Ultra-processed food and the risk of overweight and obesity: a systematic review and meta-analysis of observational studies

Development of the modified Highly Processed Food Withdrawal Scale (mProWS)

The Highly Processed Food Withdrawal Scale (ProWS) is a 29-item measure that operationalizes physical and psychological indicators of withdrawal symptoms associated with cutting down on the consumption of ultra-processed foods. The current study developed a briefer 7-item version of the ProWS (modified ProWS; mProWS) using the participant sample from the ProWS validation paper (n = 231). Then, in an independent sample recruited from Amazon Mechanical Turk, 244 participants (55.3% females) completed the mProWS, the ProWS, and measures of eating-related constructs in order to evaluate the psychometric properties of the mProWS, relative to the ProWS. The mProWS and the ProWS performed similarly on indexes of reliability, convergent validity with addictive-like eating behavior (e.g., Yale Food Addiction Scale 2.0 symptom count), discriminant validity with distinct measures (e.g., cognitive desire to restrict food consumption), and incremental validity evidenced by associations with weight cycling above and beyond body mass index (BMI) and YFAS 2.0 symptoms. The mProWS may be an appropriate choice for studies with higher participant burden (e.g., ecological momentary assessment) to assess withdrawal symptoms in real-time when they occur in response to cutting down on ultra-processed foods.

Association of ultra-processed food consumption with muscle mass among young and middle-aged US adults

INTRODUCTION

Muscle mass is vital for physical activity and fundamental physiological processes supporting long-term health. While aging is inevitable, certain modifiable factors positively influence muscle preservation and overall well-being. However, the relationship between the consumption of ultra-processed foods (UPF) and muscle mass is not yet clear.

METHODS

This study included 7,173 men and nonpregnant women aged 20-59 years with valid 24-hour dietary recalls and accessible whole-body dual-energy x-ray absorptiometry (DXA) scans from NHANES 2011-2018. UPFs were identified through the NOVA classification system, and the percentage of energy derived from UPF consumption was evaluated in quintiles. Muscle mass measures were derived from DXA scans and quantified by the total and regional muscle mass index (MMI, kg/m²) and appendicular muscle mass index (AMMI, kg/m²). Multivariable-adjusted generalized linear regression models were applied to investigate the association between consumption of UPFs and muscle mass measures overall and by sociodemographic subgroups.

RESULTS

The multivariable-adjusted differences of total MMI from the lowest to highest quintile of UPF consumption were 0 (reference), -0.03 (95% CI, -0.13, 0.07), -0.13 (95%CI, -0.24, -0.04), -0.12 (95% CI, -0.23, -0.01), and - 0.17 (95% CI, -0.27, -0.08) (P for trend < 0.001). Subtotal MMI followed a similar magnitude of associational pattern as total MMI. For trunk MMI, corresponding values from the lowest to highest quintiles of UPF consumption were 0 (reference), -0.02 (95% CI, -0.07, 0.02), -0.05 (95%CI, -0.11, 0.00), -0.07 (95% CI, -0.13, -0.01), and - 0.07 (95% CI, -0.12, -0.01). For AMMI, corresponding values from the lowest to highest quintiles of UPF consumption were 0 (reference), -0.004 (95% CI, -0.07, 0.06), -0.08 (95%CI, -0.14, -0.02), -0.05 (95% CI, -0.11, 0.02), and - 0.10 (95% CI, -0.16, -0.04) (All P for trend < 0.001). While most subgroups maintained similar overall patterns, heterogeneous findings were also observed. For example, the multivariable-adjusted differences in total MMI between the lowest and highest quantile of UPF consumption were - 0.19 (95% CI, -0.32, -0.06) for non-Hispanic Whites, 0.18 (95% CI, 0.01, 0.36) for non-Hispanic Blacks, -0.25 (95%CI, -0.45, -0.04) for Hispanics, -0.25 (95% CI, -0.51, 0.05) for non-Hispanic Asians and - 0.32 (95% CI, -0.75, 0.12) for others (P for interaction < 0.001).

CONCLUSION

Higher consumption of UPFs was significantly associated with lower values of total and regional muscle mass. Specifically, comparing the highest quantile of UPF consumption to the lowest, total MMI decreased by 0.93%, trunk MMI decreased by 0.76%, and AMMI decreased by 1.25%. The differences in associational patterns between UPF consumption and muscle mass across sociodemographic subgroups require further investigation.

Costs of obesity attributable to the consumption of sugar-sweetened beverages in Brazil

Excess sugar is considered one of the primary factors contributing to overweight status. In Brazil, sugar-sweetened beverages (SSBs) contain a significant amount of this nutrient and are consumed excessively. These beverages are associated with adverse health outcomes and impose costs on the healthcare system. The literature currently lacks studies that aim to attribute specific nutrients or foods as causes of diseases and also evaluate their economic impact, especially in middle- and low-income countries. This study aims to estimate the direct and indirect costs of obesity, stratified by sex and age group, resulting from the excessive consumption of sugar-sweetened beverages in Brazil from 2008 to 2020, and to project these costs for the year 2036. The estimation of obesity costs attributable to excessive consumption of SSBs was based on relative risks and the population prevalence of obesity, considering expenditures on hospitalizations and outpatient procedures in the Unified Health System (SUS). Cost information was obtained from the health information systems available at SUS. The highest burden attributable to the consumption of SSBs was observed among younger individuals and progressively decreased with advancing age. The total direct costs in the period between 2008 and 2020 amounted to approximately US$ 6.33 million, 87% of which was related to expenses for females. Additionally, deaths resulting from the consumption of SSBs cost the economy US$ 40 million due to the premature loss of productivity. The total costs of obesity attributable to the consumption of SSBs are substantial, impacting public spending and generating social and productivity losses that burden the economy. It is crucial to develop and implement cost-effective fiscal and regulatory policies aimed at preventing and combating obesity.

National policies to limit food marketing and competitive food sales in schools: a global scoping review

School food environments contribute to children's nutritional intake and overall health. As such, the World Health Organization and other public health organizations encourage policies that restrict children's access and exposure to foods and beverages that do not build health in and around schools. This global scoping review explores the presence and characteristics of policies that restrict competitive food sales and marketing for unhealthy foods across 193 countries using evidence from policy databases, grey literature, peer-reviewed literature, and primary policy documents. Policies were included if they were nationally mandated and regulated marketing and/or competitive foods in the school environments. Worldwide, only 28% of countries were found to have any national-level policy restricting food marketing or competitive food sales in schools: 16% of countries restrict marketing, 25% restrict competitive foods, and 12% restrict both. Over half of policies were found in high-income countries. No low-income countries had either policy type. Eight marketing policies (27%) and 14 competitive foods policies (29%) lacked explicit guidelines for either policy monitoring or enforcement. Future research is needed to assess the prevalence of policies aimed at improving other key aspects of the school food environment, such as dietary quality of school meals or food procurement, as well as assess implementation and efficacy of existing policies.

Association between ultra-processed food and snacking behavior in Brazil

PURPOSE

Ultra-processed food may play a role in facilitating snacking behavior because of their convenience and low satiety potential. This study aimed to describe the association between consumption of ultra-processed foods and frequency of snacking.

METHODS

We analyzed data from 46,164 participants (≥ 10 years old) in the 2017-2018 Brazilian Household Budget Survey. Dietary data were collected by 24-h dietary recalls over one or two days for each participant. We estimated energy intake, ultra-processed food consumption, and level of snacking. We measured the association between ultra-processed food consumption and level of snacking using multinomial logistic regression, stratified by age group (adolescents, 10-19 years old; adults, 20-64 years old; elders, 65 or older).

RESULTS

We found a statistically significant tendency of increased daily energy intake and consumption of snacks and that ultra-processed food consumption was positively associated with the level of snacking for all age groups. For adolescents, adults, and elders in the highest quintile of ultra-processed food consumption as a share of their entire diet, the relative risk ratio (95% CI) of having more than two snacks per day compared to no snacks was 14.21 (9.09-22.21), 4.44 (3.54-5.57), and 4.21 (2.67-6.64), respectively, when compared to the lowest quintile.

CONCLUSION

Higher consumption of ultra-processed food was associated with snacking behavior, and the strength of this association was stronger among adolescents. Efforts to mitigate ultra-processed food attributes that facilitate snacking should be incorporated into strategies to promote healthier food choices, especially among adolescents.

Ultra-processed food consumption, genetic susceptibility, and the risk of hip/knee osteoarthritis

BACKGROUND

The associations between ultra-processed food (UPF) consumption, genetic susceptibility, and the risk of osteoarthritis (OA) remain unknown. This study was to examine the effect of UPF consumption, genetic susceptibility, and their interactions on hip/knee OA.

METHODS

Cohort analyses included 163,987 participants from the UK Biobank. Participants' UPF consumption was derived from their 24-h dietary recall using a questionnaire. Genetic risk scores (GRSs) of 70 and 83 single nucleotide polymorphisms (SNPs) for hip and knee OA were constructed.

FINDINGS

After 1,461,447 person-years of follow-up, 11,540 patients developed OA. After adjustments, compared to participants in the low quartile of UPF consumption, those in the high quartile had a 10 % (hazard ratio [HR], 1.10; 95% confidence interval [CI], 1.03-1.18) increased risk of knee OA. No significant association was found between UPF consumption and hip OA. Replacing 20% of UPF diet weight with an equivalent proportion of unprocessed or minimally processed food caused a 6% (HR, 0.94; 95% CI, 0.89-0.98) decreased risk of knee OA, respectively. A significant interaction was found between UPF consumption, genetic predisposition, and the risk of knee OA (P = 0.01). Participants with lower OA-GRS scores experienced higher knee OA risks due to UPF consumption.

