medical and psychiatric comorbidities, functioning, and homelessness measures. RESULTS The prevalence estimate of obesity among low-income U.S. veterans was 38.2% (confidence interval (CI): 34.2; 42.2), which is higher than previously reported for the general U.S. veteran population. It was particularly high among young, females with children. Obesity was associated with co-occurring medical (chronic pain, diabetes, sleep disorders, high blood pressure, heart disease) and psychiatric (trauma- and anxiety-related) conditions, poor functioning, and current psychiatric medication use. Veterans with obesity were less likely to have current savings and more likely to have current debt. They also were more likely to have experienced evictions and foreclosures and less likely to use active coping or positive reframing as a means of dealing with stressful situations. CONCLUSION The prevalence of obesity among U.S. veterans is high. Specific demographic groups particularly vulnerable to developing obesity warrant targeted interventions. Modifying weight management programs, understanding coping styles, and assessing, monitoring, and treating obesity in low-income veterans may help improve overall health and quality of life in multiple domains.
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Affiliation(s)
- Elina A Stefanovics
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs New England Mental Illness Research and Education Clinical Center (MIRECC), West Haven, CT, USA; National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs, Tampa, FL, USA.
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Yale Child Study Center, Yale University, New Haven, CT, USA; Connecticut Mental Health Center, New Haven, CT, USA; Connecticut Council on Problem Gambling, Wethersfield, CT, USA; Department of Neuroscience, Yale University, New Haven, CT, USA; Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Jack Tsai
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs, Tampa, FL, USA; Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
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Carroll JE, Sturgeon SR, Bertone-Johnson E, VanKim N, Longacre MR, Dalton MA, Emond JA. Factors Correlated With Ultra-Processed Food (UPF) Intake in Preschool-Aged Children and Association With Weight. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024; 56:196-208. [PMID: 38340130 PMCID: PMC10999344 DOI: 10.1016/j.jneb.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Understand the correlates of ultra-processed food (UPF) intake and examine the association of UPF on body mass index in children aged 3-5 years. DESIGN Secondary analysis of a prospective cohort of 3-5-year-olds/parent, followed 1-year between March 2014 and October 2016. Usual UPF intake from 2 3-day food records completed 1 year apart, a standardized nutrient database customized with child-specific foods, and a NOVA food classification system was used. Child/parent characteristics and media use were measured via parent-reported surveys. Child weight/height objectively measured. SETTING New Hampshire community. PARTICIPANTS Six hundred and sixty-seven parent-child dyads were screened, and 624 were enrolled with 90% follow-up. MAIN OUTCOME MEASURE(S) Primary outcome: identify correlates of UPF intake. SECONDARY OUTCOME determine if UPF intake is associated with body mass index change. ANALYSIS Adjusted β linear regression, linear regression, P <0.05. RESULTS Ultra-processed food accounted for 67.6% of total caloric intake. In adjusted models, children's UPF intake was positively associated with increasing child age, greater hours watching television, and more frequent parent soda/fast-food intake. Ultra-processed food intake was negatively associated with higher parent education and reported race/ethnicity other than non-Hispanic White. There was no association between UPF intake and weight. CONCLUSIONS AND IMPLICATIONS There are several predictors of UPF intake in young children. Family-level interventions could be implemented to encourage the intake of minimally processed foods before and during preschool years.
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Affiliation(s)
- Jennifer E Carroll
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA; Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, NH.
| | - Susan R Sturgeon
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA
| | - Elizabeth Bertone-Johnson
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA; Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA
| | - Nicole VanKim
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA
| | - Meghan R Longacre
- Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, NH; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH; Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH
| | - Madeline A Dalton
- Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, NH; Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH
| | - Jennifer A Emond
- Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, NH; Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH
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Gonzales Santos M, Rosenthal A, Beatriz Araujo Martins I, de Alcantara M, Almeida Lima M, de Assis Carvalho R, Deliza R. Exploring the role of the general interest in health on the perceptions of Healthy, Industrialized, and Ultra-processed foods among Brazilians. Food Res Int 2024; 181:113992. [PMID: 38448090 DOI: 10.1016/j.foodres.2024.113992] [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: 08/16/2023] [Revised: 01/02/2024] [Accepted: 01/08/2024] [Indexed: 03/08/2024]
Abstract
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.
