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Mackenbach JD, Pinho MGM, Stuber JM, van der Roest J, Lakerveld J, Beulens JWJ. The effects of nudging and pricing strategies on the availability and purchases of ultra-processed foods: A secondary analysis of the Supreme Nudge trial. Appetite 2024; 201:107599. [PMID: 38992569 DOI: 10.1016/j.appet.2024.107599] [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: 01/17/2024] [Revised: 07/03/2024] [Accepted: 07/08/2024] [Indexed: 07/13/2024]
Abstract
Regular consumption of ultra-processed foods (UPF) is a risk factor for morbidity and mortality. UPF are widely available in supermarkets. Nudging and pricing strategies are promising strategies to promote healthier supermarket purchases and may reduce UPF purchases. We investigated whether supermarket nudging and pricing strategies targeting healthy foods, but not specifically discouraging UPF, would change UPF availability, price, promotion and placement (UPF-APPP) in supermarkets and customer UPF purchases. We used data from the Supreme Nudge parallel cluster-randomized controlled trial, testing the effect of a combined nudging and pricing intervention promoting healthy products. The Dutch Consumer Food Environment Score (D-CFES) was used to audit 12 participating supermarkets in terms of UPF-APPP. We used customer loyalty card data of the first twelve intervention weeks from 321 participants to calculate the proportion of UPF purchases. Descriptive statistics were used to assess differences in D-CFES between supermarkets. Mixed model analyses were used to assess the association between the D-CFES and UPF purchases and the effect of the intervention on UPF purchases. No difference in the D-CFES between intervention and control supermarkets were found. No statistically significant association between the D-CFES and UPF purchases (β = -0.00, 95%CI: -0.02, 0.01) and no significant effect of the intervention on UPF purchases (β = 0.02, 95%CI: -0.07, 0.12) was observed. Given the significant proportion of unhealthy and UPF products in Dutch supermarkets, nudging and pricing strategies aimed at promoting healthy food purchases are not sufficient for reducing UPF-APPP nor purchases, and nationwide regulation may be needed.Trial registration number: Dutch Trial Register ID NL7064, May 30, 2018, https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7302.
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Affiliation(s)
- J D Mackenbach
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, Netherlands; Amsterdam Public Health, Amsterdam, Netherlands; Upstream Team, Amsterdam UMC, De Boelelaan 1117, Amsterdam, Netherlands.
| | - M G M Pinho
- Upstream Team, Amsterdam UMC, De Boelelaan 1117, Amsterdam, Netherlands; Copernicus Institute of Sustainable Development, Utrecht University, Princetonlaan 8a, 3584 CB, Utrecht, Netherlands
| | - J M Stuber
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, Netherlands; Amsterdam Public Health, Amsterdam, Netherlands; Upstream Team, Amsterdam UMC, De Boelelaan 1117, Amsterdam, Netherlands
| | - J van der Roest
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, Netherlands; Amsterdam Public Health, Amsterdam, Netherlands
| | - J Lakerveld
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, Netherlands; Amsterdam Public Health, Amsterdam, Netherlands; Upstream Team, Amsterdam UMC, De Boelelaan 1117, Amsterdam, Netherlands; Institute for Risk Assessment Sciences, Utrecht University, Netherlands
| | - J W J Beulens
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, Netherlands; Amsterdam Public Health, Amsterdam, Netherlands; Upstream Team, Amsterdam UMC, De Boelelaan 1117, Amsterdam, Netherlands
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2
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Visioli F, Del Rio D, Fogliano V, Marangoni F, Ricci C, Poli A. Ultra-processed foods and health: are we correctly interpreting the available evidence? Eur J Clin Nutr 2024:10.1038/s41430-024-01515-8. [PMID: 39327455 DOI: 10.1038/s41430-024-01515-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 09/16/2024] [Accepted: 09/19/2024] [Indexed: 09/28/2024]
Abstract
Several studies have linked adverse health effects to the consumption of ultra-processed foods (UPF) according to the NOVA classification. However, whether the consumption of UPF is the actual causal factor for such health outcomes is still unknown. Indeed, different groups of UPF examined in the same epidemiologic study often show markedly different associations with the occurrence of the health endpoints. In this Comment, we discuss some such studies and point out that the available evidence on how different UPFs have been associated with health, as well as the results of studies examining specific food additives, call into question the possibility that ultra-processing per se is the real culprit. It is possible that other unaccounted for confounding factors play an important role. Future, urgently needed studies will clarify this issue.
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Affiliation(s)
- Francesco Visioli
- Department of Molecular Medicine, University of Padova, Padova, Italy.
| | - Daniele Del Rio
- Department of Food and Drugs, Human Nutrition Unit, University of Parma, Parma, Italy
| | - Vincenzo Fogliano
- Food Quality and Design Group, Wageningen University and Research, Wageningen, The Netherlands
| | | | - Cristian Ricci
- Africa Unit for Transdisciplinary Health Research AUTHeR, North-West University, Potchefstroom, South Africa
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3
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Medina-Meza IG, Vaidya Y, Barnaba C. FooDOxS: a database of oxidized sterols content in foods. Food Funct 2024; 15:6324-6334. [PMID: 38726678 DOI: 10.1039/d4fo00678j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Dietary oxidized sterols (DOxS) are cholesterol-like molecules known to exert pro-inflammatory, pro-oxidant, and pro-apoptotic effects, among others. We present the FooDOxS database, a comprehensive compilation of DOxS content in over 1680 food items from 120 publications across 25 countries, augmented by data generated by our group. This database reports DOxS content in foods classified under the NOVA and What We Eat in America (WWEIA) systems, allowing a comprehensive and statistically robust summary of DOxS content in foods. Notably, we evaluated the efficacy of using NOVA and WWEIA classifications in capturing DOxS variations across food categories. Our findings provide insights into the strengths and limitations of these classification systems, enhancing their utility for assessing dietary components. This research contributes to the understanding of DOxS in food processing and suggests refinements for classification systems, holding promise for improved food safety and public health assessments.
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Affiliation(s)
- Ilce Gabriela Medina-Meza
- Department of Biosystems and Agricultural Engineering, Michigan State University, 469 Wilson Rd. | Room 302C, East Lansing, MI, USA.
| | - Yashasvi Vaidya
- Department of Biosystems and Agricultural Engineering, Michigan State University, 469 Wilson Rd. | Room 302C, East Lansing, MI, USA.
| | - Carlo Barnaba
- Department of Pharmaceutical Chemistry, University of Kansas, 2030 Becker Dr. | Room 320D, Lawrence, KS, USA.
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4
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Juul F, Bere E. Ultra-processed foods - a scoping review for Nordic Nutrition Recommendations 2023. Food Nutr Res 2024; 68:10616. [PMID: 38720949 PMCID: PMC11077402 DOI: 10.29219/fnr.v68.10616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 01/05/2024] [Accepted: 02/22/2024] [Indexed: 05/12/2024] Open
Abstract
Ultra-processed foods (UPFs) are increasingly consumed worldwide and have been linked to several chronic diseases. This paper aims to describe the totality of the available evidence regarding UPFs in relation to health-related outcomes as a basis for setting food-based dietary guidelines for the Nordic Nutrition Recommendations 2023. Systematic literature searches were conducted to identify systematic reviews, meta-analyses, randomized controlled trials (RCTs), and prospective cohort studies examining the association between UPF intake and non-communicable diseases or mortality. A total of 12 systematic reviews (including five meta-analyses) and 44 original research studies (43 prospective cohort studies and one RCT) were included. All original research studies were deemed to be of good methodological quality. The current evidence supports that greater consumption of UPFs is associated with weight gain and increased risk of obesity, cardiovascular disease, type 2 diabetes, and all-cause mortality. The available literature also supports an association between UPFs and hypertension, cancer, and depression; however, the limited number of studies and subjects investigated preclude strong conclusions. Due to the highly diverse nature of UPFs, additional studies are warranted, with special emphasis on disentangling mediating mechanisms, whether nutritional or non-nutrient based. Nevertheless, the available evidence regarding UPFs in relation to weight gain, CVD, type 2 diabetes, and all-cause mortality is considered strong enough to support dietary recommendations to limit their consumption.
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Affiliation(s)
- Filippa Juul
- School of Global Public Health, New York University, New York, NY, USA
- Center for Epidemiological Studies in Health and Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Elling Bere
- Department of Sports Science and Physical Education, University of Agder, Kristiansand, Norway
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5
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Dicken SJ, Batterham RL. Ultra-processed Food and Obesity: What Is the Evidence? Curr Nutr Rep 2024; 13:23-38. [PMID: 38294671 PMCID: PMC10924027 DOI: 10.1007/s13668-024-00517-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 02/01/2024]
Abstract
PURPOSE OF REVIEW Obesity is a growing global healthcare concern. A proposed driver is the recent increase in ultra-processed food (UPF) intake. However, disagreement surrounds the concept of UPF, the strength of evidence, and suggested mechanisms. Therefore, this review aimed to critically appraise the evidence on UPF and obesity. RECENT FINDINGS Observational studies demonstrate positive associations between UPF intake, weight gain, and overweight/obesity, more clearly in adults than children/adolescents. This is supported by high-quality clinical data. Several mechanisms are proposed, but current understanding is inconclusive. Greater UPF consumption has been a key driver of obesity. There is a need to change the obesogenic environment to support individuals to reduce their UPF intake. The UPF concept is a novel approach that is not explained with existing nutrient- and food-based frameworks. Critical analysis of methodologies provides confidence, but future observational and experimental research outputs with greater methodological rigor will strengthen findings, which are outlined.
