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Popkin BM, Miles DR, Taillie LS, Dunford EK. A policy approach to identifying food and beverage products that are ultra-processed and high in added salt, sugar and saturated fat in the United States: a cross-sectional analysis of packaged foods. LANCET REGIONAL HEALTH. AMERICAS 2024; 32:100713. [PMID: 38495314 PMCID: PMC10943474 DOI: 10.1016/j.lana.2024.100713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 02/21/2024] [Accepted: 02/26/2024] [Indexed: 03/19/2024]
Abstract
Background Governments globally aim to reduce the intake of unhealthy foods. Many policies exist that aim to address foods high in saturated fat, salt and sugar (HFSS) but the identification of ultra-processed foods (UPF) have presented a greater challenge due to the lack of an appropriate policy definition. To support policymakers, we provide approaches that can support governments to identify both HFSS foods and UPFs. Methods Four approaches combining elements of UPF definitions (i.e., presence of additives) and HFSS definitions were compared attempting to simplify and standardize the identification of less healthy products. Nationally representative food purchase data from NielsenIQ linked with nutrition facts label data were used to examine the mean proportion of product volume purchased by US households to be targeted. Differences between approaches were examined using Student t test; Bonferroni adjusted P value < 0.0001 was considered significant. Findings In 2020, 50% of 33,054,687 products purchased by US households were considered UPFs (65% of foods and 38% of beverages) and 43% HFSS (65% of foods and 26% of beverages), however there was not 100% agreement between the two definitions (P < 0.0001). By starting with HFSS criteria and adding elements of UPF (colors and flavors), we were able to provide a method with 100% agreement between the identification of UPFs and HFSS products. Interpretation Results demonstrated how combining HFSS criteria with UPF criteria can be used to identify less healthy foods and ensure policymakers have both a simple and accurate method to target products for policy intervention. Funding Bloomberg Philanthropies and the Global Food Research Program of UNC-Chapel Hill provided funds.
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Affiliation(s)
- Barry M. Popkin
- Department of Nutrition, Gillings Global School of Public Health, The University of North Carolina at Chapel Hill, USA
- Carolina Population Center, The University of North Carolina at Chapel Hill, USA
| | - Donna R. Miles
- Carolina Population Center, The University of North Carolina at Chapel Hill, USA
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings Global School of Public Health, The University of North Carolina at Chapel Hill, USA
- Carolina Population Center, The University of North Carolina at Chapel Hill, USA
| | - Elizabeth K. Dunford
- Department of Nutrition, Gillings Global School of Public Health, The University of North Carolina at Chapel Hill, USA
- Food Policy Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Fernandez MA, Maximova K, Fulkerson JA, Raine KD. Associations between cooking skills, cooking with processed foods, and health: a cross-sectional study. Appl Physiol Nutr Metab 2024; 49:330-339. [PMID: 37931241 DOI: 10.1139/apnm-2023-0293] [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] [Indexed: 11/08/2023]
Abstract
To improve health outcomes, home cooking has been suggested as a solution to reduce intakes of processed foods. However, little is known about how cooking skills or cooking with processed foods influence health. This cross-sectional study examined associations between diet and health outcomes with cooking skills and cooking with processed foods. The dataset included a nationally representative sample of 18 460 adults from Canadian Community Health Survey (CCHS) annual component rapid response modules on food skills. In the CCHS rapid response modules, diet and health outcomes (fruit and vegetable intake, general health, mental health, and obesity) and data related to cooking skills and cooking with processed foods were collected through self-report. Separate logistic regression models were fitted for each outcome, controlling for age, income, and education, and stratified by sex. Adults with poor cooking skills were less likely to have adequate fruit and vegetable intake (≥5 servings per day) (p < 0.001), very good general health (p < 0.001) or mental health (p < 0.001), and obesity (p = 0.02) compared to advanced cooking skills. Adults who cooked with highly processed foods were less likely to have adequate fruit and vegetable intake (p < 0.001), very good general health (p = 0.002) or mental health (p < 0.001), but more likely to have obesity (p = 0.03) compared to cooking with minimally processed foods. Cooking skills alone appear insufficient to protect against obesity. Results suggest that not only are cooking skills important, but the quality of ingredients also matter. Limiting the use of processed foods in addition to improving cooking skills are potential intervention targets to promote better health and diet outcomes.