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Affiliation(s)
- Mario Gonzales Santos
- Graduate Program of Food Science and Technology, Universidade Federal Rural do Rio de Janeiro, Rodovia BR 456, km 7, Seropédica, RJ, Brazil; Faculty of Technological Sciences, Universidad Nacional de Agricultura, Carretera a Dulce Nombre de Culmí, km 215, Barrio El Espino, Catacamas, Honduras.
| | - Amauri Rosenthal
- Embrapa Agroindústria de Alimentos, Av. das Américas 29501, CEP 23.020-470 Rio de Janeiro, RJ, Brazil
| | | | - Marcela de Alcantara
- PDJ/Faperj/Embrapa Agroindústria de Alimentos, Av. das Américas 29501 CEP 23.020-470 Rio de Janeiro, RJ, Brazil
| | - Mariah Almeida Lima
- Graduate Program of Food Science and Technology, Universidade Federal Rural do Rio de Janeiro, Rodovia BR 456, km 7, Seropédica, RJ, Brazil
| | - Raíssa de Assis Carvalho
- Graduate Program of Food Science and Technology, Universidade Federal Rural do Rio de Janeiro, Rodovia BR 456, km 7, Seropédica, RJ, Brazil
| | - Rosires Deliza
- Embrapa Agroindústria de Alimentos, Av. das Américas 29501, CEP 23.020-470 Rio de Janeiro, RJ, Brazil
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Heerman WJ, Sneed NM, Sommer EC, Truesdale KP, Matheson D, Noerper TE, Samuels LR, Barkin SL. Ultra-processed food consumption and BMI-Z among children at risk for obesity from low-income households. Pediatr Obes 2023; 18:e13037. [PMID: 37070567 PMCID: PMC10434975 DOI: 10.1111/ijpo.13037] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 03/13/2023] [Accepted: 04/03/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVE To evaluate the association between baseline ultra-processed food consumption in early childhood and child BMI Z-score over 36 months. METHODS We conducted a prospective cohort analysis as a secondary data analysis of the Growing Right Onto Wellness randomised trial. Dietary intake was measured via 24-h diet recalls. The primary outcome was child BMI-Z, measured at baseline and at 3-, 9-, 12-, 24- and 36-month timepoints. Child BMI-Z was modelled using a longitudinal mixed-effects model, adjusting for covariates and stratifying by age. RESULTS Among 595 children, median (Q1-Q3) baseline age was 4.3 (3.6-5.0) years, 52.3% of the children were female, 65.4% had normal weight, 33.8% were overweight, 0.8% were obese and 91.3% of parents identified as Hispanic. Model-based estimates suggest that, compared with low ultra-processed consumption (300 kcals/day), high ultra-processed intake (1300 kcals/day) was associated with a 1.2 higher BMI-Z at 36 months for 3-year-olds (95% CI = 0.5, 1.9; p < 0.001) and a 0.6 higher BMI-Z for 4-year-olds (95% CI = 0.2, 1.0; p = 0.007). The difference was not statistically significant for 5-year-olds or overall. CONCLUSIONS In 3- and 4-year-old children, but not in 5-year-old children, high ultra-processed food intake at baseline was significantly associated with higher BMI-Z at 36-month follow-up, adjusting for total daily kcals. This suggests that it might not be only the total number of calories in a child's daily intake that influences child weight status, but also the number of calories from ultra-processed foods.