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Affiliation(s)
- Samuel J Dicken
- Centre for Obesity Research, Department of Medicine, University College London (UCL), London, WC1E 6JF, UK
| | - Rachel L Batterham
- Centre for Obesity Research, Department of Medicine, University College London (UCL), London, WC1E 6JF, UK.
- Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital (UCLH), London, NW1 2BU, UK.
- National Institute for Health Research, Biomedical Research Centre, University College London Hospital (UCLH), London, W1T 7DN, UK.
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Visioli F, Marangoni F, Fogliano V, Del Rio D, Martinez JA, Kuhnle G, Buttriss J, Da Costa Ribeiro H, Bier D, Poli A. The ultra-processed foods hypothesis: a product processed well beyond the basic ingredients in the package. Nutr Res Rev 2023; 36:340-350. [PMID: 35730561 DOI: 10.1017/s0954422422000117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The NOVA classification of food items has become increasingly popular and is being used in several observational studies as well as in nutritional guidelines and recommendations. We propose that there is a need for this classification and its use in the formulation of public health policies to be critically discussed and re-appraised. The terms 'processing' and 'ultra-processing', which are crucial to the NOVA classification, are ill-defined, as no scientific, measurable or precise reference parameters exist for them. Likewise, the theoretical grounds of the NOVA classification are unclear and inaccurate. Overall, the NOVA classification conflicts with the classic, evidence-based evaluation of foods based on composition and portion size because NOVA postulates that the food itself (or how much of it is eaten) is unimportant, but rather that dietary effects are due to how the food is produced. We contend that the NOVA system suffers from a lack of biological plausibility so the assertion that ultra-processed foods are intrinsically unhealthful is largely unproven, and needs further examination and elaboration.
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Affiliation(s)
- Francesco Visioli
- Department of Molecular Medicine, University of Padova, Padova, Italy
- IMDEA-Food, CEI UAM+CSIC, Madrid, Spain
| | | | - Vincenzo Fogliano
- Food Quality and Design Group, Wageningen University and Research, Wageningen, The Netherlands
| | - Daniele Del Rio
- Department of Food and Drugs, Human Nutrition Unit, University of Parma, Parma, Italy
| | | | - Gunter Kuhnle
- Department of Food and Nutritional Sciences, University of Reading, UK
| | | | - Hugo Da Costa Ribeiro
- Department of Pediatrics, Federal University of Bahia School of Medicine, Salvador, Bahia, Brazil
| | - Dennis Bier
- Department of Pediatrics, Children's Nutrition Research Center, Baylor College of Medicine, Houston, USA
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7
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Gyimah EA, Nicholas JL, Waters WF, Gallegos-Riofrío CA, Chapnick M, Blackmore I, Douglas KE, Iannotti LL. Ultra-processed foods in a rural Ecuadorian community: associations with child anthropometry and bone maturation. Br J Nutr 2023; 130:1609-1624. [PMID: 36912073 PMCID: PMC10551472 DOI: 10.1017/s0007114523000624] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 02/15/2023] [Accepted: 03/06/2023] [Indexed: 03/14/2023]
Abstract
Frequent ultra-processed food (UPF) consumption is consistently associated with poor health outcomes. Little is known about UPF intake during early childhood and its effects on growth. We assessed UPF in relation to child anthropometry, bone maturation, and their nutrition profiles in a rural Ecuadorian community. Covariate-adjusted regression models estimated relationships between UPF intake from a 24-hour Food Frequency Questionnaire and three outcomes: linear growth, weight status and bone maturation. Nutrient Profiling Models (NPM) evaluated a convenience sample of UPF (n 28) consumed by children in the community. In this cohort (n 125; mean age = 33·92 (sd 1·75) months), 92·8 % consumed some form of UPF the previous day. On average, children consuming UPF four to twelve times per day (highest tertile) had lower height-for-age z-scores than those with none or a single instance of UPF intake (lowest tertile) (β = -0·43 [se 0·18]; P = 0·02). Adjusted stunting odds were significantly higher in the highest tertile relative to the lowest tertile (OR: 3·07, 95 % CI 1·11, 9·09). Children in the highest tertile had significantly higher bone age z-scores (BAZ) on average compared with the lowest tertile (β = 0·58 [se 0·25]; P = 0·03). Intake of savoury UPF was negatively associated with weight-for-height z-scores (β = -0·30 [se 0·14]; P = 0·04) but positively associated with BAZ (β = 0·77 [se 0·23]; P < 0·001). NPM indicated the availability of unhealthy UPF to children, with excessive amounts of saturated fats, free sugars and sodium. Findings suggest that frequent UPF intake during early childhood may be linked to stunted growth (after controlling for bone age and additional covariates), despite paradoxical associations with bone maturation.
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Affiliation(s)
- Emmanuel A. Gyimah
- Brown School, Institute of Public Health, Washington University in St. Louis, St. Louis, MO, USA
| | - Jennifer L. Nicholas
- Department of Radiology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - William F. Waters
- Institute for Research in Health and Nutrition, Universidad San Francisco de Quito, Quito, Ecuador
| | - Carlos Andres Gallegos-Riofrío
- Brown School, Institute of Public Health, Washington University in St. Louis, St. Louis, MO, USA
- Institute for Research in Health and Nutrition, Universidad San Francisco de Quito, Quito, Ecuador
- Gund Institute for Environment, University of Vermont, Burlington, VT, USA
| | - Melissa Chapnick
- Brown School, Institute of Public Health, Washington University in St. Louis, St. Louis, MO, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ivy Blackmore
- Brown School, Institute of Public Health, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Lora L. Iannotti
- Brown School, Institute of Public Health, Washington University in St. Louis, St. Louis, MO, USA
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8
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Hou M, Qiu C. Ultra-Processed Food as Mediator of the Association between Birthweight and Childhood Body Weight Outcomes: A Retrospective Cohort Study. Nutrients 2023; 15:4178. [PMID: 37836460 PMCID: PMC10574691 DOI: 10.3390/nu15194178] [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: 08/25/2023] [Revised: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 10/15/2023] Open
Abstract
Previous studies have shown conflicting findings regarding the association between birthweight and childhood adiposity. We aimed to explore the interaction between ultra-processed food (UPF) and birthweight and its associations with bodyweight markers. The retrospective analysis of data from a Multicity Cohort Study across eastern China was conducted. UPF was computed as percentage of the energy intake and categorized into quartiles. Birthweight was categorized into low (LBW), normal (NBW) and high (HBW). The BMI z-score was calculated using the lambda-mu-sigma method. The sex- and age-specific BMI cutoff points were used to define weight status. Generalized linear models were used to examine modification effects and were performed after adjustment for covariates. The mean percentage of energy intake from UPF was 27.7% among 1370 children. Of all children, 2.3% and 21.4% were born with LBW and HBW, respectively. HBW was a permanent risk for high BMI measures, while LBW was associated with increased BMI measurements only by the addition of the interaction term. The subgroup analysis revealed that HBW and LBW were positively associated with BMI measurements in the lowest UPF intake (Q1), while HBW was related to high BMI measures in Q4. Our findings support efforts to recommend limiting UPF intake, especially for LBW children.
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Affiliation(s)
- Min Hou
- School of Public Health, College of Medicine, Shanghai Jiao Tong University, 227 Chongqing South Road, Shanghai 200025, China
| | - Chao Qiu
- College of Humanities, Jiangnan University, 1800 Lihu Road, Wuxi 214122, China
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9
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Knorr D, Sevenich R. Processed foods: From their emergence to resilient technologies. Compr Rev Food Sci Food Saf 2023; 22:3765-3789. [PMID: 37421325 DOI: 10.1111/1541-4337.13205] [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: 03/23/2023] [Revised: 05/23/2023] [Accepted: 06/11/2023] [Indexed: 07/10/2023]
Abstract
Humans need food processing assuring food safety, quality, and functionality to sustain their life. The ongoing debates regarding food processing require rational and scientific data about food processing and processed foods. This study deals with the importance, origins, and history of processing, defining processes and discussing existing food classification systems and provides recommendations for future food process development. Descriptions and comparisons of technologies for food preservation, their resource efficiency, and beneficial aspects in relation to traditional processing are summarized. Possibilities for pretreatments or combination application and related potentials are provided. A consumer-oriented paradigm change is presented using the potential of resilient technologies for food product improvements rather than the traditional adaptation of raw materials to existing processes. Means for food science and technology research toward dietary changes by transparent, gentle, and resource-efficient processes for consumers food preference, acceptance, and needs are provided.