INTERPRETATION

UPF consumption was associated with a higher risk of knee OA but not hip OA, particularly in those with lower genetic susceptibility. These results highlight the importance of reducing UPF consumption to prevent knee OA.

Ultra-processed foods and human health: An umbrella review and updated meta-analyses of observational evidence

BACKGROUND & AIMS

Ultra-processed food (UPF) intake has increased sharply over the last few decades and has been consistently asserted to be implicated in the development of non-communicable diseases. We aimed to evaluate and update the existing observational evidence for associations between ultra-processed food (UPF) consumption and human health.

METHODS

We searched Medline and Embase from inception to March 2023 to identify and update meta-analyses of observational studies examining the associations between UPF consumption, as defined by the NOVA classification, and a wide spectrum of health outcomes. For each health outcome, we estimated the summary effect size, 95% confidence interval (CI), between-study heterogeneity, evidence of small-study effects, and evidence of excess-significance bias. These metrics were used to evaluate evidence credibility of the identified associations.

RESULTS

This umbrella review identified 39 meta-analyses on the associations between UPF consumption and health outcomes. We updated all meta-analyses by including 122 individual articles on 49 unique health outcomes. The majority of the included studies divided UPF consumption into quartiles, with the lowest quartile being the reference group. We identified 25 health outcomes associated with UPF consumption. For observational studies, 2 health outcomes, including renal function decline (OR: 1.25; 95% CI: 1.18, 1.33) and wheezing in children and adolescents (OR: 1.42; 95% CI: 1.34, 1.49), showed convincing evidence (Class I); and five outcomes were reported with highly suggestive evidence (Class II), including diabetes mellitus, overweight, obesity, depression, and common mental disorders.

CONCLUSIONS

High UPF consumption is associated with an increased risk of a variety of chronic diseases and mental health disorders. At present, not a single study reported an association between UPF intake and a beneficial health outcome. These findings suggest that dietary patterns with low consumption of UPFs may render broad public health benefits.

Food price trends during the COVID-19 pandemic in Brazil

The present study aims to analyze the trends in food price in Brazil with emphasis on the period of the Covid-19 pandemic (from March 2020 to March 2022). Data from the Brazilian Household Budget Survey and the National System of Consumer Price Indexes were used as input to create a novel data set containing monthly prices (R$/Kg) for the foods and beverages most consumed in the country between January 2018 and March 2022. All food items were divided according to the Nova food classification system. We estimated the mean price of each food group for each year of study and the entire period. The monthly price of each group was plotted to analyze changes from January 2018 to March 2022. Fractional polynomial models were used to synthesize price changes up to 2025. Results of the present study showed that in Brazil unprocessed or minimally processed foods and processed culinary ingredients were more affordable than processed and ultra-processed foods. However, trend analyses suggested the reversal of the pricing pattern. The anticipated changes in the prices of minimally processed food relative to ultra-processed food, initially forecasted for Brazil, seem to reflect the impact of the Covid-19 pandemic on the global economy. These results are concerning as the increase in the price of healthy foods aggravates food and nutrition insecurity in Brazil. Additionally, this trend encourages the replacement of traditional meals for the consumption of unhealthy foods, increasing a health risk to the population.

Dismantling the myth of "all foods fit" in eating disorder treatment

We call for a reevaluation of the long-standing dogmatic nutritional principle that "all foods fit" for all cases of eating disorders (EDs) and its corollary, "there are no bad foods" (for anyone ever) during ED treatment. Based on accumulated scientific research, we challenge these ideologies as outdated, confusing, and potentially harmful to many patients. We review the evidence that indicates the folly of these assumptions and show there are a variety of exceptions to these rules, including (1) food allergies, sensitivities, and intolerances, (2) religious and spiritual preferences or doctrines, and (3) the ubiquitous emergence and widespread availability of ultra-processed foods leading to the potential development of addiction-like eating and a higher prevalence of various medical and psychiatric comorbidities, as well as higher mortality. This evidence supports a nutritional psychiatry approach that should be integrated into (rather than dissociated from) ED treatment research and practice.

Influence of culinary skills on ultraprocessed food consumption and Mediterranean diet adherence: An integrative review

The Mediterranean diet is a diet pattern with several healthy characteristics, including a high consumption of fresh fruits, vegetables, whole-grain products, and extra virgin olive oil as the main fat source. It is also characterized by a low consumption of processed foods and high-fat meats. However, there has been a nutritional transition such that, because of globalization and economic growth, the consumption of ultraprocessed foods is increasing, comprising 14% to 57% of total energy intake. North America and Australia have the worst prognosis. Further, the younger population consumes greater amounts of ultraprocessed foods compared with adults, whereas the older population has the lowest rates. Among the various factors responsible for the nutritional transition, culinary skills seem an important function of diet quality, but, unfortunately, culinary skills have been little investigated by the scientific community. Higher culinary skills may be related to increased consumption of homemade meals, higher diet quality, and greater consumption of vegetables and fruits and may be associated with higher Mediterranean diet adherence. Consequently, ultraprocessed foods, ready-to-eat food, and delivered meals, as well as meals outside the home, are reduced. Unfortunately, the process of generational transmission of cooking skills is progressively weakening, aggravated by the reduction of free time for home cooking. Still, even though there are few interventions conducted to improve culinary skills, especially those focused on children, the available results suggest that there have been positive changes in the direction of a healthier dietary pattern. This integrative review analyzes consumption levels of ultraprocessed foods. We then consider the extent to which culinary skills affect ultraprocessed food consumption levels and the relative impact on obesity.

Relationship Between Ultra-Processed and Minimally Processed Food Intake and Cardiovascular Health Among US Women of Reproductive Age

Objectives: Ultra-processed food (UPF) intake is associated with worse cardiovascular health (CVH), but associations between unprocessed/minimally processed foods (MPFs) and CVH are limited, especially among women of reproductive age (WRA). Materials and Methods: For 5,773 WRA (20-44 years) in National Health and Nutrition Examination Survey (NHANES) 2007-2018, we identified UPFs and MPFs using the Nova classification and based on 24-hour dietary recalls. We calculated usual percentages of calories from UPFs and MPFs using the National Cancer Institute's usual intake method. Seven CVH metrics were scored, and CVH levels were grouped by tertile. We used multivariable linear and multinomial logistic regression to assess associations between UPFs and MPFs and CVH. Results: The average usual percentage of calories from UPFs and MPFs was 57.2% and 29.3%, respectively. There was a graded, positive association between higher UPF intake and higher odds of poor CVH: adjusted odds ratios (aORs) for the lowest versus highest CVH were 1.74 (95% confidence interval: 1.51-2.01), 2.67 (2.07-3.44) and 4.66 (3.13-6.97), respectively, comparing quartile 2 (Q2)-Q4 to the lowest quartile (Q1) of UPF intake. Higher MPF intake was associated with lower odds of poor CVH: aORs for the lowest CVH were 0.61 (0.54-0.69), 0.39 (0.31-0.50), and 0.21 (0.14-0.31). Patterns of association remained consistent across subgroups and in sensitivity analyses. Conclusions: Higher UPF intake was associated with worse CVH, while higher MPF intake was associated with better CVH among WRA in the United States. Our analyses highlight an opportunity for WRA to improve nutrition and their CVH.

Ultraprocessed Food Intake during the Transition to Adulthood Varies According to Sociodemographic Characteristics and Maternal Intake in Cebu, Philippines

BACKGROUND

Ultraprocessed foods (UPFs) are associated with elevated risk of noncommunicable disease, but little is known about UPF intake and the individual-, household-, and community-level factors associated with it among adolescents in low- or middle-income countries.

OBJECTIVES

We estimated the association of UPF intake across adolescence with sociodemographic characteristics and maternal UPF intake in a Filipino cohort.

METHODS

Data were from 4 waves (1994-2005) of the Cebu Longitudinal Health and Nutrition Survey (n = 2068); participants were aged 11, 15, 18, and 21 y. Foods from 24-h recalls were classified using NOVA. We used two-part multilevel models to estimate time-varying associations of the odds and amount (percentage daily kilocalories) of UPF intake with sociodemographic characteristics and maternal UPF intake (none, below median among UPF-consuming mothers ["low"], at or above median ["high"]).

RESULTS

Median UPF intake (interquartile range [IQR]) among adolescents was 7.3% (IQR: 0, 17.2%) of daily kilocalories at age 11 y and 10.6% (IQR: 3.6, 19.6%) at 21 y. The odds and amount of adolescent UPF intake were positively associated with female sex, years of schooling, and household wealth and inversely associated with household size. The odds-but not amount-of adolescent UPF intake was positively associated with maternal education and urbanicity and inversely associated with the distance from a household's primary store/market. The association between odds of adolescent UPF intake and school enrollment was positive in adolescence but disappeared in early adulthood. Compared with offspring whose mothers did not consume UPFs, the odds of UPF intake among those whose mothers had low or high UPF intake was greater in adolescence, but there was no association once offspring became adults. At all ages, maternal UPF intake was positively associated with the amount of offspring intake.

CONCLUSIONS

Adolescent UPF intake varied across sociodemographic characteristics and was positively associated with maternal UPF intake, but not after adolescents entered adulthood.

Ultra-processed foods - a scoping review for Nordic Nutrition Recommendations 2023

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.