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Affiliation(s)
- William J Heerman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nadia M Sneed
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt University School of Nursing, Nashville, Tennessee, USA
| | - Evan C Sommer
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kimberly P Truesdale
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | - Lauren R Samuels
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shari L Barkin
- Virginia Commonwealth University, Richmond, Virginia, USA
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Vale D, Lyra CDO, Dantas NM, Andrade MEDC, Oliveira AGRDC. Dietary and Nutritional Profiles among Brazilian Adolescents. Nutrients 2022; 14:nu14204233. [PMID: 36296917 PMCID: PMC9608776 DOI: 10.3390/nu14204233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: The present study analyzed the prevalence of dietary and nutritional profiles among Brazilian adolescents and their associations with social determinants of health. (2) Methods: A population-based survey was administered to 16,409 adolescents assessed by the 2015 National School Health Survey. A multivariate model of dietary and nutritional profiles was estimated from correspondence analysis. (3) Results: The dietary and nutritional profiles more prevalent among Brazilian adolescents were “lower nutritional risk dietary pattern and eutrophic” (42.6%), “lower nutritional risk dietary pattern and overweight” (6.8%), and “higher nutritional risk dietary pattern and overweight” (6.0%). Healthier profiles were associated with less urbanized territories, health-promoting behaviors, and families with worse material circumstances. The less healthy profiles were associated with more urbanized environments, health risk behaviors, and families with better material circumstances. (4) Brazilian adolescents have different dietary and nutritional profiles that are characterized by sociopolitical and economic contexts, family material and school circumstances, and the behavioral and psychosocial health factors of the individuals. All of this points to the social determination of these health problems among adolescents in Brazil.
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Affiliation(s)
- Diôgo Vale
- Postgraduate Program in Collective Health, Federal University of Rio Grande do Norte, Natal 59056-000, RN, Brazil
- Federal Institute of Education, Science and Technology of Rio Grande do Norte, Natal 59015-300, RN, Brazil
- Correspondence: ; Tel.: +55-84-998625453
| | - Clélia de Oliveira Lyra
- Postgraduate Program in Collective Health, Federal University of Rio Grande do Norte, Natal 59056-000, RN, Brazil
| | - Natalie Marinho Dantas
- Postgraduate Program in Nutrition in Public Health, School of Public Health, University of São Paulo, São Paulo 05508-000, SP, Brazil
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Ashraf R, Duncan AM, Darlington G, Buchholz AC, Haines J, Ma DWL. The degree of food processing is associated with anthropometric measures of obesity in Canadian families with preschool-aged children. Front Nutr 2022; 9:1005227. [PMID: 36211496 PMCID: PMC9537364 DOI: 10.3389/fnut.2022.1005227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/06/2022] [Indexed: 11/22/2022] Open
Abstract
Adopting a healthy diet remains central for the prevention of obesity. In adults, higher intake of ultra-processed food is associated with a greater risk of overweight and obesity. However, little is known about the degree of food processing and its association with anthropometric measures in families with preschool-aged children, a critical period for the development of dietary patterns. This cross-sectional study included preschool-aged children (n = 267) between 1.5 and 5 years of age and their parents (n = 365) from 242 families enrolled in the Guelph Family Health Study. Dietary assessment was completed using ASA24-Canada-2016. Foods and beverages were classified based on their degree of food processing using the NOVA Classification (unprocessed or minimally processed foods, processed culinary ingredients, processed foods, and ultra-processed foods). Associations between the energy contribution (% kcal) of each NOVA category and anthropometric measures were examined using linear regression models with generalized estimating equations, adjusted for sociodemographic variables. The energy contribution of ultra-processed foods was the highest relative to the other NOVA categories among parents (44.3%) and children (41.3%). The energy contribution of unprocessed or minimally processed foods was 29.1% for parents and 35.3% for children, processed foods was 24.0% for parents and 21.3% for children, and processed culinary ingredients was 2.6% for parents and 2.1% for children. Ultra-processed foods (% kcal) were positively associated with BMI (β = 0.04, 95% CI: 0.01–0.07, P = 0.02), waist circumference (β = 0.11, 95% CI: 0.03–0.18, P = 0.008) and body weight (β = 0.13, 95% CI: 0.03–0.22, P = 0.01) in parents, but not children. Unprocessed foods (% kcal) were negatively associated with waist circumference in parents (β = −0.09, 95% CI: 0.18–0.01, P = 0.03) and children (β = −0.03, 95% CI: 0.05–0.01, P = 0.01), as well as body weight (β = −0.12, 95% CI: 0.23–0.00, P = 0.04) in parents. The degree of food processing primarily influenced anthropometric outcomes in parents. Nevertheless, diets of children were similar, suggesting that such exposure in families may eventually lead to outcomes observed in parents.