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Affiliation(s)
- Dietrich Knorr
- Department of Food Biotechnology and Food Process Engineering, Technische Universität Berlin (TU Berlin), Berlin, Germany
| | - Robert Sevenich
- Department of Food Biotechnology and Food Process Engineering, Technische Universität Berlin (TU Berlin), Berlin, Germany
- Leibniz Institute for Agricultural Engineering and Bioeconomy (ATB), Potsdam, Germany
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Lawrence M. Ultra-processed foods: a fit-for-purpose concept for nutrition policy activities to tackle unhealthy and unsustainable diets. Public Health Nutr 2023; 26:1384-1388. [PMID: 36514810 PMCID: PMC10346040 DOI: 10.1017/s1368980022002117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 12/15/2022]
Abstract
Modern nutrition science began approximately 100 years ago in the context of nutrient deficiency diseases. Nutrition research and policy activities were framed mostly within a reductionist paradigm in which foods were analysed as being a collection of their constituent nutrients. Today, nutrition problems extend to all forms of malnutrition as well as environmental sustainability considerations and are associated with food and dietary pattern exposures. In 2009, researchers investigating the nutrition transition in Brazil proposed that industrial food processing was a key determinant of nutrition problems. The NOVA food classification system which is based on the nature, extent and purposes of food processing was developed to operationalise this proposition. The ultra-processed food (UPF) concept within NOVA is receiving much attention in relation to nutrition research and policy activities. This commentary describes the UPF concept as being fit-for-purpose in providing guidance to inform policy activities to tackle unhealthy and unsustainable diets. There is now a substantial body of evidence linking UPF exposure with adverse population and planetary health outcomes. The UPF concept is increasingly being used in the development of food-based dietary guidelines and nutrition policy actions. It challenges many conventional nutrition research and policy activities as well as the political economy of the industrial food system. Inevitably, there are politicised debates associated with UPF and it is apparent a disproportionate number of articles claiming the concept is controversial originate from a small number of researchers with declared associations with UPF manufacturers. Prominent examples of these claims are assessed.
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Affiliation(s)
- Mark Lawrence
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Australia
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11
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Fitzgerald M. It is time to appreciate the value of processed foods. Trends Food Sci Technol 2023. [DOI: 10.1016/j.tifs.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
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12
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Lawrence M. Ultra-processed foods: a fit-for-purpose concept for nutrition policy activities to tackle unhealthy and unsustainable diets. Br J Nutr 2022; 129:1-4. [PMID: 36514813 PMCID: PMC10197079 DOI: 10.1017/s000711452200280x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 12/15/2022]
Abstract
Modern nutrition science began approximately 100 years ago in the context of nutrient deficiency diseases. Nutrition research and policy activities were framed mostly within a reductionist paradigm in which foods were analysed as being a collection of their constituent nutrients. Today, nutrition problems extend to all forms of malnutrition as well as environmental sustainability considerations and are associated with food and dietary pattern exposures. In 2009, researchers investigating the nutrition transition in Brazil proposed that industrial food processing was a key determinant of nutrition problems. The NOVA food classification system which is based on the nature, extent and purposes of food processing was developed to operationalise this proposition. The ultra-processed food (UPF) concept within NOVA is receiving much attention in relation to nutrition research and policy activities. This commentary describes the UPF concept as being fit-for-purpose in providing guidance to inform policy activities to tackle unhealthy and unsustainable diets. There is now a substantial body of evidence linking UPF exposure with adverse population and planetary health outcomes. The UPF concept is increasingly being used in the development of food-based dietary guidelines and nutrition policy actions. It challenges many conventional nutrition research and policy activities as well as the political economy of the industrial food system. Inevitably, there are politicised debates associated with UPF and it is apparent a disproportionate number of articles claiming the concept is controversial originate from a small number of researchers with declared associations with UPF manufacturers. Prominent examples of these claims are assessed.
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Affiliation(s)
- Mark Lawrence
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Australia email
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13
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Targeted formulation of plant-based protein-foods: Supporting the food system’s transformation in the context of human health, environmental sustainability and consumer trends. Trends Food Sci Technol 2022. [DOI: 10.1016/j.tifs.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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14
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Amorim A, Laurindo JB, Sobral PJDA. On how people deal with industrialized and non-industrialized food: A theoretical analysis. Front Nutr 2022; 9:948262. [PMID: 36118768 PMCID: PMC9479213 DOI: 10.3389/fnut.2022.948262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022] Open
Abstract
“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.
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Affiliation(s)
- Alessandra Amorim
- Department of Food Engineering, Faculty of Animal Science and Food Engineering, University of São Paulo, Pirassununga, SP, Brazil
- *Correspondence: Alessandra Amorim
| | - João Borges Laurindo
- Department of Chemical and Food Engineering, Federal University of Santa Catarina, EQA/CTC/UFSC, Florianópolis, SC, Brazil
| | - Paulo José do Amaral Sobral
- Department of Food Engineering, Faculty of Animal Science and Food Engineering, University of São Paulo, Pirassununga, SP, Brazil
- Food Research Center (FoRC), University of São Paulo, São Paulo, SP, Brazil
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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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16
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Food as we knew it: Food processing as an evolutionary discourse. Trends Food Sci Technol 2022. [DOI: 10.1016/j.tifs.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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17
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Forde CG, Decker EA. The Importance of Food Processing and Eating Behavior in Promoting Healthy and Sustainable Diets. Annu Rev Nutr 2022; 42:377-399. [PMID: 35671530 DOI: 10.1146/annurev-nutr-062220-030123] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Numerous association studies and findings from a controlled feeding trial have led to the suggestion that "processed" foods are bad for health. Processing technologies and food formulation are essential for food preservation and provide access to safe, nutritious, affordable, appealing and sustainable foods for millions globally. However, food processing at any level can also cause negative health consequences that result from thermal destruction of vitamins; formation of toxins such as acrylamide; or excessive intakes of salt, sugar, and fat. Research on ultraprocessed foods centers on food composition and formulation. In addition, many modern food formulations can have poor nutritional quality and higher energy density. We outline the role of processing in the provision of a safe and secure food supply and explore the characteristics of processed foods that promote greater energy intake. Despite the potential for negative health effects, food processing and formulation represent an opportunity to apply the latest developments in technology and ingredient innovation to improve the food supply by creating foods that decrease the risk of overeating. Expected final online publication date for the Annual Review of Nutrition, Volume 42 is August 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Ciarán G Forde
- Sensory Science and Eating Behavior Group, Division of Human Nutrition, Wageningen University and Research, Wageningen, The Netherlands;
| | - Eric A Decker
- Department of Food Science, University of Massachusetts, Amherst, Massachusetts, USA
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18
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Abstract
Dramatically increasing trends in consumption of ultra-processed foods have been reported across the globe. Public concern about the health consequences of ultra-processed foods is high. This manuscript provides a comprehensive review of trends in global consumption of ultra-processed foods, dietary nutrient profile of ultra-processed foods, demographic, socioeconomic, psychological, and behavioral characteristics of ultra-processed food consumers, current evidence from longitudinal studies at the population level on the association between ultra-processed foods consumption and major health outcomes (including all-cause and cause-specific mortality, cardiovascular disease, overweight and obesity, body composition and fat deposition, diabetes, cancer, and gastrointestinal and other diseases), potential mechanisms linking ultra-processed foods with these outcomes (nutrient displacement, factors that influence adiposity, and processing), and challenges and future research directions. The global trends in consumption of ultra-processed foods, the generally unfavorable nutrient profile of ultra-processed foods, the characteristics of ultra-processed food consumers, the accumulating longitudinal studies associating ultra-processed foods with major health outcomes, and the uncertainties and complexities in putative mechanisms all highlight the need for future high-quality epidemiologic and mechanistic investigations on this topic. It is critical to interpret findings in the light of the totality of evidence.