Trends in the prevalence of obesity, overweight, and thinness among schoolchildren aged 7-14 years from southern Brazil (2002-2019)

OBJECTIVE

To analyze the obesity, overweight, and thinness trends among Brazilian schoolchildren by sex, age group, and type of school according to World Health Organization (WHO) and International Obesity Task Force (IOTF) criteria.

METHODS

We conducted four surveys between 2002 and 2018/19 involving schoolchildren aged 7-14 years from a state capital in southern Brazil. Weight status was classified using both WHO and IOTF criteria.

RESULTS

In the total sample, obesity prevalence based on the IOTF and the WHO criteria were 72% and 44% higher in 2018/19 compared with 2002, respectively. Over the whole period, the obesity prevalence increased among children (WHO: 10.1% vs. 14.1%; IOTF: 5.0% vs. 8.3%), and those from public schools (WHO: 10.5% vs. 16.4%; IOTF: 5.6% vs. 10.1%). There was no significant reduction in thinness prevalence over the analyzed period.

CONCLUSION

Obesity prevalence remains on an upward trend in a state capital in southern Brazil, especially among children from public schools. A higher prevalence of overweight and obesity was observed using the WHO criteria compared with IOTF criteria.

Factors Correlated With Ultra-Processed Food (UPF) Intake in Preschool-Aged Children and Association With Weight

OBJECTIVE

Understand the correlates of ultra-processed food (UPF) intake and examine the association of UPF on body mass index in children aged 3-5 years.

DESIGN

Secondary analysis of a prospective cohort of 3-5-year-olds/parent, followed 1-year between March 2014 and October 2016. Usual UPF intake from 2 3-day food records completed 1 year apart, a standardized nutrient database customized with child-specific foods, and a NOVA food classification system was used. Child/parent characteristics and media use were measured via parent-reported surveys. Child weight/height objectively measured.

SETTING

New Hampshire community.

PARTICIPANTS

Six hundred and sixty-seven parent-child dyads were screened, and 624 were enrolled with 90% follow-up.

MAIN OUTCOME MEASURE(S)

Primary outcome: identify correlates of UPF intake.

SECONDARY OUTCOME

determine if UPF intake is associated with body mass index change.

ANALYSIS

Adjusted β linear regression, linear regression, P <0.05.

RESULTS

Ultra-processed food accounted for 67.6% of total caloric intake. In adjusted models, children's UPF intake was positively associated with increasing child age, greater hours watching television, and more frequent parent soda/fast-food intake. Ultra-processed food intake was negatively associated with higher parent education and reported race/ethnicity other than non-Hispanic White. There was no association between UPF intake and weight.

CONCLUSIONS AND IMPLICATIONS

There are several predictors of UPF intake in young children. Family-level interventions could be implemented to encourage the intake of minimally processed foods before and during preschool years.

Determinants of polycystic ovary syndrome: A matched case-control study

BACKGROUND

Polycystic ovarian syndrome (PCOS) is a multifaceted endocrine disorder of women of reproductive age with a multifactorial aetiology. Despite much research, there is still inconclusive data on the impact of dietary, lifestyle and socio-economic factors on PCOS aetiology. Thus, the present study explored the association of PCOS with diet, eating behaviour, other lifestyle and socio-economic factors.

METHODS

A matched-pair case-control study was conducted on 150 women with PCOS and 150 healthy controls. Information on diet, eating behaviour and physical activity, and also anthropometric and socio-economic data were collected through standard questionnaires. The adjusted odds ratios (AmOR) were calculated and reported using conditional multivariable logistic regression.

RESULTS

The results showed low education level (AmOR = 8.44; 95% confidence interval [CI] = 1.63-43.68), high sugar consumption (AmOR = 11.61; 95% CI = 2.05-65.72) along with higher body mass index (BMI) and inactivity to be significantly associated with PCOS. Also, a significant protective effect was found for cognitive dietary restraint (AmOR = 0.79; 95% CI = 0.66-0.93), crude fibre (AmOR = 0.61; 95% CI = 0.45-0.82) and protein intake.

CONCLUSIONS

Low education status may contribute to higher receptiveness to choosing unhealthy diets and lifestyles, resulting in adiposity and an increased risk of PCOS.

Association between sedentary behavior, diet and nutritional status in adolescents: baseline results from the LONCAAFS Study

The aim of the present study was to analyze the relationship between time spent engaged in sedentary behaviors, type of diet, and overweight in adolescents. A cross-sectional study using data from the Longitudinal Study on Sedentary Behavior, Physical Activity, Eating Habits, and Health of Adolescents - LONCAAFS Study. A total of 1,438 adolescents (10 to 14 years old) from public schools in the city of João Pessoa, Brazil, participated in the study. To evaluate the combined effects of excessive time in sedentary behavior and consumption from two food groups: Convenience and Prudent on overweight, we performed multiple logistic regression analyses, adjusted for energy, level of physical activity, sex, and age. Excessive time in sedentary behavior increased the chance of adolescents being overweight by 37% (OR = 1.37; 95%CI: 1.04-1.80). This chance increased to 43% when the adolescents were simultaneously engaged in excessive sedentary behavior and had high consumption of the Convenience food group (OR = 1.43; 95%CI: 1.05-1.94) and increased to 39% on those who engaged in excessive sedentary behavior and had low consumption of foods from the Prudent (OR = 1.39; 95%CI: 1.04-1.84). Excessive sedentary behavior is associated with being overweight and the chance increases with the consumption of convenient foods.

Ultra-Processed Foods-Dietary Foe or Potential Ally?

The prevalence of non-communicable diseases (NCDs) has steadily increased in the United States. Health experts attribute the increasing prevalence of NCDs, in part, to the consumption of ultra-processed foods (UPFs) based on epidemiological observations. However, no definitive evidence of causality has been established. Consequently, there is an ongoing debate over whether adverse health outcomes may be due to the low nutrient density per kilocalorie, the processing techniques used during the production of UPFs, taste preference-driven overconsumption of calories, or unidentified factors. Recognizing that "the science is not settled," we propose an investigative process in this narrative review to move the field beyond current controversies and potentially identify the basis of causality. Since many consumers depend on UPFs due to their shelf stability, affordability, availability, ease of use, and safety from pathogens, we also suggest a paradigm for guiding both the formulation of UPFs by food designers and the selection of UPFs by consumers.

Association between ultra-processed food and flavonoid intakes in a nationally representative sample of the US population

Consumption of ultra-processed food (UPF) has been associated with several chronic diseases and poor diet quality. It is reasonable to speculate that the consumption of UPF negatively associates with flavonoid dietary intake; however, this assumption has not been previously examined. The present study aims to assess association between the dietary contribution of UPF and flavonoid intake in the US population aged 0 years and above. We performed a cross-sectional analysis of dietary data collected by 24-h recalls from 7640 participants participating in the National Health and Nutrition Examination Survey 2017-2018. Foods were classified according to the Nova classification system. The updated US Department of Agriculture (USDA) Database for the Flavonoid Content of Selected Foods (Release 3.3) database was used to estimate total and six classes of flavonoid intakes. Flavonoid intakes were compared across quintiles of dietary contribution of UPF (% of total energy intake) using linear regression models. The total and five out of six class flavonoid intakes decreased between 50 and 70 % across extreme quintiles of the dietary contribution of UPF (Pfor linear trend < 0·001); only isoflavones increased by over 260 %. Our findings suggest that consumption of UPF is associated with lower total and five of six class flavonoid intakes and with higher isoflavone intakes, supporting previous evidence of the negative impact of UPF consumption on the overall quality of the diet and health outcomes.

Ultra-processed food consumption and chronic kidney disease risk: a systematic review and dose-response meta-analysis

Background

High intake of ultra-processed food (UPF) has been associated with increased risk of chronic kidney disease(CKD), but the results remain inconsistent. We therefore performed this systematic review and dose–response meta-analysis of observational studies that shed light on the association between UPF consumption and the risk of CKD.

Methods

A systematic literature search of PubMed, Embase, Web of Science, Scopus and China National Knowledge Infrastructure (CNKI) databases was carried out to find the eligible articles published up to October 31, 2023. Random-effects or fixed-effects models were used to pool the relative risks(RRs) and their 95% confidence intervals (CIs).The potential sources of heterogeneity across studies were examined using the Cochran’s Q test and I-square(I2). Publication bias was examined using the visual inspection of asymmetry in funnel plots and quantified by Begg’s and Egger’s tests.

Results

Eight studies (six cohort and two cross-sectional studies) exploring the association between UPF consumption and risk of CKD, were included in the final analysis. The pooled analyses revealed that high consumption of UPF was associated with an increased risk of CKD (RR = 1.25; 95%CI: 1.09–1.42, p &lt; 0.0001). Moreover, a 10% increase of UPF consumption was associated with a 7% higher risk of CKD (RR = 1.07; 95%CI: 1.04–1.10, p &lt; 0.001). Dose–response analysis of all included studies showed a linear association between UPF consumption and the risk of CKD (RR = 1.02; 95%CI:0.99–1.05, Pdose–response = 0.178, Pnonlinearity = 0.843).

Conclusion

Our findings indicate that high consumption of UPF is significantly associated with an increased risk of CKD. Future research with prospective design is required to confirm this positive association.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023478483, PROSPERO identifier CRD42023478483.