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Affiliation(s)
- Rahbika Ashraf
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Alison M. Duncan
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Gerarda Darlington
- Department of Mathematics and Statistics, University of Guelph, Guelph, ON, Canada
| | - Andrea C. Buchholz
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON, Canada
| | - Jess Haines
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON, Canada
| | - David W. L. Ma
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
- *Correspondence: David W. L. Ma,
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Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an update on the available data regarding the associations of Ultra-processed food (UPF) consumption with food intake and possible underlying mechanisms relating UPF consumption to weight gain and co-morbidities. RECENT FINDINGS In primarily observational studies, UPF consumption is consistently associated with an increased risk for weight gain among adults and children and increased risk for adiposity-related co-morbidities in adults. In a single mechanistic study, consumption of UPFs led to increased energy intake and weight gain relative to whole foods. UPFs tend to be more energy-dense than nutrient-dense, and UPF consumption is associated with increased adiposity and co-morbidity risk. These data suggest that recommendations to limit UPF consumption may be beneficial to health - though further mechanistic studies are needed.
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Affiliation(s)
- Anthony Crimarco
- Stanford Prevention Research Center, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Matthew J Landry
- Stanford Prevention Research Center, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Christopher D Gardner
- Stanford Prevention Research Center, School of Medicine, Stanford University, Palo Alto, CA, USA.
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Ultra-processed foods and obesity and adiposity parameters among children and adolescents: a systematic review. Eur J Nutr 2022; 61:2297-2311. [PMID: 35322333 PMCID: PMC8942762 DOI: 10.1007/s00394-022-02873-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/08/2022] [Indexed: 12/18/2022]
Abstract
PURPOSE According to the NOVA classification, ultra-processed foods are products made through physical, biological and chemical processes and typically with multiple ingredients and additives, in which whole foods are mostly or entirely absent. From a nutritional point of view, they are typically energy-dense foods high in fat, sugar, and salt and low in fiber. The association between the consumption of ultra-processed food and obesity and adiposity measurements has been established in adults. However, the situation remains unclear in children and adolescents. METHODS We carried out a systematic review, in which we summarize observational studies investigating the association between the consumption of ultra-processed food, as defined by NOVA classification, and obesity and adiposity parameters among children and adolescents. A literature search was performed using PUBMED and Web of Science databases for relevant articles published prior to May 2021. RESULTS Ten studies, five longitudinal and five cross-sectional, mainly conducted in Brazil, were included in this review. Four longitudinal studies in children with a follow-up longer than 4 years found a positive association between the consumption of ultra-processed food and obesity and adiposity parameters, whereas cross-sectional studies failed to find an association. CONCLUSION These data suggest that a consistent intake of ultra-processed foods over time is needed to impact nutritional status and body composition of children and adolescents. Further well-designed prospective studies worldwide are needed to confirm these findings considering country-related differences in dietary habits and food production technologies.