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Affiliation(s)
- Yin Zhang
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Edward L Giovannucci
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
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19
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Messina M, Sievenpiper JL, Williamson P, Kiel J, Erdman JW. Perspective: Soy-based Meat and Dairy Alternatives, Despite Classification as Ultra-processed Foods, Deliver High-quality Nutrition on Par with Unprocessed or Minimally Processed Animal-based Counterparts. Adv Nutr 2022; 13:726-738. [PMID: 35325028 PMCID: PMC9156366 DOI: 10.1093/advances/nmac026] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/13/2022] [Accepted: 03/18/2022] [Indexed: 01/16/2023] Open
Abstract
In many non-Asian countries, soy is consumed via soy-based meat and dairy alternatives, in addition to the traditional Asian soyfoods, such as tofu and miso. Meat alternatives are typically made using concentrated sources of soy protein, such as soy protein isolate (SPI) and soy protein concentrate (SPC). Therefore, these products are classified as ultra-processed foods (UPFs; group 4) according to NOVA, an increasingly widely used food-classification system that classifies all foods into 1 of 4 groups according to the processing they undergo. Furthermore, most soymilks, even those made from whole soybeans, are also classified as UPFs because of the addition of sugars and emulsifiers. Increasingly, recommendations are being made to restrict the consumption of UPFs because their intake is associated with a variety of adverse health outcomes. Critics of UPFs argue these foods are unhealthful for a wide assortment of reasons. Explanations for the proposed adverse effects of UPFs include their high energy density, high glycemic index (GI), hyper-palatability, and low satiety potential. Claims have also been made that UPFs are not sustainably produced. However, this perspective argues that none of the criticisms of UPFs apply to soy-based meat and dairy alternatives when compared with their animal-based counterparts, beef and cow milk, which are classified as unprocessed or minimally processed foods (group 1). Classifying soy-based meat and dairy alternatives as UPFs may hinder their public acceptance, which could detrimentally affect personal and planetary health. In conclusion, the NOVA classification system is simplistic and does not adequately evaluate the nutritional attributes of meat and dairy alternatives based on soy.
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Affiliation(s)
- Mark Messina
- Soy Nutrition Institute Global, Washington, DC, USA
| | - John L Sievenpiper
- Departments of Nutritional Sciences and Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Patricia Williamson
- Scientific and Regulatory Affairs, Research and Development, Cargill, Wayzata, MN, USA
| | - Jessica Kiel
- Scientific and Clinical Affairs, Medifast, Inc., Baltimore, MD, USA
| | - John W Erdman
- Department of Food Science and Human Nutrition, Division of Nutritional Sciences and Beckman Institute, University of Illinois at Urbana/Champaign, Urbana, IL, USA
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20
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Sarmiento-Santos J, Souza MBN, Araujo LS, Pion JMV, Carvalho RA, Vanin FM. Consumers' Understanding of Ultra-Processed Foods. Foods 2022; 11:1359. [PMID: 35564081 PMCID: PMC9099562 DOI: 10.3390/foods11091359] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/28/2022] [Accepted: 05/04/2022] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Juliana Sarmiento-Santos
- Laboratory of Bread and Dough Process (LAPROPAMA), Food Engineering Department, Faculty of Animal Science and Food Engineering (USP/FZEA), University of São Paulo, Av. Duque de Caxias Norte 225, Pirassununga 13635-900, SP, Brazil; (J.S.-S.); (M.B.N.S.); (L.S.A.)
| | - Melissa B. N. Souza
- Laboratory of Bread and Dough Process (LAPROPAMA), Food Engineering Department, Faculty of Animal Science and Food Engineering (USP/FZEA), University of São Paulo, Av. Duque de Caxias Norte 225, Pirassununga 13635-900, SP, Brazil; (J.S.-S.); (M.B.N.S.); (L.S.A.)
| | - Lydia S. Araujo
- Laboratory of Bread and Dough Process (LAPROPAMA), Food Engineering Department, Faculty of Animal Science and Food Engineering (USP/FZEA), University of São Paulo, Av. Duque de Caxias Norte 225, Pirassununga 13635-900, SP, Brazil; (J.S.-S.); (M.B.N.S.); (L.S.A.)
| | - Juliana M. V. Pion
- NOZ Pesquisa e Inteligência, Rua Cauowaá, 1575-92, São Paulo 01258-011, SP, Brazil;
| | - Rosemary A. Carvalho
- Food Engineering Department, Macromolecules Functionality Multi-User Center (CEMFUM), Faculty of Animal Science and Food Engineering (USP/FZEA), University of São Paulo, Av. Duque de Caxias Norte 225, Pirassununga 13635-900, SP, Brazil;
| | - Fernanda M. Vanin
- Laboratory of Bread and Dough Process (LAPROPAMA), Food Engineering Department, Faculty of Animal Science and Food Engineering (USP/FZEA), University of São Paulo, Av. Duque de Caxias Norte 225, Pirassununga 13635-900, SP, Brazil; (J.S.-S.); (M.B.N.S.); (L.S.A.)
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21
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Capozzi F. Food Innovation in the Frame of Circular Economy by Designing Ultra-Processed Foods Optimized for Sustainable Nutrition. Front Nutr 2022; 9:886220. [PMID: 35592637 PMCID: PMC9113194 DOI: 10.3389/fnut.2022.886220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/05/2022] [Indexed: 12/11/2022] Open
Abstract
Despite the large debate about the relationship between ultra-processed foods and the prevalence of some diet-related diseases, the innovative potential of various processing technologies has been evidenced in pathways that could lead to modifications of the food matrix with beneficial health effects. Many efforts have been directed toward the conjugation of a healthy diet and sustainable exploitation of natural resources for the preparation of accessible foods. This minireview highlights the possible links between processing, sustainability, and circular economy through the valorization of by-products that could be exploited to prepare nutrient-rich ingredients at lower economic and environmental costs. The assessment of the quality and safety of functional foods based on ingredients derived from food waste requires a more robust validation by means of the food-omics approach, which considers not only the composition of the final products but also the structural characterization of the matrix, as the bioaccessibility and the bioavailability of nutrients are strictly dependent on the functional characteristics of the innovative ingredients.
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Affiliation(s)
- Francesco Capozzi
- Interdepartmental Centre for Industrial Agrofood Research—CIRI Agrofood, Alma Mater Studiorum-University of Bologna, Cesena, Italy
- Department of Agricultural and Food Sciences (DISTAL), Alma Mater Studiorum-University of Bologna, Cesena, Italy
- *Correspondence: Francesco Capozzi,
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22
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Jideani AIO, Onipe OO, Ramashia SE. Classification of African Native Plant Foods Based on Their Processing Levels. Front Nutr 2022; 9:825690. [PMID: 35571923 PMCID: PMC9102804 DOI: 10.3389/fnut.2022.825690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/22/2022] [Indexed: 11/22/2022] Open
Abstract
With increasing advocacy for plant food consumption, the sub-Saharan Africa landscape is home to diverse plant-based food commodities. The need to leverage the advantages of unprocessed/minimally processed foods (PFs) over ultra-processed foods (UPFs) is a system that requires exploitation. Most of the crops produced in the continent are either classified as traditionally or moderately PFs. However, the rise in industrialization and formalization of markets is impacting and marginalizing traditional food processing (FP). Current FP classification frameworks are briefly discussed. The level of processing of cereals, grains, fruits, vegetables, roots, and tuber crops in the continent requires intervention from nutritionists, food scientists, and scientific and governmental bodies to gain a holistic view and tackle the issue of food insecurity in Africa. This study reviews the levels of processing of African foods, challenges, and future directions.
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Affiliation(s)
- Afam I. O. Jideani
- Vicfame Pty Ltd., Cape Town, South Africa
- Special Interest Group, Postharvest Handling Group, ISEKI-Food Association, Vienna, Austria
| | - Oluwatoyin O. Onipe
- Department of Food Science and Technology, Faculty of Science Engineering and Agriculture, University of Venda, Thohoyandou, South Africa
| | - Shonisani E. Ramashia
- Department of Food Science and Technology, Faculty of Science Engineering and Agriculture, University of Venda, Thohoyandou, South Africa
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23
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Sadler CR, Grassby T, Hart K, Raats MM, Sokolović M, Timotijevic L. "Even We Are Confused": A Thematic Analysis of Professionals' Perceptions of Processed Foods and Challenges for Communication. Front Nutr 2022; 9:826162. [PMID: 35284464 PMCID: PMC8904920 DOI: 10.3389/fnut.2022.826162] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/11/2022] [Indexed: 12/29/2022] Open
Abstract
Processed foods are increasingly under the spotlight since the development of classification systems based on proxies for food processing. Published critical reviews and commentaries suggest different views among professional disciplines about the definition and classification of processed food. There is a need to further understand perspectives of professionals on the conceptualisation of processed food and the agreements and disagreements among experts, to encourage interdisciplinary dialogue and aid communication to the public. The aim of this research was to elicit views and understandings of professionals on processed food, their perceptions of lay people's perceptions of the same, and their perspectives on the challenges of communicating about processed foods to the public. The online discussion groups brought together a range of professionals (n = 27), covering the fields of nutrition, food technology, policy making, industry, and civil society, mixed in 5 heterogenous groups. Through thematic analysis the following themes relating to the conceptualisation of processed food and challenges for communication were identified: (1) Broad concepts that need differentiation; (2) Disagreements on scope and degree of processing; (3) The role of food processing within the food system: the challenges in framing risks and benefits; and (4) The challenge of different perspectives and interests for risk communication. Throughout the discussions blurred lines in the characterisation of processing, processed foods, and unhealthy foods were observed. Participants agreed that consensus is important, but difficult. Participants identified a need for further interdisciplinary dialogue, including public engagement, to break down the observed issues, and work towards a mutual understanding and develop clear communication messages.