Enhancing the palatability of cultivated meat

Cultivated meat (CM) has transitioned from a futuristic concept to a present reality, with select products approved for consumption and sale in Singapore, Israel, and the USA. This evolution has emphasized scalable, cost-effective, and sustainable production, as well as navigation of regulatory pathways. As CM develops, a crucial challenge lies in delivering products that are highly appealing to consumers. Central to this will be refining CM palatability, a term encompassing food's taste, aroma, texture, tenderness, juiciness, and color. We explore the scientific and engineering approaches to producing palatable CM, including cell-line selection, cell differentiation, and post-processing techniques. This includes a discussion of the structural and compositional properties of meat that are intrinsically coupled to palatability.

Higher ultra-processed food intake is associated with an increased incidence risk of cardiovascular disease: the Tehran lipid and glucose study

BACKGROUND

Cardiovascular disease (CVD) is a major cause of death worldwide, although limited data are currently available regarding the impact of consuming ultra-processed food (UPF) on its incidence. Given the increased consumption of UPF in Iran, we aimed to investigate the association between UPF intake and CVD risk.

METHODS

Individuals without CVD (n = 2050) aged ≥ 30 years old were recruited from the Tehran Lipid and Glucose Study (TLGS). Dietary data were collected using a validated food frequency questionnaire (FFQ) and UPF intakes were assessed based on the Nova food classification. Multivariable Cox proportional hazard models adjusted for potential confounders were used to estimate the hazard ratio (HR) and 95% confidence intervals (95% CI) for the risk of CVD across tertiles of UPF intake.

RESULTS

A 10.1% incidence of CVD occurred over a median follow-up of 10.6 years, with a 22% increase in CVD risk per each 50 g/day UPF intake. Participants with the highest intake of UPF had a 68% greater incidence of CVD compared to those with the lowest intake (HR = 1.68, 95% CI=1.14-2.48) after controlling for potential confounders. Regarding sub-groups of UPF, participants in the 3rd tertile compared to the reference had a significantly increased risk of CVD (HR = 1.56, 95% CI=1.04-2.34). Nevertheless, intake of bread, fast food, sweetened beverages, sweets and desserts, high-fat dairy products, and other UPFs were not associated with greater CVD risk.

CONCLUSION

Our findings support the hypothesis that the incidence of CVD is enhanced with the higher consumption of UPF in a representative sample of the Iranian population.

Greater Frequency of Cooking Dinner at Home and More Time Spent Cooking Are Inversely Associated With Ultra-Processed Food Consumption Among US Adults

BACKGROUND

Cooking at home has been promoted as a strategy to improve diet quality; however, the association between cooking behavior and ultra-processed food intake is unknown.

OBJECTIVE

The objective of this study was to examine associations between frequency of cooking dinner at home and time spent cooking dinner with ultra-processed food intake.

DESIGN

Cross-sectional, nationally representative data from the 2007-2010 National Health and Nutrition Examination Survey were analyzed.

PARTICIPANTS/SETTING

Participants were 9,491 adults (20 years and older) in the United States.

MAIN OUTCOME MEASURES

The main outcome measure was the proportion of energy intake (averaged from two 24-hour dietary recalls) from the following 4 Nova food-processing groups: (1) unprocessed or minimally processed foods, (2) processed culinary ingredients, (3) processed foods, and (4) ultra-processed foods.

STATISTICAL ANALYSES PERFORMED

Separate linear regression models examined associations between cooking frequency and time spent cooking dinner and proportion of energy intake from the 4 Nova food-processing groups, adjusting for sociodemographic characteristics and total energy intake.

RESULTS

Ultra-processed foods comprised >50% of energy consumed independent of cooking frequency or time spent cooking. Higher household frequency of cooking dinner and greater time spent cooking dinner were both associated with lower intake of ultra-processed foods (P trends < .001) and higher intake of unprocessed or minimally processed foods (P trends < .001) in a dose-response manner. Compared with cooking 0 to 2 times/wk, adults who cooked dinner 7 times/wk consumed a mean of 6.30% (95% CI -7.96% to -4.64%; P < .001) less energy from ultra-processed foods. Adults who spent more than 90 minutes cooking dinner consumed 4.28% less energy from ultra-processed foods (95% CI -6.08% to -2.49%; P < .001) compared with those who spent 0 to 45 minutes cooking dinner.

CONCLUSIONS

Cooking at home is associated with lower consumption of ultra-processed foods and higher consumption of unprocessed or minimally processed foods. However, ultra-processed food intake is high among US adults regardless of cooking frequency.

Exploring the association between ultra-processed foods and COPD: a case-control study

BACKGROUND

While it is known that the overconsumption of ultra-processed foods (UPFs) is associated with a heightened risk of respiratory ailments, the specific effects of UPF intake on COPD remain unclear. This study was designed to explore the potential link between COPD and the consumption of UPFs among adult individuals in Iran.

METHODS

In this hospital-based case-control study conducted at Alzahra University Hospital in Isfahan, Iran, we enrolled 84 patients newly diagnosed with COPD, along with 252 healthy controls matched for age and sex. COPD was defined based on the results of spirometry tests, specifically when the forced expiratory volume per second (FEV1) was less than 80% or the ratio of FEV1 to forced vital capacity (FVC) was less than 70%. To evaluate the dietary intake of the participants, we utilized a validated food frequency questionnaire (FFQ) consisting of 168 items. Additionally, we gathered data on potential confounding factors using a pre-tested questionnaire.

RESULTS

The mean ages for the case and control groups were 57.07 and 55.05 years, respectively. Our study found no significant association between the intake of ultra-processed foods (UPFs) and the likelihood of COPD, with an odds ratio (OR: 0.78, 95% CI: 0.34-1.77). This lack of association persisted even after adjusting for factors such as energy intake, sex, and age (OR: 0.48; 95% CI: 0.19-1.21). Further controlling for potential confounders like body mass index (BMI), physical activity, and smoking status did not alter this finding (OR: 0.367; 95% CI: 0.123-1.1008, P = 0.074).

CONCLUSIONS

In our study, we observed no significant association between the intake of Ultra-Processed Foods (UPFs) and the odds of Chronic Obstructive Pulmonary Disease (COPD). This finding remained consistent even after adjusting for factors such as energy intake, sex, age, Body Mass Index (BMI), physical activity, and smoking status. Therefore, within the scope of our study, it appears that the consumption of UPFs does not significantly impact the likelihood of developing COPD. However, we recommend further research to deepen our understanding of the intricate relationship between dietary habits and respiratory health.

Ultra-processed Food and Obesity: What Is the Evidence?

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.

Determinants of obesity in Latin America

Obesity rates are increasing almost everywhere in the world, although the pace and timing for this increase differ when populations from developed and developing countries are compared. The sharp and more recent increase in obesity rates in many Latin American countries is an example of that and results from regional characteristics that emerge from interactions between multiple factors. Aware of the complexity of enumerating these factors, we highlight eight main determinants (the physical environment, food exposure, economic and political interest, social inequity, limited access to scientific knowledge, culture, contextual behaviour and genetics) and discuss how they impact obesity rates in Latin American countries. We propose that initiatives aimed at understanding obesity and hampering obesity growth in Latin America should involve multidisciplinary, global approaches that consider these determinants to build more effective public policy and strategies, accounting for regional differences and disease complexity at the individual and systemic levels.

Reporting quality and risk of bias of systematic reviews of ultra-processed foods: a methodological study

A dramatic shift in the global food system is occurring with the rapid growth of ultra-processed foods (UPFs) consumption, which poses potentially serious health risks. Systematic review (SR) method has been used to summarise the association between UPF consumption and multiple health outcomes; however, a suboptimal-quality SR may mislead the decision-making in clinical practices and health policies. Therefore, a methodological review was conducted to identify the areas that can be improved regarding the risk of bias and reporting quality of relevant SRs. Systematic searches to collect SRs with meta-analyses of UPFs were performed using four databases from their inception to April 14, 2023. The risk of bias and reporting quality were evaluated using ROBIS and PRISMA 2020, respectively. The key characteristics of the included SRs were summarised descriptively. Excel 2019 and R 4.2.3 were used to analyse the data and draw graphs. Finally, 16 relevant SRs written in English and published between 2020 and 2023 in 12 academic journals were included. Only one SR was rated as low risk of bias, and the others were rated as higher risk of bias mainly because the risk of bias in the original studies was not explicitly addressed when synthesising the evidence. The reporting was required to be advanced significantly, involving amendments of registration and protocol, data and analytic code statement, and lists of excluded studies with justifications. The reviews' results could improve the quality, strengthen future relevant SRs' robustness, and further underpin the evidence base for supporting clinical decisions and health policies.

Emerging Trends in Atherosclerosis: Time to Address Atherosclerosis From a Younger Age

Over the past two decades, research efforts into cardiovascular disease (CVD) have uncovered findings that fundamentally challenge our understanding of CVD, particularly atherosclerosis. Atherosclerosis was primarily attributed to the well-described abnormal lipid accumulation theory, involving plaque growth with subsequent plaque hemorrhage resulting in acute vessel thrombosis that may or may not rupture. This perspective has now evolved to encompass more complex pathways, wherein the accumulation of abnormal products of oxidation and inflammation is the most likely factor mediating atherosclerotic plaque growth. Furthermore, atherosclerosis was traditionally thought of as a disease in patients aged 40 and older. However, mounting evidence has demonstrated that significant atherosclerosis and CVD events are more prevalent in younger patients than previously realized and accelerating in incidence. With this alarming trend among younger individuals, our review sought to explore why this trend may be happening and what can be done about this developing problem.