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12
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Jardim MZ, Costa BVDL, Pessoa MC, Duarte CK. Ultra-processed foods increase noncommunicable chronic disease risk. Nutr Res 2021; 95:19-34. [PMID: 34798466 DOI: 10.1016/j.nutres.2021.08.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022]
Abstract
Several studies have associated the food processing classification - NOVA - and health, but this is not true for all noncommunicable chronic diseases (NCDs). This study aimed to systematically review the association between the intake of NOVA food groups and NCDs. We hypothesized that ultra-processed foods and drinks (UPFD) and processed foods (PF) could increase the risk of NCDs, and that unprocessed (UPF) and minimally processed foods (MPF) may provide protection. We carried out a systematic review of observational studies in January 2021. Searches were performed in SCOPUS, MEDLINE (via PubMed), EMBASE, WEB OF SCIENCE, SCIELO, related articles, hand-searching of reference lists, and direct author contact. In all, 2217 citations were identified and 38 articles met the eligibility criteria for inclusion in this systematic review. Among the analyzed food groups, higher UPFD consumption was positively associated with obesity and associated with the development of all NCDs, mainly hypertension, diabetes and dyslipidemia. However, only a few studies have demonstrated the protective effect of natural foods and MPF consumption on the occurrence of NCDs. In conclusion, UPF may increase the risk of NCDs, and natural foods and MPF may reduce it. Our results reinforce the need for the implementation of policies to mitigate the intake of UPF by the population, as it would improve the quality of the dietary patterns, and directly impact on the incidence of NCDs.
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Affiliation(s)
- Mariana Zogbi Jardim
- Post-Graduate Program in Nutrition and Health, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Bruna Vieira de Lima Costa
- Department of Nutrition and Health, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Department of Nutrition, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Milene Cristine Pessoa
- Department of Nutrition and Health, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Department of Nutrition, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Camila Kümmel Duarte
- Department of Nutrition, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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Lauria F, Dello Russo M, Formisano A, De Henauw S, Hebestreit A, Hunsberger M, Krogh V, Intemann T, Lissner L, Molnar D, Moreno LA, Reisch LA, Tornaritis M, Veidebaum T, Williams G, Siani A, Russo P. Ultra-processed foods consumption and diet quality of European children, adolescents and adults: Results from the I.Family study. Nutr Metab Cardiovasc Dis 2021; 31:3031-3043. [PMID: 34518085 DOI: 10.1016/j.numecd.2021.07.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Food processing has been indicated as a factor capable of negatively affecting the global food system, including the profile of consumers' diets. The objectives of the present study were to provide a description of the consumption of ultra-processed foods (UPFs) in the large population of children, adolescents and adults from eight European countries participating to the I.Family study, and to investigate the association between UPFs intake and nutritional quality of the diet. METHODS AND RESULTS Dietary intake was assessed using a 24-h dietary recall. The quality of the diet was evaluated by the Healthy Dietary Adherence Score (HDAS) using an FFQ. UPFs were classified according to the NOVA classification. Almost half of the daily energy intake of the 7073 participants came from UPFs, and this trend decreased progressively with age. UPFs contributed more than 50 % of the daily intake of total and saturated fat, carbohydrates and about 70 % of sugars intake in children and adolescents. No differences in UPFs consumption were found according to the educational and socio-economic status of the population. Energy intake increased across the quintiles of UPFs intake, while HDAS decreased. The frequency of consumption of fruit and vegetable, fish, and fibre rich foods was low in the fifth quintile of UPFs intake, both in adolescents and in adults. The consumption of foods rich in calories and low in nutritional content, operationally defined as "junk food", was significantly higher in the fifth quintile. CONCLUSIONS In the population of the European I.Family study, UPFs contributed a large proportion of the daily energy intake, especially in children and adolescents. Higher consumption of UPFs was associated with a lower quality of the diet. REGISTRATION NUMBER FOR CLINICAL TRIALS ISRCTN62310987.
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Affiliation(s)
- Fabio Lauria
- Institute of Food Sciences, National Research Council, Avellino, Italy.