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Affiliation(s)
- Melissa A Fernandez
- School of Nutrition Sciences, University of Ottawa, Ottawa, ON, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Katerina Maximova
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Kim D Raine
- School of Public Health, University of Alberta, Edmonton, AB, Canada
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Andreeva VA, Perez-Jimenez J, St-Onge MP. A Systematic Review of the Bidirectional Association Between Consumption of Ultra-processed Food and Sleep Parameters Among Adults. Curr Obes Rep 2023; 12:439-452. [PMID: 37477854 PMCID: PMC11165373 DOI: 10.1007/s13679-023-00512-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE OF REVIEW We summarized research on the bidirectional association between intake of ultra-processed food (UPF) and sleep. RECENT FINDINGS Sleep contributes to cardiometabolic health in part via food intake patterns. Restricting sleep increases intakes of high-carbohydrate/high-fat foods, a profile representative of UPF. This systematic review covers the association of UPF intake, as an exposure or an outcome, and sleep. UPF was defined as NOVA Group 4. MEDLINE and EMBASE were searched through April 2023 for epidemiological studies with general-population adult samples. Fifteen studies met the inclusion criteria; all were cross-sectional, published between 2016 and 2023, with samples from Brazil (n = 8), Spain (n = 2), Italy (n = 1), the UK (n = 1), Paraguay (n = 1), Iran (n = 1) and China (n = 1). Thirteen studies examined UPF intake as the exposure whereas two tested UPF intake as the outcome. UPF intakes were determined using food frequency questionnaires (73%) or 24-h recalls (27%). Two studies assessed sleep via accelerometry; the remaining studies relied on self-reports of sleep quality, duration, anxiety-induced insomnia, and napping, with 60% using a single question. The average methodological quality across the studies was deemed "fair". Six of the 13 studies that examined UPF consumption as the exposure revealed inverse associations with sleep outcomes in adjusted (n = 5) or bivariate (n = 1) analyses. Both studies addressing UPF consumption as the outcome and sleep as the exposure showed significant inverse associations. Evidence for UPF-sleep associations is accumulating, although sleep assessment limitations are apparent. This review can provide impetus for research using comprehensive and validated sleep measures and nudge policymakers towards refining dietary guidelines worldwide.
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Affiliation(s)
- Valentina A Andreeva
- Nutritional Epidemiology Research Group, INSERM U1153/INRAE U1125/CNAM, Epidemiology and Statistics Research Center (CRESS), Sorbonne Paris Nord University, 93017, Bobigny, France
- Division of General Medicine and Center of Excellence for Sleep & Circadian Research, Department of Medicine, Columbia University, New York, NY, 10032, USA
| | - Jara Perez-Jimenez
- Institute of Food Science, Technology and Nutrition, Spanish Research Council (ICTAN-CSIC), 28040, Madrid, Spain
- Division of General Medicine and Center of Excellence for Sleep & Circadian Research, Department of Medicine, Columbia University, New York, NY, 10032, USA
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), ISCIII, 28029, Madrid, Spain
| | - Marie-Pierre St-Onge
- Division of General Medicine and Center of Excellence for Sleep & Circadian Research, Department of Medicine, Columbia University, New York, NY, 10032, USA.