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Affiliation(s)
- Christina R. Sadler
- Department of Nutritional Sciences, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
- Food, Consumer Behaviour and Health Research Centre, School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
- European Food Information Council, Brussels, Belgium
| | - Terri Grassby
- Department of Nutritional Sciences, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Kathryn Hart
- Department of Nutritional Sciences, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Monique M. Raats
- Food, Consumer Behaviour and Health Research Centre, School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | | | - Lada Timotijevic
- Food, Consumer Behaviour and Health Research Centre, School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
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24
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Klerks M, Román S, Verkerk R, Sanchez-Siles L. Are cereal bars significantly healthier and more natural than chocolate bars? A preliminary assessment in the German market. J Funct Foods 2022. [DOI: 10.1016/j.jff.2022.104940] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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25
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Amorim A, Barbosa ADH, Sobral PJDA. Hunger, Obesity, Public Policies, and Food-Based Dietary Guidelines: A Reflection Considering the Socio-Environmental World Context. Front Nutr 2022; 8:805569. [PMID: 35118106 PMCID: PMC8804338 DOI: 10.3389/fnut.2021.805569] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/17/2021] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
- Alessandra Amorim
- Department of Food Engineering, Faculty of Animal Science and Food Engineering, University of São Paulo, Pirassununga, Brazil
| | | | - Paulo José do Amaral Sobral
- Department of Food Engineering, Faculty of Animal Science and Food Engineering, University of São Paulo, Pirassununga, Brazil
- Food Research Center, University of São Paulo, São Paulo, Brazil
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26
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Dicken SJ, Batterham RL. The Role of Diet Quality in Mediating the Association between Ultra-Processed Food Intake, Obesity and Health-Related Outcomes: A Review of Prospective Cohort Studies. Nutrients 2021; 14:23. [PMID: 35010898 PMCID: PMC8747015 DOI: 10.3390/nu14010023] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 12/11/2022] Open
Abstract
Prospective cohort studies show that higher intakes of ultra-processed food (UPF) increase the risk of obesity and obesity-related outcomes, including cardiovascular disease, cancer and type 2 diabetes. Whether ultra-processing itself is detrimental, or whether UPFs just have a lower nutritional quality, is debated. Higher UPF intakes are inversely associated with fruit, vegetables, legumes and seafood consumption. Therefore, the association between UPFs and poor health could simply be from excess nutrient intake or from a less healthful dietary pattern. If so, adjustment for dietary quality or pattern should explain or greatly reduce the size of the significant associations between UPFs and health-related outcomes. Here, we provide an overview of the literature and by using a novel approach, review the relative impact of adjusting for diet quality/patterns on the reported associations between UPF intake and health-related outcomes in prospective cohort studies. We find that the majority of the associations between UPFs, obesity and health-related outcomes remain significant and unchanged in magnitude after adjustment for diet quality or pattern. Our findings suggest that the adverse consequences of UPFs are independent of dietary quality or pattern, questioning the utility of reformulation to mitigate against the obesity pandemic and wider negative health outcomes of UPFs.
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Affiliation(s)
- Samuel J. Dicken
- Centre for Obesity Research, Department of Medicine, University College London (UCL), London WC1E 6JF, UK;
| | - Rachel L. Batterham
- Centre for Obesity Research, Department of Medicine, University College London (UCL), London WC1E 6JF, UK;
- Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital (UCLH), London NW1 2BU, UK
- National Institute for Health Research, Biomedical Research Centre, University College London Hospital (UCLH), London W1T 7DN, UK
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27
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Verma MK, Shakya S, Kumar P, Madhavi J, Murugaiyan J, Rao MVR. Trends in packaging material for food products: historical background, current scenario, and future prospects. JOURNAL OF FOOD SCIENCE AND TECHNOLOGY 2021; 58:4069-4082. [PMID: 34538891 PMCID: PMC8405760 DOI: 10.1007/s13197-021-04964-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 05/26/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
The commercial demand for food products and dietary supplements has increased drastically in the last few decades. The packed food products and nutritional supplements have made a profound impact on the modern human lifestyle. Since ancient times, storage and long-term use of food products remain a significant challenge for humans. There are different parameters for the evaluation of food products and dietary supplements broadly categorized as quality control and quality assurance. On an average million tons of food, materials get spoiled daily worldwide due to lack of storage and transportation point out packaging systems inequalities. To ensure the quality of packed food products and nutritional supplements among available measures, packaging remained an important event and had been refined from time to time to provide a standard. Over a period, the packaging industry has evolved using modern technology from the conventional methods of new generation packaging, including glass, wood, and paper to most new biodegradable materials. The ancient pattern of packaging; manual packaging has been taken over by an automated system of packing, resulting in enhanced output with minimal chance of damage to valuable products for humanity. The article will emphasize new insights into current packaging system not only provide the quality of these products but also in aiming new heights beyond conventional technologies and consumer opinions. In the present study, we have given more emphasis on novel methods of packaging, the packaging materials, quality of packed products, and their impacts of food products on the environment.
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Affiliation(s)
- M. K. Verma
- Department of Biotechnology, Acharya Nagarjuna University, Guntur, Andhra Pradesh 522019 India
| | - S. Shakya
- Indian Institute of Technology, Indore, Madhya Pradesh India
| | - P. Kumar
- Avalon School of Medicine, Avalon University, Willemstad, Curaçao
| | - J. Madhavi
- Department of Microbiology, Acharya Nagarjuna University, Guntur, Andhra Pradesh 522019 India
| | - J. Murugaiyan
- Department of Biology/Biotechnology, SRM University Amravati, Guntur, Andhra Pradesh 522502 India
| | - M. V. R. Rao
- Apollo Institute of Medical Sciences and Research, Hyderabad, Telangana India
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28
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Petrus RR, do Amaral Sobral PJ, Tadini CC, Gonçalves CB. The NOVA classification system: A critical perspective in food science. Trends Food Sci Technol 2021. [DOI: 10.1016/j.tifs.2021.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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29
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Upstream and downstream explanations of the harms of ultra-processed foods in national dietary guidelines. Public Health Nutr 2021; 24:5426-5435. [PMID: 34392856 DOI: 10.1017/s1368980021003505] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Dietary advice about the potential health risks of unhealthy foods or diets has historically been communicated in terms of nutrients. Recent evidence has shown that the processing of food itself is independently attributable to harmful outcomes, particularly a new category of foods described to be "ultra-processed". Dietary guidelines are a key policy tool to translate and communicate nutrition research, however there is little research exploring whether and how the harms of food processing are communicated and rationalized in dietary advice. DESIGN Nineteen publicly available dietary guidelines were thematically analysed to explore: 1) the diversity of terms used to refer to processed foods and 2) the underlying explanations and rationales provided to reduce consumption of processed foods. SETTING International. RESULTS Seventeen different descriptive terms were used to refer to processed foods, with many countries using a large variation of terms within their dietary guidelines. Six rationales to reduce consumption of processed foods were identified, which were grouped into four overarching domains: harmful outcomes (disease risk, environmental risk); food quality (food quality, nutrient content); diet quality; and food environment. CONCLUSION The rationales provided to reduce the consumption of processed foods reflect upstream and downstream determinants of health. However, the persistence of nutrient-based rationales indicate that most dietary guidelines do not apply an upstream understanding of the issues with ultra-processing. Further, the diversity of terms and foods referenced in dietary guidelines suggest that the concept of ultra-processing is subject to multiple interpretations.
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30
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Marino M, Puppo F, Del Bo’ C, Vinelli V, Riso P, Porrini M, Martini D. A Systematic Review of Worldwide Consumption of Ultra-Processed Foods: Findings and Criticisms. Nutrients 2021; 13:2778. [PMID: 34444936 PMCID: PMC8398521 DOI: 10.3390/nu13082778] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 02/06/2023] Open
Abstract
A debate is ongoing on the significance and appropriateness of the NOVA classification as a tool for categorizing foods based on their degree of processing. As such, the role of ultra-processed food (UPF) on human health is still not completely understood. With this review, we aimed to investigate the actual level of consumption of UPF across countries and target populations to determine the impact in real contexts. Suitable articles published up to March 2021 were sourced through the PubMed and SCOPUS databases. Overall, 99 studies providing data on the level of UPF consumption expressed as the percentage of total energy intake were identified, for a total of 1,378,454 participants. Most of them were published in Brazil (n = 38) and the United States (n = 15), and the 24 h recall was the most-used tool (n = 63). Analysis of the results revealed that the United States and the United Kingdom were the countries with the highest percent energy intake from UPF (generally >50%), whereas Italy had the lowest levels (about 10%); the latter was inversely associated with adherence to the Mediterranean diet. High variability was also observed based on sex, age, and body mass index, with men, young people, and overweight/obese subjects generally having higher levels of consumption compared to older subjects. Overall, our findings underline the large differences in UPF intake. Since most of the observations derived from studies conducted with food questionnaires are not specifically validated for UPF, further efforts are essential to confirm the results previously obtained and to investigate further the association between UPF consumption and health status, also considering the actual contribution within different dietary patterns, which has been less investigated to date.