Consumption of ultra-processed foods and multiple health outcomes: An umbrella study of meta-analyses

Consumption of ultra-processed foods (UPFs) is associated with various adverse health outcomes, which significantly influence the global disease burden. This umbrella review aimed to fill the knowledge gap and guide public health practices by summarizing the association between UPFs and multiple health outcomes. A total of four databases were systematically searched from inception to December 2022, and 14 eligible systematic reviews (SRs) with meta-analyses (MAs) were identified. The SRs were published in 10 journals from 2020 to 2023, with 54,147-5,750,133 participants and 5-61 studies. The overall corrected covered area (CCA) was corresponded to a slight overlap. The results showed that an increased UPFs consumption is associated with multiple health outcomes (e.g., obesity, diabetes, hypertension, mortality). Only two SRs were "Moderate" regarding the overall methodological quality, while the other twelve were "Low" or "Critically low". Therefore, well-conducted SRs with high-quality prospective cohorts with a particular focus on special populations are needed to verify these findings further.

Food additive emulsifiers and cancer risk: Results from the French prospective NutriNet-Santé cohort

BACKGROUND

Emulsifiers are widely used food additives in industrially processed foods to improve texture and enhance shelf-life. Experimental research suggests deleterious effects of emulsifiers on the intestinal microbiota and the metabolome, leading to chronic inflammation and increasing susceptibility to carcinogenesis. However, human epidemiological evidence investigating their association with cancer is nonexistent. This study aimed to assess associations between food additive emulsifiers and cancer risk in a large population-based prospective cohort.

METHODS AND FINDINGS

This study included 92,000 adults of the French NutriNet-Santé cohort without prevalent cancer at enrolment (44.5 y [SD: 14.5], 78.8% female, 2009 to 2021). They were followed for an average of 6.7 years [SD: 2.2]. Food additive emulsifier intakes were estimated for participants who provided at least 3 repeated 24-h dietary records linked to comprehensive, brand-specific food composition databases on food additives. Multivariable Cox regressions were conducted to estimate associations between emulsifiers and cancer incidence. Overall, 2,604 incident cancer cases were diagnosed during follow-up (including 750 breast, 322 prostate, and 207 colorectal cancers). Higher intakes of mono- and diglycerides of fatty acids (FAs) (E471) were associated with higher risks of overall cancer (HR high vs. low category = 1.15; 95% CI [1.04, 1.27], p-trend = 0.01), breast cancer (HR = 1.24; 95% CI [1.03, 1.51], p-trend = 0.04), and prostate cancer (HR = 1.46; 95% CI [1.09, 1.97], p-trend = 0.02). In addition, associations with breast cancer risk were observed for higher intakes of total carrageenans (E407 and E407a) (HR = 1.32; 95% CI [1.09, 1.60], p-trend = 0.009) and carrageenan (E407) (HR = 1.28; 95% CI [1.06, 1.56], p-trend = 0.01). No association was detected between any of the emulsifiers and colorectal cancer risk. Several associations with other emulsifiers were observed but were not robust throughout sensitivity analyses. Main limitations include possible exposure measurement errors in emulsifiers intake and potential residual confounding linked to the observational design.

CONCLUSIONS

In this large prospective cohort, we observed associations between higher intakes of carrageenans and mono- and diglycerides of fatty acids with overall, breast and prostate cancer risk. These results need replication in other populations. They provide new epidemiological evidence on the role of emulsifiers in cancer risk.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03335644.

Complementarity between the updated version of the front-of-pack nutrition label Nutri-Score and the food-processing NOVA classification

OBJECTIVE

To compare the initial and the updated versions of the front-of-pack label Nutri-Score (related to the nutritional content) with the NOVA classification (related to the degree of food processing) at the food level.

DESIGN

Using the OpenFoodFacts database - 129,950 food products - we assessed the complementarity between the Nutri-Score (initial and updated) with the NOVA classification through a correspondence analysis. Contingency tables between the two classification systems were used.

SETTINGS

The food offer in France.

PARTICIPANTS

Not applicable.

RESULTS

With both versions (i.e. initial and updated) of the Nutri-Score, the majority of ultra-processed products received medium to poor Nutri-Score ratings (between 77·9 % and 87·5 % of ultra-processed products depending on the version of the algorithm). Overall, the update of the Nutri-Score algorithm led to a reduction in the number of products rated A and B and an increase in the number of products rated D or E for all NOVA categories, with unprocessed foods being the least impacted (-3·8 percentage points (-5·2 %) rated A or B and +1·3 percentage points (+12·9 %) rated D or E) and ultra-processed foods the most impacted (-9·8 percentage points (-43·4 %) rated A or B and +7·8 percentage points (+14·1 %) rated D or E). Among ultra-processed foods rated favourably with the initial Nutri-Score, artificially sweetened beverages, sweetened plant-based drinks and bread products were the most penalised categories by the revision of Nutri-Score while low-sugar flavoured waters, fruit and legume preparations were the least affected.

CONCLUSION

These results indicate that the update of the Nutri-Score reinforces its coherence with the NOVA classification, even though both systems measure two distinct health dimensions at the food level.

One Anastomosis Gastric Bypass versus Roux-en-Y Gastric Bypass: A Randomized Prospective Trial

Background and Objectives: One anastomosis gastric bypass (OAGB) and Roux-en-Y gastric bypass (RYGB) surgeries are effective methods used in bariatric surgery. There are limited randomized studies comparing these procedures over more than 2 years. Here, we aimed to compare the 3-year results of two bariatric procedures. Materials and Methods: Patients included in this randomized prospective study were compared in OAGB and RYGB groups. A total of 55 patients, aged between 18 and 65, were eligible for the study. Thirteen patients who did not accept randomization were excluded. Patients were evaluated at 6, 12, 24, and 36 months postoperatively. Results: Three patients were excluded from the study due to loss of communication during the clinical follow-up and one due to death by amyotrophic lateral sclerosis, which started in the eighth month after surgery. The study was completed with a total of 38 patients (OAGB; n = 20, RYGB; n = 18). Patients in the two groups were similar in terms of age, gender, body mass index (BMI), and obesity-related comorbidities. At the end of 3-year follow-up, BMI in the OAGB and RYGB groups was 28.80 ± 4.53 kg/m2 and 29.17 ± 5.36 kg/m2, respectively (p = 0.822). Percentage total weight loss (TWL%) was similar. No significant differences were found between the groups regarding percentage excess weight loss (EWL%). Remission of comorbidities was similar. De novo refluxes developed in four OAGB patients; there were no occurrences of these in RYGB patients (p = 0.066). Conclusions: Both OAGB and RYGB are effective in the treatment of morbid obesity. The two procedures are similarly successful in terms of obesity-related comorbidities.

The environmental impact of beef and ultra-processed food consumption in Brazil

OBJECTIVE

This study evaluated the independent and combined environmental impacts of the consumption of beef and ultra-processed foods in Brazil.

DESIGN

Cross-sectional study.

SETTING

Brazil.

PARTICIPANTS

We used food purchases data from a national household budget survey conducted between July 2017 and July 2018, representing all Brazilian households. Food purchases were converted into energy, carbon footprints and water footprints. Multiple linear regression models were used to assess the association between quintiles of beef and ultra-processed foods in total energy purchases and the environmental footprints, controlling for sociodemographic variables.

RESULTS

Both beef and ultra-processed foods had a significant linear association with carbon and water footprints (P < 0·01) in crude and adjusted models. In the crude upper quintile of beef purchases, carbon and water footprints were 47·7 % and 30·8 % higher, respectively, compared to the lower quintile. The upper quintile of ultra-processed food purchases showed carbon and water footprints 14·4 % and 22·8 % higher, respectively, than the lower quintile. The greatest reduction in environmental footprints would occur when both beef and ultra-processed food purchases are decreased, resulting in a 21·1 % reduction in carbon footprint and a 20·0 % reduction in water footprint.

CONCLUSIONS

Although the environmental footprints associated with beef consumption are higher, dietary patterns with lower consumption of beef and ultra-processed foods combined showed the greatest reduction in carbon and water footprints in Brazil. The high consumption of beef and ultra-processed foods is harmful to human health, as well as to the environment; thus, their reduction is beneficial to both.

High intake of ultra-processed food is associated with dementia in adults: a systematic review and meta-analysis of observational studies

BACKGROUND AND AIMS

Poor cardiometabolic health is associated with dementia. Considering previous meta-analyses have confirmed associations between ultra-processed foods (UPFs) and cardiometabolic disease, we were interested in the contribution of UPF consumption to the risk of developing dementia.

METHODS

We performed a systematic review and meta-analysis of all records registered on Ovid Medline and Web of Science from inception until December 2022 [PROSPERO (CRD42023388363)]. Studies that assessed UPF consumption in adults, determined according to NOVA, and that reported dementia (Alzheimer's disease, vascular dementia and mild cognitive impairment) determined by clearly stated diagnostic criteria (including formal assessment of dementia or use of diagnostic codes) were included. The association between UPF consumption and dementia was assessed using random-effects meta-analysis, controlling for confounding variables. Study quality was assessed using the Newcastle Ottawa Scale and evidence credibility evaluated using the NutriGrade system.

RESULTS

Seven thousand ten records were screened, and 122 records underwent full text review. From these, 10 observational (8 longitudinal) studies, analysing 867,316 individuals, were included. Included studies adjusted for age, socioeconomic status and co-morbidity, alongside other confounders. High (vs. low) intake of UPF was associated with increased risk of dementia (pooled relative risk 1.44 (95% confidence interval 1.09-1.90) (p = 0.02)) (I2 = 97.0%), although moderate (vs. low) intake of UPF was not (1.12 (0.96-1.31) (0.13)) (85.0%). Funnel plots demonstrate low risk of publication bias.