| | | | | | - Stefaan De Henauw
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Antje Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology, BIPS, Bremen, Germany
| | - Monica Hunsberger
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Vittorio Krogh
- Epidemiology and Prevention Unit, Department of Research, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Timm Intemann
- Leibniz Institute for Prevention Research and Epidemiology, BIPS, Bremen, Germany
| | - Lauren Lissner
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Denes Molnar
- Department of Paediatrics, Clinical Centre, University of Pécs, Pécs, Hungary
| | - Luis A Moreno
- GENUD Research Group, Instituto Agroalimentario de Aragón (IA2), University of Zaragoza, Zaragoza, Spain
| | - Lucia A Reisch
- El-Erian Institute for Behavioural Economics and Policy, Cambridge University, UK
| | | | - Toomas Veidebaum
- Department of Chronic Diseases, National Institute for Health Development, Tallinn, Estonia
| | - Garrath Williams
- Department of Politics, Philosophy and Religion, Lancaster University, Lancaster, UK
| | - Alfonso Siani
- Institute of Food Sciences, National Research Council, Avellino, Italy
| | - Paola Russo
- Institute of Food Sciences, National Research Council, Avellino, Italy
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14
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de Moraes MM, Oliveira B, Afonso C, Santos C, Torres D, Lopes C, de Miranda RC, Rauber F, Antoniazzi L, Levy RB, Rodrigues S. Dietary Patterns in Portuguese Children and Adolescent Population: The UPPER Project. Nutrients 2021; 13:nu13113851. [PMID: 34836107 PMCID: PMC8622610 DOI: 10.3390/nu13113851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 02/07/2023] Open
Abstract
Considering the nature, extent, and purpose of food processing, this study aims to identify dietary patterns (DPs) and their associations with sociodemographic factors and diet quality in Portuguese children and adolescents. Cross-sectional data were obtained from the National Food, Nutrition and Physical Activity Survey (2015-2016) of the Portuguese population. Dietary intake was obtained from two non-consecutive days and food items were classified according to the NOVA system. The proportion (in grams) of foods in the total daily diet was considered to identify DPs by latent class analysis, with age and sex as concomitant variables. Associations of DPs with sociodemographic characteristics were assessed using multinomial logistic regression. Linear regressions adjusted by sociodemographic characteristics tested associations of DPs with diet quality. DPs identified were: "Unhealthy" (higher sugar-sweetened beverages, industrial breads, and sausages intake), "Traditional" (higher vegetables, fish, olive oil, breads, ultra-processed yogurts, and sausages intake), and "Dairy" (higher intake of milk, yogurt, and milk-based beverages). "Unhealthy" was associated with older ages and lower intake of dietary fibre and vitamins and the highest free sugars and ultra-processed foods (UPF), although all DPs presented significant consumption of UPF. These findings should be considered for the design of food-based interventions and school-feeding policies in Portugal.
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Affiliation(s)
- Milena Miranda de Moraes
- Faculty of Nutrition and Food Sciences, University of Porto, 4150-180 Porto, Portugal; (B.O.); (C.A.); (C.S.); (D.T.); (S.R.)
- Associated Laboratory ITR, Laboratory for Integrative and Translational Research in Population Health, Institute of Public Health, University of Porto, 4050-600 Porto, Portugal;
- Correspondence: ; Tel.: +351-22-507-4320
| | - Bruno Oliveira
- Faculty of Nutrition and Food Sciences, University of Porto, 4150-180 Porto, Portugal; (B.O.); (C.A.); (C.S.); (D.T.); (S.R.)
- Artificial Intelligence and Decision Support (LIAAD), Institute for Systems and Computer Engineering, Technology and Science (INESC TEC), 4200-465 Porto, Portugal
| | - Cláudia Afonso
- Faculty of Nutrition and Food Sciences, University of Porto, 4150-180 Porto, Portugal; (B.O.); (C.A.); (C.S.); (D.T.); (S.R.)
- Associated Laboratory ITR, Laboratory for Integrative and Translational Research in Population Health, Institute of Public Health, University of Porto, 4050-600 Porto, Portugal;
| | - Cristina Santos
- Faculty of Nutrition and Food Sciences, University of Porto, 4150-180 Porto, Portugal; (B.O.); (C.A.); (C.S.); (D.T.); (S.R.)
- Center for Health Technology and Services Research (CINTESIS), Associate Laboratory RISE-Health Research Network, University of Porto, 4200-450 Porto, Portugal
| | - Duarte Torres
- Faculty of Nutrition and Food Sciences, University of Porto, 4150-180 Porto, Portugal; (B.O.); (C.A.); (C.S.); (D.T.); (S.R.)