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Anastasiou K, Ribeiro De Melo P, Slater S, Hendrie GA, Hadjikakou M, Baker PK, Lawrence MA. From harmful nutrients to ultra-processed foods: exploring shifts in 'foods to limit' terminology used in national food-based dietary guidelines. Public Health Nutr 2023; 26:2539-2550. [PMID: 36458692 DOI: 10.1017/s1368980022002580] [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] [Indexed: 12/04/2022]
Abstract
OBJECTIVE The choice of terms used to describe 'foods to limit' (FTL) in food-based dietary guidelines (FBDG) can impact public understanding, policy translation and research applicability. The choice of terms in FBDG has been influenced by available science, values, beliefs and historical events. This study aimed to analyse the terms used and definitions given to FTL in FBDG around the world, including changes over time and regional differences. DESIGN A review of terms used to describe FTL and their definitions in all current and past FBDG for adults was conducted, using a search strategy informed by the FAO FBDG website. Data from 148 guidelines (96 countries) were extracted into a pre-defined table and terms were organised by the categories 'nutrient-based', 'food examples' or 'processing-related'. SETTING National FBDG from all world regions. PARTICIPANTS None. RESULTS Nutrient-based terms (e.g. high-fat foods) were the most frequently used type of term in both current and past dietary guidelines (91 %, 85 %, respectively). However, food examples (e.g. cakes) and processing-related terms (e.g. ultra-processed foods) have increased in use over the past 20 years and are now often used in conjunction with nutrient-based terms. Regional differences were only observed for processing-related terms. CONCLUSION Diverse, and often poorly defined, terms are used to describe FTL in FBDG. Policymakers should ensure that FTL terms have clear definitions and can be integrated with other disciplines and understood by consumers. This may facilitate the inclusion of the most contemporary and potentially impactful terminology in nutrition research and policies.
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Affiliation(s)
- Kim Anastasiou
- School of Exercise and Nutrition Sciences, Deakin University, Building J, Holland Ave, Burwood, VIC3125, Australia
| | - Patricia Ribeiro De Melo
- School of Exercise and Nutrition Sciences, Deakin University, Building J, Holland Ave, Burwood, VIC3125, Australia
| | - Scott Slater
- School of Exercise and Nutrition Sciences, Deakin University, Building J, Holland Ave, Burwood, VIC3125, Australia
| | | | - Michalis Hadjikakou
- Centre for Integrative Ecology, School of Life and Environmental Sciences, Deakin University, Melbourne, VIC, Australia
| | - Phillip K Baker
- School of Exercise and Nutrition Sciences, Deakin University, Building J, Holland Ave, Burwood, VIC3125, Australia
- Institute of Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Mark Andrew Lawrence
- School of Exercise and Nutrition Sciences, Deakin University, Building J, Holland Ave, Burwood, VIC3125, Australia
- Institute of Physical Activity and Nutrition, Deakin University, Geelong, Australia
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Shinozaki N, Murakami K, Asakura K, Masayasu S, Sasaki S. Consumption of highly processed foods in relation to overall diet quality among Japanese adults: a nationwide study. Public Health Nutr 2023; 26:1784-1797. [PMID: 37092752 PMCID: PMC10478055 DOI: 10.1017/s1368980023000721] [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: 07/19/2022] [Revised: 12/23/2022] [Accepted: 04/01/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE To (i) examine the consumption of highly processed foods (HPF) in relation to diet quality among Japanese adults and (ii) compare the results when dishes prepared away home are disaggregated into food ingredients before classification by processing levels and the results when they are not. DESIGN Cross-sectional analysis using 4-day dietary record data. Foods were categorised by level of processing using the framework developed by the University of North Carolina at Chapel Hill. Specifically, dishes prepared away from home were classified at both the food level (classified after disaggregation into ingredients) and dish level (classified without disaggregation). Diet quality was assessed using the Healthy Eating Index-2015 and Nutrient-Rich Food Index 9·3. SETTING Twenty areas in Japan. PARTICIPANTS Adults aged 20-69 years (n 388). RESULTS Energy contribution of HPF was higher when dishes prepared away from home were classified at dish level than food level (48·3 % v. 32·9 %, P < 0·0001). Regardless of the classification method, cereals and starchy foods were the top food groups contributing to total energy intake from HPF. After adjusting for potential confounders, participants in higher tertiles of the energy contribution of HPF had lower total scores for Healthy Eating Index-2015 and Nutrient-Rich Food Index 9·3 (P for trend ≤ 0·007 for all), irrespective of the food- or dish-level classification. CONCLUSIONS HPF accounted for at least one-third of energy intake of Japanese adults. Regardless of the classification methods for dishes prepared away from home, higher consumption of HPF was associated with lower diet quality.