CONCLUSION

High UPF consumption is associated with dementia. Public health measures to reduce overconsumption of UPFs are imperative to reduce the burden of dementia.

Frequency of breakfast consumption and its associations with food consumption by degree of industrial processing and with indicators of overweight in Brazilian adolescents (EVA-JF Study)

OBJECTIVE

The aim of this study was to investigate the frequency of breakfast consumption and estimate its associations with the consumption of food at different degrees of industrial processing and with overweight indicators in Brazilian adolescents.

METHODS

This cross-sectional study involved a probabilistic sample of 14- to 19-y-old adolescents enrolled in 29 public schools in the municipality of Juiz de Fora, MG, Southeast Brazil (n = 805). The frequency of breakfast consumption was evaluated via a questionnaire (classified into "do not consume", "sometimes consume", and "regularly consume"). The evaluation of food consumption involved two 24-h dietary recalls, the items of which were analyzed according to the NOVA classification system. Overweight indicators (waist circumference, body mass index for age (BMI-for-age), and body fat percentage) were evaluated according to a standard protocol. Linear regression models were performed, first without and then with adjustments for sociodemographic characteristics.

RESULTS

We found that 20% of adolescents skipped breakfast, and ∼46% of the caloric intake came from ultra-processed foods. Breakfast omission was associated with a mean increase of 3.02% (95% confidence interval [CI], 0.52-5.53) in energy intake from ultra-processed foods, in addition to a mean increase of 0.28 z-score (95% CI, 0.05- 0.52) of BMI-for-age and of 1.64% (95% CI, 0.21-3.08) in body fat.

CONCLUSIONS

We verified that the omission of breakfast was associated with higher consumption of ultra-processed foods, as well as a higher BMI-for-age and higher percentage of body fat, reinforcing the importance of actions to encourage the consumption of this meal and the adoption of healthy eating practices in adolescents.

Ultra-processed food consumption and non-alcoholic fatty liver disease, metabolic syndrome and insulin resistance: A systematic review

Background

High ultra-processed food (UPF) consumption is associated with the development of various diet-related non-communicable diseases, especially obesity and type 2 diabetes. The present study aimed to systematically review the association between UPF consumption and non-alcoholic fatty liver disease (NAFLD) and its leading risk factors; metabolic syndrome (MetS) and insulin resistance (IR).

Methods

A comprehensive search was conducted in PubMed, Scopus, Embase, Web of Science, CINAHL, and Cochrane (March 2023), and references of the identified articles were checked. The search keywords were defined through an exploratory investigation in addition to MeSH and similarly controlled vocabulary thesauruses. Observational and interventional studies were included. Studies that focused only on specific groups of processed foods or overlapping dietary patterns were excluded. The quality assessment was conducted using the Joanna Briggs Institute's critical appraisal tools for observational studies and Cochrane's risk of bias 2 tool for randomized-control trials. A narrative synthesis was employed to report the results.

Results

Fifteen studies were included, with a total of 52,885 participants, one randomized-controlled trial, and fourteen observational studies (nine cross-sectional and five prospective). The review has shown a significant association between UPF consumption and NAFLD in three studies out of six, MetS in five out of eight, and IR in one out of three. All large-scale prospective cohorts that studied NAFLD or MetS outcomes demonstrated a positive association. In contrast, studies that did not demonstrate significant associations were mostly cross-sectional and small. The evidence for an association with IR was insufficient and conflicting.

Conclusion

The included studies are few, observational, and based upon self-reported dietary assessment tools. However, current evidence indicates that UPF is not only associated with obesity and type 2 diabetes but may also be a risk factor for NAFLD and MetS. UPF is a worldwide concern deserving further longitudinal research.

Impact and implications

Overconsumption of ultra-processed food (UPF) may lead to the development of obesity and type 2 diabetes, but the association with non-alcoholic fatty liver disease (NAFLD) is not well established. The present systematic review shows that UPF may be associated with NAFLD, although more large prospective studies are needed. These findings emphasize the importance of minimizing the consumption of UPF to prevent NAFLD and other metabolic diseases among the general adult population. This systematic review and further prospective studies, epidemiological or interventional, can help physicians provide patients with evidence-based nutritional recommendations and will support policymakers in restricting the marketing of UPF as well as promoting affordable, healthy, and minimally processed foods.

Association between body weight misperception and snacking patterns among adolescents: a population-based cross-sectional study

BACKGROUND

Unhealthy snacking behaviors and body weight misperception are both significant concerns in adolescent health. Weight misperception are common among youth and may influence their motivation to engage in health-related behaviors, however, the effect on snacking patterns choice remains unclear. Our study aimed to examine the relationship between body weight misperception and snacking pattern choice among school adolescents.

METHODS

A cross-sectional study was conducted using an online survey platform. Body weight misperception was defined based on perceived body weight and true weight. Snack intake was measured using a qualitative food-frequency questionnaire. Factor analysis was used to identify snacking patterns, and multiple linear regression was employed to examine the association between body weight misperception and snacking patterns.

RESULTS

190,296 students with the average age of 13.3 ± 1.0 years was included, and 44.5% of students misperceived their weight. Overestimation was more prevalent than underestimation. Two snacking patterns, namely a high-calorie snacking pattern and a healthy snacking pattern, were identified with eigenvalues > 1. Weight underestimation was positively linked to high-calorie snacking pattern scores for both normal weight students (β: 0.16, 95% CI: 0.11, 0.21) and students with overweight/obesity (β: 0.44, 95% CI: 0.35, 0.52), and to healthy snacking scores for students with overweight/obesity (β: 0.28, 95% CI: 0.22, 0.33), but negatively linked to healthy snacking pattern scores for normal weight students (β: -0.12, 95% CI: -0.15, -0.09). Conversely, weight overestimation was negatively linked to both high-calorie and healthy snacking pattern scores for normal weight students (β: -0.07, 95% CI: -0.11, -0.04 and β: -0.13, 95% CI: -0.15, -0.10), but positively linked to healthy snacking scores for underweight students (β: 0.15, 95% CI: 0.08, 0.21). Interactions were found between sex, grade, accommodation, only child, primary guardians, parental education level and weight misperception to snacking patterns.

CONCLUSIONS

Adolescents with normal weight and overweight/obesity who misperceived their weight exhibited less healthy snacking patterns, whereas underweight students who misperceived their weight displayed healthier snacking patterns. Comprehensive programs are crucial to educate and guide adolescents in understanding their weight status and making healthier snack choices, involving families, schools, and society.

Stability of clustering of lifestyle risk factors in the Dutch adult population and the association with mental health

BACKGROUND

Lifestyle factors often co-occur in clusters. This study examines whether clusters of lifestyle risk factors, such as smoking, alcohol use, physical inactivity, poor diet, sexual risk behaviour, cannabis and other drug use, change over time in a representative sample of Dutch adults. Additionally, the association between mental health and self-reported depression of lifestyle clusters was examined.

METHODS

Each year cross-sectional data of approximately 7500 individuals of 18 years and older from the annual Dutch Health Survey of 2014-2019 were used. Clusters were determined by a two-step cluster analysis. Furthermore, regression analyses determined the association between clusters of lifestyle risk factors and mental health.

RESULTS

Results show six clusters composed of one, multiple or no lifestyle risk factors. The clusters remained relatively stable over time: in some clusters, the number of people slightly changed between 2014 and 2019. More specifically, clusters that increased in size were the cluster with no lifestyle risk factors and the cluster with multiple lifestyle risk factors. Furthermore, results show that clusters with none to a few lifestyle risk factors were associated with better mental health and a lower prevalence of self-reported depression compared with clusters with multiple lifestyle risk factors.

CONCLUSIONS

The clustering of lifestyle risk factors remained stable over time. People with multiple lifestyle risk factors had poorer mental health than those without risk factors. These findings may emphasize the need for intervention strategies targeting this subgroup with multiple lifestyle risk factors.

Evaluation of food purchasing in the Brazilian School Feeding Programme: feasibility of the requirements and recommendations

OBJECTIVE

To analyse the purchase of food for school feeding, according to the extent and purpose of industrial processing and variety, exploring the feasibility of achieving the requirements and recommendations of the Brazilian School Feeding Programme, and the variety of unprocessed or minimally processed foods according to the purchase of ultra-processed foods.

DESIGN

Secondary data from 2016 from the Accountability Management System of the National Fund for Educational Development, concerning the food items purchased, were used to explore the feasibility of the requirements and recommendations. The foods were grouped according to the NOVA classification system. Variety was assessed by counting different types of unprocessed or minimally processed foods.

SETTING

Brazil.

PARTICIPANTS

3698 Brazilian municipalities.

RESULTS

Energy share from unprocessed or minimally processed foods was 44·1 % while that of ultra-processed foods was 29·9 %. The average of unprocessed or minimally processed food types purchased annually was 33·8 items. Of the municipalities, 35·8 % were within the limit established for the expenditure of funds for the purchase of processed and ultra-processed foods, while 8·7 % followed the recommendation for variety. The proportion of ultra-processed foods did not influence the variety of food items purchased.

CONCLUSIONS

The results showed the feasibility of achieving the requirements and recommendations and underscored the importance of continued efforts to promote the inclusion of unprocessed or minimally processed foods in the school feeding programme while addressing the challenges associated with expenditure limits of processed and ultra-processed foods and enhancing variety, which is strategic to promote adequate and healthy meals.