- Associated Laboratory ITR, Laboratory for Integrative and Translational Research in Population Health, Institute of Public Health, University of Porto, 4050-600 Porto, Portugal;
| | - Carla Lopes
- Associated Laboratory ITR, Laboratory for Integrative and Translational Research in Population Health, Institute of Public Health, University of Porto, 4050-600 Porto, Portugal;
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Renata Costa de Miranda
- Center for Epidemiological Research in Nutrition and Health, University of São Paulo, São Paulo 01246-90, Brazil; (R.C.d.M.); (F.R.); (L.A.); (R.B.L.)
- Department of Nutrition, Institute of Health Sciences, Federal University of Triângulo Mineiro, Uberaba 38025-440, Brazil
| | - Fernanda Rauber
- Center for Epidemiological Research in Nutrition and Health, University of São Paulo, São Paulo 01246-90, Brazil; (R.C.d.M.); (F.R.); (L.A.); (R.B.L.)
- Department of Preventive Medicine, Faculty of Medicine, University of São Paulo, São Paulo 01246-90, Brazil
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo 01246-90, Brazil
| | - Luiza Antoniazzi
- Center for Epidemiological Research in Nutrition and Health, University of São Paulo, São Paulo 01246-90, Brazil; (R.C.d.M.); (F.R.); (L.A.); (R.B.L.)
- Department of Preventive Medicine, Faculty of Medicine, University of São Paulo, São Paulo 01246-90, Brazil
| | - Renata Bertazzi Levy
- Center for Epidemiological Research in Nutrition and Health, University of São Paulo, São Paulo 01246-90, Brazil; (R.C.d.M.); (F.R.); (L.A.); (R.B.L.)
- Department of Preventive Medicine, Faculty of Medicine, University of São Paulo, São Paulo 01246-90, Brazil
| | - Sara Rodrigues
- Faculty of Nutrition and Food Sciences, University of Porto, 4150-180 Porto, Portugal; (B.O.); (C.A.); (C.S.); (D.T.); (S.R.)
- Associated Laboratory ITR, Laboratory for Integrative and Translational Research in Population Health, Institute of Public Health, University of Porto, 4050-600 Porto, Portugal;
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Fruh S, Williams S, Hayes K, Hauff C, Hudson GM, Sittig S, Graves RJ, Hall H, Barinas J. A practical approach to obesity prevention: Healthy home habits. J Am Assoc Nurse Pract 2021; 33:1055-1065. [PMID: 33534281 PMCID: PMC8313625 DOI: 10.1097/jxx.0000000000000556] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 11/06/2020] [Indexed: 12/11/2022]
Abstract
ABSTRACT Families have the potential to foster a healthy home environment aimed at reducing the risk of overweight and obesity. Establishing habits associated with reduced risk of obesity and overweight early in childhood can have lasting effects into adulthood. Nurse practitioners can encourage families to participate in healthy habits by addressing areas of growth for obesity prevention within the home. A review of the most recent literature, approximately over the past decade, was used to provide a consolidated source of reference for healthy home habits for the nurse practitioner. The search included terms such as "obesity," "overweight," "healthy habits," "physical activity," "obesogenic behaviors," "family meals," "screen time," "depression," "sugary beverages," and "portion sizes." The information was synthesized into three content areas: nutrition and consumption, patterns of activity, and stress within the home. Establishing healthy habits early in life can protect against the development of overweight and obesity. Nurse practitioners can serve a vital role in the prevention of pediatric, adolescent, and adult obesity. Equipped with the unique role of assisting those from a diverse patient base, nurse practitioners can inform patients how to improve healthy habits to decrease the likelihood of obesity or overweight. Encouraging behavior change related to the healthy habits associated with the prevention of overweight and obesity can have a long-term impact on the health of an entire family.