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Affiliation(s)
| | | | - Cristian Del Bo’
- Department of Food, Environmental and Nutritional Sciences (DeFENS), Università degli Studi di Milano, 20123 Milan, Italy; (M.M.); (F.P.); (V.V.); (P.R.); (M.P.); (D.M.)
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31
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Starck CS, Blumfield M, Keighley T, Marshall S, Petocz P, Inan-Eroglu E, Abbott K, Cassettari T, Ali A, Wham C, Kruger R, Kira G, Fayet-Moore F. Nutrient Dense, Low-Cost Foods Can Improve the Affordability and Quality of the New Zealand Diet-A Substitution Modeling Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7950. [PMID: 34360243 PMCID: PMC8345759 DOI: 10.3390/ijerph18157950] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/09/2021] [Accepted: 07/20/2021] [Indexed: 12/16/2022]
Abstract
The high prevalence of non-communicable disease in New Zealand (NZ) is driven in part by unhealthy diet selections, with food costs contributing to an increased risk for vulnerable population groups. This study aimed to: (i) identify the nutrient density-to-cost ratio of NZ foods; (ii) model the impact of substituting foods with a lower nutrient density-to-cost ratio with those with a higher nutrient density-to-cost ratio on diet quality and affordability in representative NZ population samples for low and medium socioeconomic status (SES) households by ethnicity; and (iii) evaluate food processing level. Foods were categorized, coded for processing level and discretionary status, analyzed for nutrient density and cost, and ranked by nutrient density-to-cost ratio. The top quartile of nutrient dense, low-cost foods were 56% unprocessed (vegetables, fruit, porridge, pasta, rice, nuts/seeds), 31% ultra-processed (vegetable dishes, fortified bread, breakfast cereals unfortified <15 g sugars/100 g and fortified 15-30 g sugars/100 g), 6% processed (fruit juice), and 6% culinary processed (oils). Using substitution modeling, diet quality improved by 59% and 71% for adults and children, respectively, and affordability increased by 20-24%, depending on ethnicity and SES. The NZ diet can be made healthier and more affordable when nutritious, low-cost foods are selected. Processing levels in the healthier, modeled diet suggest that some non-discretionary ultra-processed foods may provide a valuable source of low-cost nutrition for food insecure populations.
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Affiliation(s)
- Carlene S. Starck
- Department of Translational Science, Nutrition Research Australia, Sydney, NSW 2000, Australia; (C.S.S.); (T.C.)
- Riddet Institute, Massey University, Palmerston North 4474, New Zealand
| | - Michelle Blumfield
- Department of Science, Nutrition Research Australia, Sydney, NSW 2000, Australia; (M.B.); (T.K.); (S.M.); (P.P.); (E.I.-E.)
| | - Tim Keighley
- Department of Science, Nutrition Research Australia, Sydney, NSW 2000, Australia; (M.B.); (T.K.); (S.M.); (P.P.); (E.I.-E.)
| | - Skye Marshall
- Department of Science, Nutrition Research Australia, Sydney, NSW 2000, Australia; (M.B.); (T.K.); (S.M.); (P.P.); (E.I.-E.)
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD 4226, Australia
| | - Peter Petocz
- Department of Science, Nutrition Research Australia, Sydney, NSW 2000, Australia; (M.B.); (T.K.); (S.M.); (P.P.); (E.I.-E.)
| | - Elif Inan-Eroglu
- Department of Science, Nutrition Research Australia, Sydney, NSW 2000, Australia; (M.B.); (T.K.); (S.M.); (P.P.); (E.I.-E.)
- Charles Perkins Centre, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2000, Australia
| | - Kylie Abbott
- Nutrition Research Australia, Sydney, NSW 2000, Australia;
| | - Tim Cassettari
- Department of Translational Science, Nutrition Research Australia, Sydney, NSW 2000, Australia; (C.S.S.); (T.C.)
| | - Ajmol Ali
- School of Sport, Exercise and Nutrition, College of Health, Massey University, North Shore City, Auckland 0745, New Zealand; (A.A.); (C.W.); (R.K.)
| | - Carol Wham
- School of Sport, Exercise and Nutrition, College of Health, Massey University, North Shore City, Auckland 0745, New Zealand; (A.A.); (C.W.); (R.K.)
| | - Rozanne Kruger
- School of Sport, Exercise and Nutrition, College of Health, Massey University, North Shore City, Auckland 0745, New Zealand; (A.A.); (C.W.); (R.K.)
| | - Geoff Kira
- School of Health Sciences, College of Health, Massey University, Palmerston North 4474, New Zealand;
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Lane MM, Davis JA, Beattie S, Gómez-Donoso C, Loughman A, O'Neil A, Jacka F, Berk M, Page R, Marx W, Rocks T. Ultraprocessed food and chronic noncommunicable diseases: A systematic review and meta-analysis of 43 observational studies. Obes Rev 2021; 22:e13146. [PMID: 33167080 DOI: 10.1111/obr.13146] [Citation(s) in RCA: 274] [Impact Index Per Article: 91.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/26/2020] [Accepted: 09/03/2020] [Indexed: 12/22/2022]
Abstract
This systematic review and meta-analysis investigated the association between consumption of ultraprocessed food and noncommunicable disease risk, morbidity and mortality. Forty-three observational studies were included (N = 891,723): 21 cross-sectional, 19 prospective, two case-control and one conducted both a prospective and cross-sectional analysis. Meta-analysis demonstrated consumption of ultraprocessed food was associated with increased risk of overweight (odds ratio: 1.36; 95% confidence interval [CI], 1.23-1.51; P < 0.001), obesity (odds ratio: 1.51; 95% CI, 1.34-1.70; P < 0.001), abdominal obesity (odds ratio: 1.49; 95% CI, 1.34-1.66; P < 0.0001), all-cause mortality (hazard ratio: 1.28; 95% CI, 1.11-1.48; P = 0.001), metabolic syndrome (odds ratio: 1.81; 95% CI, 1.12-2.93; P = 0.015) and depression in adults (hazard ratio: 1.22; 95% CI, 1.16-1.28, P < 0.001) as well as wheezing (odds ratio: 1.40; 95% CI, 1.27-1.55; P < 0.001) but not asthma in adolescents (odds ratio: 1.20; 95% CI, 0.99-1.46; P = 0.065). In addition, consumption of ultraprocessed food was associated with cardiometabolic diseases, frailty, irritable bowel syndrome, functional dyspepsia and cancer (breast and overall) in adults while also being associated with metabolic syndrome in adolescents and dyslipidaemia in children. Although links between ultraprocessed food consumption and some intermediate risk factors in adults were also highlighted, further studies are required to more clearly define associations in children and adolescents. STUDY REGISTRATION: Prospero ID: CRD42020176752.
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Affiliation(s)
- Melissa M Lane
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food and Mood Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Jessica A Davis
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food and Mood Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Sally Beattie
- The Barwon Centre of Orthopaedic Research and Education (B-CORE), Barwon Health and St John of God Hospital Geelong, Geelong, Victoria, Australia
| | - Clara Gómez-Donoso
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain
| | - Amy Loughman
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food and Mood Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Adrienne O'Neil
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food and Mood Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Felice Jacka
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food and Mood Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Black Dog Institute, Randwick, New South Wales, Australia.,College of Public Health, Medical & Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Michael Berk
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food and Mood Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Richard Page
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food and Mood Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia.,The Barwon Centre of Orthopaedic Research and Education (B-CORE), Barwon Health and St John of God Hospital Geelong, Geelong, Victoria, Australia.,School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Wolfgang Marx
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food and Mood Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Tetyana Rocks
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food and Mood Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
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Bassaganya-Riera J, Berry EM, Blaak EE, Burlingame B, le Coutre J, van Eden W, El-Sohemy A, German JB, Knorr D, Lacroix C, Muscaritoli M, Nieman DC, Rychlik M, Scholey A, Serafini M. Goals in Nutrition Science 2020-2025. Front Nutr 2021; 7:606378. [PMID: 33665201 PMCID: PMC7923694 DOI: 10.3389/fnut.2020.606378] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/26/2020] [Indexed: 12/12/2022] Open
Abstract
Five years ago, with the editorial board of Frontiers in Nutrition, we took a leap of faith to outline the Goals for Nutrition Science - the way we see it (1). Now, in 2020, we can put ourselves to the test and take a look back. Without a doubt we got it right with several of the key directions. To name a few, Sustainable Development Goals (SDGs) for Food and Nutrition are part of the global public agenda, and the SDGs contribute to the structuring of international science and research. Nutritional Science has become a critical element in strengthening work on the SDGs, and the development of appropriate methodologies is built on the groundwork of acquiring and analyzing big datasets. Investigation of the Human Microbiome is providing novel insight on the interrelationship between nutrition, the immune system and disease. Finally, with an advanced definition of the gut-brain-axis we are getting a glimpse into the potential for Nutrition and Brain Health. Various milestones have been achieved, and any look into the future will have to consider the lessons learned from Covid-19 and the sobering awareness about the frailty of our food systems in ensuring global food security. With a view into the coming 5 years from 2020 to 2025, the editorial board has taken a slightly different approach as compared to the previous Goals article. A mind map has been created to outline the key topics in nutrition science. Not surprisingly, when looking ahead, the majority of scientific investigation required will be in the areas of health and sustainability. Johannes le Coutre, Field Chief Editor, Frontiers in Nutrition.