Double burden of malnutrition among women in reproductive Age (15-49 years) in Sierra Leone: a secondary data analysis of the demographic health survey 2019 (SLDHS-2019)

BACKGROUND

The double burden of malnutrition (DBM) is rising globally, particularly in sub-Saharan Africa. In Sierra Leone, the incidence of overweight, obesity (OWOB), and overnutrition among women has sharply increased. This finding accompanies the high incidence of undernutrition, which has been prevalent for decades. This study aimed to determine the prevalence of different malnutrition categories (underweight, overweight, obesity, and overnutrition) and associated factors among women of reproductive age (15-49 years) in Sierra Leone using secondary data analysis of the Sierra Leone Demographic Health Survey of 2019 (SLDHS-2019).

METHODS

We conducted secondary data analysis of the SLDHS-2019 of 7,514 women aged 15-49 years. We excluded pregnant, post-natal, lactating, and post-menopausal women. Data was collected using validated questionnaires, and respondents were selected through a multistage stratified sampling approach. A multivariable logistic regression analysis was used to determine factors associated with malnutrition among 15-49-year-old women in Sierra Leone.

RESULTS

Among 15-49-year-old women in Sierra Leone, the prevalence of underweight was 6.7% (95%CI: 4.5-8.9%); overweight at 19.7% (95%CI: 17.7-21.7%); obesity was 7.4% (95% CI: 5.2-9.6%); and overnutrition, 27.1% (95%CI: 25.2-29.0%). Women aged 25-34 years were more likely to be underweight (adjusted Odds Ratios, aOR = 1.670, 95%CI: 1.254-2.224; p < 0.001) than those aged 15-24 years; women who were not married were less likely to be underweight (aOR = 0.594, 95%CI: 0.467-0.755; p < 0.001) than married women. Women from the North were less likely to be underweight (aOR = 0.734, 95%CI: 0.559-0.963; p = 0.026) than the East, and those who did not listen to the radio were less likely to be underweight (aOR = 0.673; 95%CI: 0.549-0.826; p < 0.001) than those who did. Overweight was less likely among 25-34 years (aOR = 0.609, 95%CI: 0.514-0.722; p < 0.001) and 35-49 years (aOR = 0.480, 95%CI: 0.403-0.571; p < 0.001) age-groups than 15-24 years; more likely among not married women (aOR = 1.470, 95%CI:1.249-1.730; p < 0.001) than married; less likely among working-class (aOR = 0.840, 95%CI: 0.720-0.980; p = 0.026) than not working-class; most likely in women from the North (aOR = 1.325, 95%CI:1.096-1.602; p = 0.004), and less likely among women from the South (aOR = 0.755, 95%CI: 0.631-0.903; p = 0.002) than the East; less likely among women of middle-wealth-index (aOR = 0.656, 95%CI: 0.535-0.804; p < 0.001), richer-wealth-index (aOR = 0.400, 95%CI: 0.309-0.517; p < 0.001), and richest-wealth-index (aOR = 0.317, 95%CI: 0.234-0.431; p < 0.001) than the poorest-wealth-index; and more likely among women who did not listen to radios (aOR = 1.149; 95%CI:1.002-1.317; p = 0.047) than those who did. The predictors of overweight among women 15-49 years are the same as obesity and overnutrition, except overnutrition and obesity were less likely in female-headed households (aOR = 0.717,95%CI: 0.578-0.889; p < 0.001).

CONCLUSION

The prevalence of all categories of malnutrition among women of reproductive age in Sierra Leone is high, affirming a double burden of malnutrition in this study population. Underweight was more likely among the 25-34-year age group than 15-24-year. The predictors of overweight, obesity, and overnutrition were being unmarried/single, residing in the North, and not listening to the radio. There is an urgent need for policymakers in Sierra Leone to design comprehensive educational programs for women of reproductive age on healthy lifestyles and the dangers of being underweight or over-nourished.

The psychological legacy of past obesity and early mortality: evidence from two longitudinal studies

BACKGROUND

We test a novel 'weight scarring' hypothesis which suggests that past obesity is associated with impairments in current psychological well-being and this increases risk of negative physical health outcomes associated with obesity. Across two nationally representative studies, we tested whether past obesity is associated with current psychological outcomes and whether these psychological outcomes explain the association between past obesity and subsequent early mortality.

METHODS

Data were from the National Health and Nutrition Examination Survey (NHANES) (n = 29,047) and the Health and Retirement Study (HRS) (n = 11,998). Past obesity was defined based on maximum lifetime weight in NHANES and the highest weight from past study waves in the HRS. Across both studies, current depressive symptoms were analysed. A set of 10 additional well-being measures were combined to produce an 'index of impaired well-being' in HRS. Subsequent all-cause mortality was examined using National Deaths Index records in NHANES and household interviews in HRS. Linear or logistic regression, Cox proportional hazard regression, and causal mediation models were used.

RESULTS

We found that past obesity was associated with greater current depressive symptoms after controlling for current weight status and in analyses limited to those who were no longer classified as having obesity in NHANES (β = 0.17; 95% CI: 0.13, 0.22) and HRS (β = 0.20; 95% CI: 0.08, 0.31). In HRS, past obesity was also associated with a range of current negative psychological outcomes, including an index of impaired psychological well-being (β = 0.16; 95% CI: 0.05, 0.27). Past obesity was associated with a higher risk of early mortality in both NHANES and HRS (HR = 1.31; 95% CI: 1.16, 1.48 and HR = 1.34; 95% CI: 1.20, 1.50, respectively). Depressive symptoms explained 6% (95% CI: 0.01, 0.10) and 5% (95% CI: 0.01, 0.09) of the association between past obesity and premature mortality in NHANES and HRS, respectively. Impaired psychological well-being partly mediated the association between past obesity and premature mortality by 10% (95% CI: 0.04, 0.16) in HRS.

CONCLUSIONS

Our findings suggest that there may be a psychological legacy of past obesity that is associated with raised mortality risk. Ensuring people with obesity receive psychological support even after experiencing weight loss may be important.

Ultra-processed foods in a rural Ecuadorian community: associations with child anthropometry and bone maturation

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.

Food and Nutrition Surveillance System markers predict diet quality

OBJECTIVE

To investigate the performance of food consumption markers of the Food and Nutrition Surveillance System (Sisvan) in assessing the overall dietary quality.

METHODS

The study was carried out based on the reproduction of responses to markers in 24-hour recall data from 46,164 individuals aged ≥ 10 years, from the 2017-2018 Household Budget Survey (POF). Seven Sisvan markers were evaluated, and two scores were calculated for each participant, based on the sum of the number of healthy food markers (beans, fruits, and vegetables, ranging from 0 to 3) and unhealthy (hamburgers/sausages, sweetened beverages, instant noodles/salt snacks/crackers, stuffed cookies/sweets/candies, ranging from 0 to 4) consumed. Linear regression analyses were used to assess the association between scores and diet quality indicators (ultra-processed foods, dietary diversity, and levels of saturated and trans fat, added sugar, sodium, potassium, and fiber in the diet).

RESULTS

The score of healthy eating markers increased significantly with increasing dietary diversity and potassium and fiber contents in the diet, while the opposite trend was observed for the densities of added sugar, sodium, saturated and trans fat (p < 0.001). The score of unhealthy eating markers increased significantly with the increase in the consumption of ultra-processed foods and densities of added sugar, saturated and trans fat levels in the diet, while an inverse trend was observed for potassium and fiber (p < 0.001). The joint analysis of the combination of the two marker scores showed that individuals with better performance (3 in the healthy food score, and 0 in the unhealthy food score) have a lower number of inadequacies in nutrient consumption.

CONCLUSION

Sisvan food consumption markers, quickly and easily applied and already incorporated into the Brazilian public health system, have good potential to reflect the overall dietary quality.

Perspective: A Research Roadmap about Ultra-Processed Foods and Human Health for the United States Food System: Proceedings from an Interdisciplinary, Multi-Stakeholder Workshop

Our objective was to convene interdisciplinary experts from government, academia, and industry to develop a Research Roadmap to identify research priorities about processed food intake and risk for obesity and cardiometabolic diseases (CMD) among United States populations. We convened attendees at various career stages with diverse viewpoints in the field. We held a "Food Processing Primer" to build foundational knowledge of how and why foods are processed, followed by presentations about how processed foods may affect energy intake, obesity, and CMD risk. Breakout groups discussed potential mechanistic and confounding explanations for associations between processed foods and obesity and CMD risk. Facilitators created research questions (RQs) based on key themes from discussions. Different breakout groups convened to discuss what is known and unknown for each RQ and to develop sub-RQs to address gaps. Workshop attendees focused on ultra-processed foods (UPFs; Nova Group 4) because the preponderance of evidence is based on this classification system. Yet, heterogeneity and subjectivity in UPF classification was a challenge for RQ development. The 6 RQs were: 1) What objective methods or measures could further categorize UPFs, considering food processing, formulation, and the interaction of the two? 2) How can exposure assessment of UPF intake be improved? 3) Does UPF intake influence risk for obesity or CMDs, independent of diet quality? 4) What, if any, attributes of UPFs influence ingestive behavior and contribute to excess energy intake? 5) What, if any, attributes of UPFs contribute to clinically meaningful metabolic responses? 6) What, if any, external environmental factors lead people to consume high amounts of UPFs? Uncertainty and complexity around UPF intake warrant further complementary and interdisciplinary causal, mechanistic, and methodological research related to obesity and CMD risk to understand the utility of applying classification by degree of processing to foods in the United States.