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Affiliation(s)
- Sharon Fruh
- Research, Evaluation, and Development, College of Nursing, University of South Alabama, Mobile, Alabama
| | - Susan Williams
- College of Nursing, University of South Alabama, Mobile, Alabama
| | - Katey Hayes
- Department of Psychology, University of South Alabama, Mobile, Alabama
| | - Caitlyn Hauff
- Department of Health, Kinesiology, and Sport, University of South Alabama, Mobile, Alabama
| | - Geoffrey M. Hudson
- Department of Health, Kinesiology, and Sport, University of South Alabama, Mobile, Alabama
| | - Scott Sittig
- Department of Information Systems and Technology, University of South Alabama, Mobile, Alabama
| | - Rebecca J. Graves
- Special Projects and Evaluation, College of Nursing, University of South Alabama, Mobile, Alabama
| | - Heather Hall
- College of Nursing, University of South Alabama, Mobile, Alabama
| | - Jennifer Barinas
- Combined-Integrated Clinical & Counseling Psychology Program, University of South Alabama, Mobile, Alabama
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Fliss-Isakov N, Zelber-Sagi S, Ivancovsky-Wajcman D, Shibolet O, Kariv R. Ultra-Processed Food Intake and Smoking Interact in Relation with Colorectal Adenomas. Nutrients 2020; 12:nu12113507. [PMID: 33202603 PMCID: PMC7698317 DOI: 10.3390/nu12113507] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/04/2020] [Accepted: 11/11/2020] [Indexed: 12/15/2022] Open
Abstract
Smoking and ultra-processed foods (UPFs), a substantial part of the western diet, have been suggested to have a potential carcinogenic effect, though epidemiologic data are lacking. We aimed to examine the association between high UPF intake and colorectal adenomas, and to test the interaction with smoking. In a case-control study among consecutive subjects undergoing colonoscopy in a tertiary center during 2010–2015, UPF intake and smoking were compared between cases with colorectal adenomas and controls. Within 652 participants (cases, n = 294 and controls, n = 358), high UPF intake (defined as percent of kcal from UPF above the study sample upper tertile) was positively associated with adenomas (Odds ratio (OR) = 1.75, 95% Confidence interval (CI) 1.14–2.68), advanced and proximal adenomas (OR = 2.17, 1.29–3.65 and OR = 2.38, 1.37–4.11) among the whole study sample; and with adenomas (OR = 3.54, 1.90–6.61), non-advanced adenomas (OR = 2.60, 1.20–5.63), advanced adenomas (OR = 4.76, 2.20–10.30), proximal adenomas (OR = 6.23, 2.67–14.52), and distal adenomas (OR = 2.49, 1.21–5.13) among smokers. Additionally, a dose-dependent association was observed between tertiles of UPF intake and adenomas only among smokers (p for trend < 0.001). A significant interaction between smoking and high UPF intake was detected (p for interaction = 0.004). High intake of UPFs is strongly and independently associated with colorectal adenomas, especially advanced and proximal adenoma, and interacts with smoking. Results highlight smokers as more susceptible to the negative health effects of UPF consumption on colorectal neoplasia.
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Affiliation(s)
- Naomi Fliss-Isakov
- Department of Gastroenterology, Tel Aviv Medical Center, Tel Aviv 6423906, Israel; (S.Z.-S.); (O.S.); (R.K.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence: ; Tel.: +97-(23)-6947305
| | - Shira Zelber-Sagi
- Department of Gastroenterology, Tel Aviv Medical Center, Tel Aviv 6423906, Israel; (S.Z.-S.); (O.S.); (R.K.)
- School of Public Health, University of Haifa, Haifa 3498838, Israel;
| | | | - Oren Shibolet
- Department of Gastroenterology, Tel Aviv Medical Center, Tel Aviv 6423906, Israel; (S.Z.-S.); (O.S.); (R.K.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Revital Kariv
- Department of Gastroenterology, Tel Aviv Medical Center, Tel Aviv 6423906, Israel; (S.Z.-S.); (O.S.); (R.K.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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