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Affiliation(s)
- Josep Bassaganya-Riera
- Nutritional Immunology and Molecular Medicine Laboratory (NIMML) Institute, Blacksburg, VA, United States
| | - Elliot M Berry
- Braun School of Public Health, Hebrew University - Hadassah Medical School, Jerusalem, Israel
| | - Ellen E Blaak
- Department of Human Biology, Maastricht University, Maastricht, Netherlands
| | | | - Johannes le Coutre
- School of Chemical Engineering, University of New South Wales, Sydney, NSW, Australia
| | - Willem van Eden
- Department of Infectious Diseases and Immunology, Utrecht University, Utrecht, Netherlands
| | - Ahmed El-Sohemy
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - J Bruce German
- Department of Food Science and Technology, University of California, Davis, Davis, CA, United States
| | - Dietrich Knorr
- Institute of Food Technology and Chemistry, Technische Universität Berlin, Berlin, Germany
| | - Christophe Lacroix
- Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland
| | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - David C Nieman
- Human Performance Laboratory, Department of Biology, Appalachian State University, Kannapolis, NC, United States
| | - Michael Rychlik
- Technical University of Munich, Analytical Food Chemistry, Freising, Germany
| | - Andrew Scholey
- Centre for Human Psychopharmacology, Swinburne University, Melbourne, VIC, Australia
| | - Mauro Serafini
- Functional Food and Metabolic Stress Prevention Laboratory, Faculty of Biosciences and Technologies for Agriculture, Food and Environment, University of Teramo, Teramo, Italy
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Dinu M, Bonaccio M, Martini D, Madarena MP, Vitale M, Pagliai G, Esposito S, Ferraris C, Guglielmetti M, Rosi A, Angelino D. Reproducibility and validity of a food-frequency questionnaire (NFFQ) to assess food consumption based on the NOVA classification in adults. Int J Food Sci Nutr 2021; 72:861-869. [PMID: 33550856 DOI: 10.1080/09637486.2021.1880552] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
NOVA is a classification that divides foods into four groups according to processing. Since no questionnaires have been validated to assess the consumption of foods with different levels of processing in the general adult population, we tested the reliability and validity of a 94-item Food Frequency Questionnaire (NFFQ) designed to estimate the intake (g/day) and the weight ratio (%) of the NOVA food groups in Italian adults. Time reliability and validity were tested by administrating the NFFQ to 110 subjects on two different occasions and comparing it with a weighed dietary record (WDR). Strong correlations between NFFQs (r > 0.7, p < 0.001) and intraclass correlation coefficients (ICC) of 0.851-0.940 indicated good test-retest reliability. Moderate correlations between the NFFQ and the WDR (0.6<r < 0.7), ICC of 0.536-0.741, and consistent agreement for intake percentages as revealed by Bland-Altman plots indicated moderate to good validity. The NFFQ could be useful for future investigations in this research field.
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Affiliation(s)
- Monica Dinu
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Daniela Martini
- Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
| | - Maria Pia Madarena
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Marilena Vitale
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Italy
| | - Giuditta Pagliai
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Simona Esposito
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | - Cinzia Ferraris
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.,Laboratory of Food Education and Sport Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Monica Guglielmetti
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Alice Rosi
- Human Nutrition Unit, Department of Food and Drug, University of Parma, Parma, Italy
| | - Donato Angelino
- Faculty of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Teramo, Italy
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Fangupo LJ, Haszard JJ, Taylor BJ, Gray AR, Lawrence JA, Taylor RW. Ultra-Processed Food Intake and Associations With Demographic Factors in Young New Zealand Children. J Acad Nutr Diet 2020; 121:305-313. [PMID: 33500114 DOI: 10.1016/j.jand.2020.08.088] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Children consume ultra-processed food (UPF) from a young age, but the proportional contribution of UPF to young children's total energy intakes has not been evaluated in developed countries. OBJECTIVES To describe UPF intake and associations with demographic factors in young children from 12 to 60 months of age. DESIGN Cohort study comprising a secondary analysis of data from a randomized controlled trial. Demographic data were collected by questionnaire. At 12, 24, and 60 months of age validated food frequency questionnaires estimated percentage of energy intake from UPF (%kcal UPF). PARTICIPANTS/SETTING The 669 children were born in Dunedin, New Zealand, between May 2009 and December 2010. MAIN OUTCOME MEASURES Mean percentage of energy intake from UPF at 12, 24, and 60 months of age, mean differences in %kcal UPF by demographic variables. STATISTICAL ANALYSES PERFORMED Mixed effects regression models were used to estimate relationships between demographics and %kcal UPF. Multiple imputation methods were used to impute missing UPF data. RESULTS UPF contributed mean (95% confidence interval) 45% (44%, 47%), 42% (41%, 44%), and 51% (50%, 52%) of energy intake to the diets of children at 12, 24, and 60 months of age, respectively. Energy intake from UPF was moderately correlated between 24 and 60 months (r = 0.36). No demographic factors were associated with mean %kcal UPF across time points, except for maternal obesity predicting higher UPF intake at 12 months. Bread, yoghurt, crackers, whole-wheat breakfast cereal, sausages, and muesli bars were among the 10 foods making the greatest contribution to mean %kcal UPF intakes at all time points. CONCLUSIONS UPF contribute a substantial proportion of energy to the diets of young children. A range of foods with varying nutritional profiles contribute to these high intakes.
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Processing in the food chain: do cereals have to be processed to add value to the human diet? Nutr Res Rev 2020; 34:159-173. [PMID: 32854794 DOI: 10.1017/s0954422420000207] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Cereals and cereal products have a long history of use by humans. Recently, there have been some discussions regarding level of processing as a descriptor to define food products, including cereal-based foods. This has led to a somewhat emotional debate on food processing. Given the widespread inclusion of cereals in the diet, this review highlights the history of cereal processing as well as their consumption by humans. It provides an evidence-based discussion on their production, contribution to human nutrition, benefits and disadvantages. The present review illustrates the impact of processing on nutrients, as well as non-nutrients specifically in bread and ready-to-eat breakfast cereals (RTEC), two cereal-based foods which are widely consumed and integral parts of food-based dietary guidelines globally. As a category, most cereals must be processed in some way to enable consumption by humans as we are not equipped to survive exclusively on raw grains. Even thousands of years ago, the processing of cereals was a common practice by humans, turning raw grains into palatable, safe and nutritious foods. Modern processes for cereal-based products are efficient in providing safe and good-quality products to satisfy population needs, as well as helping to meet consumer expectations by providing a range of foods that allows for a varied and balanced diet. Today, RTEC and bread make significant contributions to dietary energy and nutrient requirements and underpin food-based dietary guidance globally. They have been positively linked with intake of dietary fibre, vitamins and minerals, especially when consumed as whole grain.
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Drewnowski A, Gupta S, Darmon N. An Overlap Between "Ultraprocessed" Foods and the Preexisting Nutrient Rich Foods Index? NUTRITION TODAY 2020; 55:75-81. [PMID: 37987022 PMCID: PMC10659579 DOI: 10.1097/nt.0000000000000400] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The category of "ultra-processed" foods in the NOVA food classification scheme is ostensibly based on industrial processing. We compared NOVA category assignments with the pre-existing family of Nutrient Rich Food (NRF) indices, first developed in 2005. NRF n.3 indices are composed of two subscores; the positive NRn based on protein, fiber, and n vitamins and minerals, and the negative LIM subscore based on saturated fat, added sugar, and sodium. The 378 foods that were components of the widely used Fred Hutchinson Cancer Center food frequency questionnaire were assigned to NOVA categories and scored using multiple NRF indices. Contrary to published claims, NOVA was largely based on the foods' content of saturated fat, added sugars, and sodium. There were strong similarities between NOVA categories and NRF scores that were largely driven by the foods' content of fat, sugar, and salt. Nutrient density increased NRF scores but had less impact on NOVA categories. As a result, the NOVA scheme misclassified some nutrient-rich foods. Both NOVA categories and NRF9.3 scores were strongly affected by the amounts of saturated fat, added sugars, and sodium. Ultra-processed foods and culinary ingredients received lower NRFn.3 scores. We conclude that the arbitrary NOVA classification scheme adds little to the pre-existing nutrient profiling models. The purported links between NOVA categories and health outcomes could have been obtained using pre-existing NRFn.3 nutrient density metrics.