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Affiliation(s)
- Nana Shinozaki
- Department of Social and Preventive Epidemiology, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo113-0033, Japan
| | - Kentaro Murakami
- Department of Social and Preventive Epidemiology, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo113-0033, Japan
| | - Keiko Asakura
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Ota-ku, Tokyo, Japan
| | | | - Satoshi Sasaki
- Department of Social and Preventive Epidemiology, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo113-0033, Japan
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Valicente VM, Peng CH, Pacheco KN, Lin L, Kielb EI, Dawoodani E, Abdollahi A, Mattes RD. Ultraprocessed Foods and Obesity Risk: A Critical Review of Reported Mechanisms. Adv Nutr 2023; 14:718-738. [PMID: 37080461 PMCID: PMC10334162 DOI: 10.1016/j.advnut.2023.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/02/2023] [Accepted: 04/14/2023] [Indexed: 04/22/2023] Open
Abstract
Epidemiologic evidence supports a positive association between ultraprocessed food (UPF) consumption and body mass index. This has led to recommendations to avoid UPFs despite very limited evidence establishing causality. Many mechanisms have been proposed, and this review critically aimed to evaluate selected possibilities for specificity, clarity, and consistency related to food choice (i.e., low cost, shelf-life, food packaging, hyperpalatability, and stimulation of hunger/suppression of fullness); food composition (i.e., macronutrients, food texture, added sugar, fat and salt, energy density, low-calorie sweeteners, and additives); and digestive processes (i.e., oral processing/eating rate, gastric emptying time, gastrointestinal transit time, and microbiome). For some purported mechanisms (e.g., fiber content, texture, gastric emptying, and intestinal transit time), data directly contrasting the effects of UPF and non-UPF intake on the indices of appetite, food intake, and adiposity are available and do not support a unique contribution of UPFs. In other instances, data are not available (e.g., microbiome and food additives) or are insufficient (e.g., packaging, food cost, shelf-life, macronutrient intake, and appetite stimulation) to judge the benefits versus the risks of UPF avoidance. There are yet other evoked mechanisms in which the preponderance of evidence indicates ingredients in UPFs actually moderate body weight (e.g., low-calorie sweetener use for weight management; beverage consumption as it dilutes energy density; and higher fat content because it reduces glycemic responses). Because avoidance of UPFs holds potential adverse effects (e.g., reduced diet quality, increased risk of food poisoning, and food wastage), it is imprudent to make recommendations regarding their role in diets before causality and plausible mechanisms have been verified.
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Affiliation(s)
- Vinicius M Valicente
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States
| | - Ching-Hsuan Peng
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN, United States
| | - Kathryn N Pacheco
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States
| | - Luotao Lin
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States
| | - Elizabeth I Kielb
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN, United States
| | - Elina Dawoodani
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States
| | - Afsoun Abdollahi
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States
| | - Richard D Mattes
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States.