Association of ultra-processed foods consumption with risk of cardio-cerebrovascular disease: A systematic review and meta-analysis of cohort studies

AIMS

The epidemiological evidence regarding the impact of ultra-processed foods (UPFs) on the risk of cardio-cerebrovascular diseases (CCVDs) is controversial. The aim of this systematic review and meta-analysis is to examine the association between UPF consumption and the risk of CCVDs within cohort studies.

DATA SYNTHESIS

A systematic literature search was conducted across multiple databases, including PubMed/Medline, Embase, Web of Science, Scopus, and the Cochrane Library databases, covering the inception of these databases up until January 1st, 2023. A total of 39 cohort studies involving 63,573,312 human participants were deemed eligible according to the inclusion criteria. Utilizing random-effects models, risk ratios (RRs) were estimated to determine the pooled results. Our findings indicate a significant association between a higher consumption of UPF and an increased likelihood of CCVDs (RR: 1.08, 95% CI: 1.01-1.16, I2 = 89%; p < 0.01) compared to individuals who either abstain from or consume lesser amounts of UPF. Nonlinear dose-response meta-analyses showed that a consistent high intake of UPFs was associated with an elevated risk of developing CCVDs (p non-linearity <0.001). Notably, the risk of CCVDs escalated by approximately 7% with an UPF intake of up to 1 serving per day. Subgroup analysis further revealed a significant augmentation in the risk of total CVD and hypertension with increased UPF consumption.

CONCLUSIONS

A higher intake of UPF significantly increases the risk of developing CCVDs. Prospective studies controlling for confounding factors are needed to validate the relationship between UPF intake and the development of CCVDs.

Consumption of ultra-processed foods and cardiometabolic risk factors in Brazilian adolescents: results from ERICA

INTRODUCTION

The consumption of ultra-processed foods (UPF) has increased over the past few decades. However, few studies have investigated the association between UPF consumption and cardiometabolic risk factors in adolescents from developing countries.

OBJECTIVE

To evaluate the association between UPF consumption and cardiometabolic risk factors in Brazilian adolescents.

METHODS

This study included students aged 12-17 years who participated in the ERICA. Food consumption was assessed using a 24-h food recall, and the foods were classified based on their degree of processing, utilizing the NOVA classification. Participants' blood samples were collected after an overnight fast and exams were performed (triglycerides, total cholesterol, HDL-c, LDL-c, fasting glucose, insulin, and HbA1c). Overweight/obesity and blood pressure were also investigated. Associations were evaluated using Poisson regression models.

RESULTS

The analysis included a total of 36,952 adolescents. The energy consumption from UPF was 30.7% (95%CI: 29.7-31.6) per day. Adolescents with high UPF consumption, defined as the top tertile (≥38.7% per day), were observed to have higher intake of sodium, saturated and trans-fat, while having lower intake of proteins, fibers, polyunsaturated fats, vitamins and minerals. After adjusting for potential confounders, it was observed that higher UPF consumption was directly associated with high LDL-c (PR = 1.012; 95%CI: 1.005-1.029) and inversely with low HDL-c (PR = 0.972; 95%CI: 0.952-0.993). No associations were found between UPF consumption and other cardiometabolic risk factors.

CONCLUSION

Brazilian adolescents have presented a high consumption of UPF, which is associated to poor diet quality and can contribute to elevated LDL-c levels.

Food preferences and periodontal status of adults assisted by a public health care system

This study aimed to investigate the relationship between food choices and periodontal health status (PHS) in adults who receive care through a public health system. We evaluated food preferences and periodontal status in a sample of 442 individuals with at least eight natural teeth. We employed the Food Frequency Questionnaire (FFQ) to assess food choices and the Periodontal Screening and Recording (PSR) instrument to evaluate periodontal health status during clinical appointments. Fisher's discriminant analysis was used to differentiate the participants according to PHS severity within three age-ranges (18-39; 40-59 and > 60 years-old). The results showed that the prevalence of overweight/obesity was high in all age groups (above 65%), and BMI increased with age, accompanied by an increase in the prevalence of chronic diseases. A lower preference for natural foods and a higher intake of processed and ultra-processed foods, along with a high waist circumference and diabetes, were associated with a poorer periodontal health status. In the 18-39 age group, a lower waist circumference was associated with healthier periodontal status. In the 40-59 age group, a worse periodontal status resulted from a higher frequency of diabetes, lower intake of green leafy vegetables, olive oil, and fruit, and higher intake of industrialized juice. Conversely, a healthier periodontal status was associated with a lower frequency of diabetes and higher intake of fruit and vegetables. In the > 60age group, the worst periodontal status was associated with male sex. Overall, the study highlights the possible beneficial role of a healthy diet in maintaining periodontal health, particularly for those who receive care through a public health system.

The Longitudinal Effect of Ultra-Processed Food on the Development of Dyslipidemia/Obesity as Assessed by the NOVA System and Food Compass Score

SCOPE

Ultra-processing food (UPF) has been a nutrition and health interest. This study is aimed to investigate the association between UPF consumption and the risk of obesity or dyslipidemia.

METHODS AND RESULTS

This study is performed using an ongoing cohort study including 17 310 individuals aged ≥40 years in South Korea. UPF is categorized by the NOVA system and FCS, respectively. After an average 5-year follow-up, there is a positive association between NOVA-defined UPF and dyslipidemia. The risk of the Q4 group is almost 20% higher than that of the Q1 group (men, adjusted HR = 1.209 [95% CI 1.039-1.407], women, adjusted HR = 1.195 [95% CI 1.096-1.303]). Consuming high-FCS foods (less processed and healthier foods) show a lower risk for dyslipidemia in both sexes and lower obesity risk in women compared to low-FCS consumption (men, dyslipidemia, adjusted HR = 0.857 [95% CI 0.744-0.988]; women, dyslipidemia, adjusted HR = 0.919 [95% CI 0.850-0.993], obesity, adjusted HR = 0.759 [95% CI 0.628-0.916]).

CONCLUSION

Higher UPF intakes assessed by the NOVA system and FCS are associated with increased incidences of dyslipidemia and obesity. Furthermore, NOVA-defined UPF shows a statistically significant negative association with AMED score, indicating poor diet quality.

Speed limits: the effects of industrial food processing and food texture on daily energy intake and eating behaviour in healthy adults

PURPOSE

Frequent consumption of industrially processed foods has been associated with obesity. However, it is unknown what drives this association. Food textures of industrially processed foods that stimulate energy overconsumption may be an important driver of this association. Therefore, this study aimed to determine the independent and combined effects of food texture and level of industrial food processing (based on the NOVA classification) on daily energy intake and eating behaviour.

METHODS

Eighteen healthy adults (F/M: 11/7, 23 ± 3 y, 22.1 ± 2.0 kg/m2) participated in a 2 × 2 randomized crossover dietary intervention with four conditions (total of 288 meals): hard unprocessed, hard (ultra-)processed, soft unprocessed and soft (ultra-)processed. Daily diets were offered ad libitum and were equal in energy density (1 kcal/g). Food Intake (g) was measured by pre- and post-consumption weighing of the plates. Eating behaviour parameters were derived from video annotations.

RESULTS

Daily energy intake and food intake were, respectively, 33% (571 ± 135 kcal) and 14% (247 ± 146 g) lower in the hard compared to the soft conditions (main texture p < 0.001). Energy intake was lower in both hard conditions compared to the (ultra)processed soft condition (Tukey p < 0.04). Eating rate (g/min) was on average 85% slower (P < 0.001) in the hard compared to the soft conditions (p < 0.001). Level of processing did not affect food intake.

CONCLUSION

Consumption of hard-textured foods reduces daily energy intake of (ultra-) processed foods. This preliminary investigation shows that there is great variability in food properties that affect energy and food intake beyond industrial food processing. However, findings should be interpreted with precaution considering the limited sample size of this trial. Future classification systems for public health messaging should include energy intake rate to help reduce overconsumption.

CLINICAL TRIAL REGISTRY

NCT04280146, https://www.

CLINICALTRIALS

gov , February 21st 2020.

Chronic hyperpalatable diet induces impairment of hippocampal-dependent memories and alters glutamatergic and fractalkine axis signaling

Chronic consumption of hyperpalatable and hypercaloric foods has been pointed out as a factor associated with cognitive decline and memory impairment in obesity. In this context, the integration between peripheral and central inflammation may play a significant role in the negative effects of an obesogenic environment on memory. However, little is known about how obesity-related peripheral inflammation affects specific neurotransmission systems involved with memory regulation. Here, we test the hypothesis that chronic exposure to a highly palatable diet may cause neuroinflammation, glutamatergic dysfunction, and memory impairment. For that, we exposed C57BL/6J mice to a high sugar and butter diet (HSB) for 12 weeks, and we investigated its effects on behavior, glial reactivity, blood-brain barrier permeability, pro-inflammatory features, glutamatergic alterations, plasticity, and fractalkine-CX3CR1 axis. Our results revealed that HSB diet induced a decrease in memory reconsolidation and extinction, as well as an increase in hippocampal glutamate levels. Although our data indicated a peripheral pro-inflammatory profile, we did not observe hippocampal neuroinflammatory features. Furthermore, we also observed that the HSB diet increased hippocampal fractalkine levels, a key chemokine associated with neuroprotection and inflammatory regulation. Then, we hypothesized that the elevation on glutamate levels may saturate synaptic communication, partially limiting plasticity, whereas fractalkine levels increase as a strategy to decrease glutamatergic damage.