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Affiliation(s)
- Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Box 353410, Seattle, WA 98195, USA
| | - Shilpi Gupta
- Center for Public Health Nutrition, University of Washington, Box 353410, Seattle, WA 98195, USA
| | - Nicole Darmon
- MOISA, INRA, Univ Montpellier, CIRAD, CIHEAM-IAMM, Montpellier SupAgro, Montpellier, France
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Vergeer L, Veira P, Bernstein JT, Weippert M, L’Abbé MR. The Calorie and Nutrient Density of More- Versus Less-Processed Packaged Food and Beverage Products in the Canadian Food Supply. Nutrients 2019; 11:E2782. [PMID: 31731664 PMCID: PMC6893502 DOI: 10.3390/nu11112782] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 12/31/2022] Open
Abstract
The association between the degree of processing and healthfulness of foods remains unclear. Most evidence of this relationship is based on dietary intake surveys rather than individual products and varies depending on the food processing classification system used. This study aimed to compare the nutritional quality of more- versus less-processed packaged foods and beverages in Canada, using a large, branded food database and two processing classification systems. Nutritional information for products (n = 17,269) was sourced from the University of Toronto FLIP 2017 database. Products were categorized using the NOVA and Poti et al. processing classification systems. Calories, sodium, saturated fat, total and free sugars, fibre and protein per 100 g (or mL) were examined by processing category using descriptive statistics and linear regression. Overall, the most-processed products under both systems were more likely to be lower in protein, and higher in total and free sugars, compared with less-processed foods (p < 0.05); the direction and strength of the association between other nutrients/components and level of processing were less consistent. These findings demonstrate that calorie- and nutrient-dense foods exist across different levels of processing, suggesting that food choices and dietary recommendations should be based primarily on energy or nutrient density rather than processing classification.
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Affiliation(s)
| | | | | | | | - Mary R. L’Abbé
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (L.V.); (P.V.); (J.T.B.); (M.W.)
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Industrialized foods in early infancy: a growing need of nutritional research. Porto Biomed J 2019; 4:e47. [PMID: 31930180 PMCID: PMC6924974 DOI: 10.1097/j.pbj.0000000000000047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 07/04/2019] [Indexed: 12/29/2022] Open
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Hall KD, Ayuketah A, Brychta R, Cai H, Cassimatis T, Chen KY, Chung ST, Costa E, Courville A, Darcey V, Fletcher LA, Forde CG, Gharib AM, Guo J, Howard R, Joseph PV, McGehee S, Ouwerkerk R, Raisinger K, Rozga I, Stagliano M, Walter M, Walter PJ, Yang S, Zhou M. Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake. Cell Metab 2019; 30:67-77.e3. [PMID: 31105044 PMCID: PMC7946062 DOI: 10.1016/j.cmet.2019.05.008] [Citation(s) in RCA: 755] [Impact Index Per Article: 151.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/05/2019] [Accepted: 05/02/2019] [Indexed: 12/13/2022]
Abstract
We investigated whether ultra-processed foods affect energy intake in 20 weight-stable adults, aged (mean ± SE) 31.2 ± 1.6 years and BMI = 27 ± 1.5 kg/m2. Subjects were admitted to the NIH Clinical Center and randomized to receive either ultra-processed or unprocessed diets for 2 weeks immediately followed by the alternate diet for 2 weeks. Meals were designed to be matched for presented calories, energy density, macronutrients, sugar, sodium, and fiber. Subjects were instructed to consume as much or as little as desired. Energy intake was greater during the ultra-processed diet (508 ± 106 kcal/day; p = 0.0001), with increased consumption of carbohydrate (280 ± 54 kcal/day; p < 0.0001) and fat (230 ± 53 kcal/day; p = 0.0004), but not protein (-2 ± 12 kcal/day; p = 0.85). Weight changes were highly correlated with energy intake (r = 0.8, p < 0.0001), with participants gaining 0.9 ± 0.3 kg (p = 0.009) during the ultra-processed diet and losing 0.9 ± 0.3 kg (p = 0.007) during the unprocessed diet. Limiting consumption of ultra-processed foods may be an effective strategy for obesity prevention and treatment.
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Affiliation(s)
- Kevin D Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA.
| | - Alexis Ayuketah
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Robert Brychta
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Hongyi Cai
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Thomas Cassimatis
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Kong Y Chen
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Stephanie T Chung
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Elise Costa
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Amber Courville
- National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Valerie Darcey
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Laura A Fletcher
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Ciaran G Forde
- Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - Ahmed M Gharib
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Juen Guo
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Rebecca Howard
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Paule V Joseph
- National Institute of Nursing Research, Bethesda, MD, USA
| | - Suzanne McGehee
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Ronald Ouwerkerk
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | | | - Irene Rozga
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Michael Stagliano
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Mary Walter
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Peter J Walter
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Shanna Yang
- National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Megan Zhou
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
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Abstract
Recently, processed foods received negative images among consumers and experts regarding food-health imbalance. This stresses the importance of the food processing-nutrition interface and its relevance within the diet-health debates. In this review, we approach the related questions in a 3-fold way. Pointing out the distinguished role food processing has played in the development of the human condition and during its 1.7 million year old history, we show the function of food processing for the general design principles of food products. Secondly, a detailed analysis of consumer related design principles and processing reveals questions remaining from the historical transformation from basic cooking into advanced food technology. As a consequence, we analyze new and emerging technologies in relation to their contributions to food-health impacts. During the last 35 years, new and emerging food technologies have initiated a paradigm shift away from conventional process methodologies to gentler, non-thermal processing. Reducing the existing uncertainties in the assessment of impact of technology like "minimal processing," we propose the use of the newly established ISO standard for natural food ingredients as a "reference point." Finally, we assess the usefulness of recently proposed classification systems, e.g., NOVA classification, based on comprehensive insights of recently published nutritional analysis of those classifications. This paper calls for a radical change and worldwide adaptation of the key research and developmental areas tackling the grand challenges in our food systems.
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Affiliation(s)
- Dietrich Knorr
- Food Biotechnology and Food Process Engineering, Technical University Berlin, Berlin, Germany
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Relative Validity and Reproducibility of a Food Frequency Questionnaire to Assess Energy Intake from Minimally Processed and Ultra-Processed Foods in Young Children. Nutrients 2019; 11:nu11061290. [PMID: 31181631 PMCID: PMC6627316 DOI: 10.3390/nu11061290] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 05/31/2019] [Accepted: 06/05/2019] [Indexed: 02/06/2023] Open
Abstract
NOVA is a food classification system that categorises food items into one of four categories according to the extent and purpose of their processing: minimally processed food (MPF), processed culinary ingredient (PCI), processed food (PF), or ultra-processed food (UPF). The aim of this study was to determine the relative validity and reproducibility of a food frequency questionnaire (EAT5 FFQ) for measuring daily energy intake (EI kJ) and percentage of daily energy intake (EI%) from each NOVA group in New Zealand children. One hundred parents of five year old children completed the 123 item EAT5 FFQ on two occasions four weeks apart. A 3 day weighed diet record (WDR) was completed on non-consecutive randomly assigned days between FFQ appointments. The FFQ overestimated EI (both as kJ and %) from MPF and UPF, and underestimated intakes from PCI and PF, compared with the WDR. Bland–Altman plots indicated reasonably consistent agreement between FFQ and WDR for MPF and UPF but not PCI or PF. Correlation coefficients between the FFQ and WDR were acceptable for EI (%) for MPF (r = 0.31) and UPF (r = 0.30). The FFQ differentiated between the highest and lowest quartiles for EI (%) from MPF and UPF foods (p-values for the trends were 0.006 and 0.009 respectively), and for EI (kJ) from UPF foods (p-value for trend 0.003). Bland–Altman plots indicated consistent agreement between repeat administrations of FFQ for MPF and UPF only, while intra-class correlations suggested good reproducibility for EI (kJ and %) for all four NOVA categories (range 0.51–0.76). The EAT5 FFQ has acceptable relative validity for ranking EI (%) from MPF and UPF. It has good reproducibility for measuring EI from all four NOVA categories, in young children.
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Nutrient–nutrient interactions: competition, bioavailability, mechanism and function in health and diseases. Proc Nutr Soc 2019; 78:1-3. [DOI: 10.1017/s0029665118002732] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Nutrition Society Spring Conference 2018, held in Glasgow, brought together experts focusing on the interaction between different nutrients and how this impacts absorption, metabolism and health from biochemical and physiological perspectives. This cross-cutting theme was examined from a range of perspectives, bringing together experts on topics ranging from food processing to the impact of inflammation on nutrient status. Two plenary lectures provided a food landscape and lifecourse background to the proceedings, with on the first day a focus on processed/ultra-processed foods and their nutrient composition and, on the second day, a plenary lecture exploring the role that nutrient–nutrient interactions within the maternal diet have for the lifelong health of the offspring. The meeting was framed around three symposia, examining the competition and bioavailability of dietary components, nutrient–nutrient interactions and their role in protection from chronic diseases and the mechanisms of nutrient–nutrient interactions. The meeting ended with a round table, and an overall conclusion highlighting the opportunities to derive further understanding of the short- and long-term implications of diets through the study of nutrient–nutrient interactions.
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