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Koios D, Machado P, Lacy-Nichols J. Representations of Ultra-Processed Foods: A Global Analysis of How Dietary Guidelines Refer to Levels of Food Processing. Int J Health Policy Manag 2022; 11:2588-2599. [PMID: 35184508 PMCID: PMC9818109 DOI: 10.34172/ijhpm.2022.6443] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 01/15/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND As evidence grows about negative health impacts of ultra-processed foods (UPFs), nutrient-centred advice is contested, and food-based dietary guidelines are increasingly utilised. Previous analyses of dietary guidelines evaluated their potential impact on health and sustainability, but little research has been conducted to examine how the concept of UPFs is reflected in dietary advice for consumers. This paper systematically analyses whether and how UPFs are represented in dietary guidelines internationally. METHODS Based on a systematic online search, the consumer-targeted key messages of 106 dietary guidelines were identified and a qualitative content analysis was conducted. A coding framework was developed to classify messages as 'eat more' or 'eat less' according to the language used (eg, 'choose' vs 'avoid') and to differentiate between a focus on nutrients or food processing. Specific foods mentioned in 'eat less' guidelines were classified according to their level of processing using the NOVA framework. RESULTS 99% of guidelines utilised some type of nutrient-based message, either promoting 'positive' nutrients (eg, vitamins) or discouraging the consumption of 'negative' nutrients (mainly salt, sugar and fat). Explicit references to food processing were present in 45% of 'eat less' guidelines and 5% of 'eat more' guidelines. Implicit references (eg, promoting 'raw' or discouraging 'packaged' foods) were found in 43% of 'eat less' and 75% of 'eat more' guidelines. 53% of the specific foods referred to in 'eat less' advice were UPFs. CONCLUSION Overall, nutrient-based messages were more common than messages about processing levels. The majority of discouraged foods were UPFs, however some minimally processed foods were discouraged, which points to tensions and contradictions between nutrient- and processing-based dietary advice. As dietary guidelines begin to include advice about food processing, it is important to consider both consumer understanding of the terms used and their capacity to act on the advice.
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Affiliation(s)
- Daniela Koios
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Priscila Machado
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
| | - Jennifer Lacy-Nichols
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Murillo AG, Gómez G, Durán-Agüero S, Parra-Soto SL, Araneda J, Morales G, Ríos-Castillo I, Carpio-Arias V, Cavagnari BM, Nava-González EJ, Bejarano-Roncancio JJ, Núñez-Martínez B, Cordón-Arrivillaga K, Meza-Miranda ER, Mauricio-Alza S, Landaeta-Díaz L. Dietary Patterns and Dietary Recommendations Achievement From Latin American College Students During the COVID-19 Pandemic Lockdown. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2022. [DOI: 10.3389/fsufs.2022.836299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study aimed to compare the diet quality of different dietary patterns among college students from Latin American countries, including vegetarians, vegans, and omnivores during the COVID-19 pandemic. A cross-sectional, observational, multicenter study was conducted including a non- probabilistic sample of university students from 10 countries. University students were invited to participate in the study through social network platforms. Participants were self-reported to have followed a specific dietary pattern; either the Prudent diet, Western diet, Ovo-dairy-vegetarian diet, Fish-vegetarian diet, Strict vegetarian diet (vegan) or other. The last three patterns (vegetarians and vegans) were grouped as following a plant-based diet. A self-assessment survey was used to evaluate healthy eating habits using a questionnaire with values between 1 (do not consume) and 5 (consume) for a total of 9–45 points (higher values represent better eating habits). Unhealthy habits were assessed with nine questions. A total of 4,809 students filled out the questionnaire, and the majority of them were females (73.7%). A high percentage have been in lockdown for more than 5 months and were in lockdown when the survey was released. 74.3% were self-reported to follow a prudent diet, while 11.4% reported following a western dietary pattern and 8.8% a plant-based diet. When compliance with healthy and unhealthy dietary habits was analyzed, although all groups had low compliance, the plant-based diet group (56.09 ± 6.11) performed better than the Western diet group (48.03 ± 5.99). The total diet quality score was significantly higher for plant-based diet followers, who also tended to better achieve the recommendations than omnivorous students, especially the ones following a western diet. These results present evidence that young adults such as college-aged students have unhealthy dietary habits. However, the ones who follow a plant-based diet such as vegetarians and vegans exhibit better scores and healthier dietary conducts.
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