The degree of processing of foods which are most widely consumed by the French elderly population is associated with satiety and glycemic potentials and nutrient profiles

Isocaloric replacement of ultraprocessed foods was associated with greater weight loss in the POUNDS Lost trial

OBJECTIVE

Higher intake of ultraprocessed foods (UPFs) is associated with obesity. We examined whether replacing UPFs (NOVA 4) with minimally processed foods and culinary ingredients (NOVA 1 + 2) was associated with differential weight change in this secondary prospective analysis of the Preventing Overweight Using Novel Dietary Strategies (POUNDS) Lost trial.

METHODS

We estimated percent energy intake (%kcal) from the four NOVA groups using 24-h dietary recalls in a subset of 356 participants. Multivariable-adjusted substitution models examined whether replacing %kcal from UPFs with NOVA 1 + 2 was associated with greater weight, body fat percentage, trunk fat, and waist circumference reduction at 6 months; changes in parameters were compared among NOVA 1 + 2 tertiles (T).

RESULTS

Participants were on average 52.3 years of age, 85% White, 55% female, and 58.2% nonsmoking, with a mean BMI of 32.7 kg/m2. Replacing 10%kcal of UPFs with NOVA 1 + 2 was associated with greater 6-month weight (ß = 0.51, 95% CI: -0.93 to -0.09, p = 0.02), body fat percentage (ß = 2.7, 95% CI: -5.10 to -0.43, p = 0.02), and trunk fat reduction (ß = 3.9, 95% CI: -7.01 to -0.70, p = 0.02), but not waist circumference reduction. Participants in T3 (-8.33 kg) versus T1 (-5.32 kg) of NOVA 1 + 2 had greater weight loss (p < 0.001).

CONCLUSIONS

Isocaloric substitution of UPFs with NOVA 1 + 2 was associated with marginally greater weight loss under energy restriction. These modest findings support more research exploring the mechanisms linking UPFs with body weight regulation beyond energy intake.

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.

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

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

Is Ultra-Processed Food Intake Associated with a Higher Risk of Glaucoma? A Prospective Cohort Study including 19,255 Participants from the SUN Project

OBJECTIVE

The aim of this study was to examine the relationship of ultra-processed food (UPF) intake with the incidence of glaucoma in a large sample of Spanish university graduates followed prospectively.

METHODS

Prospective cohort study using data from the SUN Project. A final sample of 19,225 participants (60.1% women) was included in this study, with a mean age of 38.2 years (standard deviation (SD) = 12.4). Participants were followed-up for a mean time of 12.9 years (SD = 5.4). Dietary intake was measured using a 136-item semiquantitative food-frequency questionnaire. UPFs were defined based on the NOVA classification system. Glaucoma diagnosis was determined by asking the participants if they had ever been diagnosed with glaucoma by an ophthalmologist. This self-reported diagnosis of glaucoma has been previously validated.

RESULTS

After adjusting for several covariates, participants with the highest UPF consumption were at higher risk of glaucoma (hazard ratio (HR) = 1.83; 95% confidence interval (CI) 1.06 to 3.17) when compared to participants in the lowest category of UPF consumption. Regarding subgroup analyses, a significant multiplicative interaction was found for age (p = 0.004) and omega 3:6 ratio (p = 0.040). However, an association between UPF consumption and glaucoma was only found in older participants (aged ≥ 55 years), in men, in the most physically active group, in the group of non- or former smokers, in those with a lower omega 3:6 ratio, and in those with a lower energy intake. Regarding the contribution of each type of UPF group, UPF coming from sweets showed a significant risky effect (HR = 1.51; CI 95% 1.07 to 2.12).

CONCLUSIONS

This prospective cohort study shows that participants with a greater UPF consumption have a higher risk of developing glaucoma when compared to participants with a lower consumption. Our findings emphasize the relevance of monitoring and limiting the consumption of UPFs as a means of preventing glaucoma incidence.

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.

Designing healthier and more sustainable ultraprocessed foods

The food industry has been extremely successful in creating a broad range of delicious, affordable, convenient, and safe food and beverage products. However, many of these products are considered to be ultraprocessed foods (UPFs) that contain ingredients and are processed in a manner that may cause adverse health effects. This review article introduces the concept of UPFs and briefly discusses food products that fall into this category, including beverages, baked goods, snacks, confectionary, prepared meals, dressings, sauces, spreads, and processed meat and meat analogs. It then discusses correlations between consumption levels of UPFs and diet-related chronic diseases, such as obesity and diabetes. The different reasons for the proposed ability of UPFs to increase the risk of these chronic diseases are then critically assessed, including displacement of whole foods, high energy densities, missing phytochemicals, contamination with packaging chemicals, hyperpalatability, harmful additives, rapid ingestion and digestion, and toxic reaction products. Then, potential strategies to overcome the current problems with UPFs are presented, including reducing energy density, balancing nutritional profile, fortification, increasing satiety response, modulating mastication and digestion, reengineering food structure, and precision processing. The central argument is that it may be possible to reformulate and reengineer many UPFs to improve their healthiness and sustainability, although this still needs to be proved using rigorous scientific studies.

Prediagnosis ultra-processed food consumption and prognosis of patients with colorectal, lung, prostate, or breast cancer: a large prospective multicenter study

Background and aims

Whether ultra-processed food consumption is associated with cancer prognosis remains unknown. We aimed to test whether prediagnosis ultra-processed food consumption is positively associated with all-cause and cancer-specific mortality in patients with colorectal, lung, prostate, or breast cancer.

Methods

This study included 1,100 colorectal cancer patients, 1750 lung cancer patients, 4,336 prostate cancer patients, and 2,443 breast cancer patients. Ultra-processed foods were assessed using the NOVA classification before the diagnosis of the first cancer. Multivariable Cox regression was used to calculate hazard ratio (HR) and 95% confidence interval (CI) for all-cause and cancer-specific mortality.

Results

High ultra-processed food consumption before cancer diagnosis was significantly associated with an increased risk of all-cause mortality in lung (HRquartile 4 vs. 1: 1.18; 95% CI: 0.98, 1.40; Ptrend = 0.021) and prostate (HRquartile 4 vs. 1: 1.18; 95% CI: 1.00, 1.39; Ptrend = 0.017) cancer patients in a nonlinear dose-response manner (all Pnonlinearity < 0.05), whereas no significant results were found for other associations of interest. Subgroup analyses additionally revealed a significantly positive association with colorectal cancer-specific mortality among colorectal cancer patients in stages I and II but not among those in stages III and IV (Pinteraction = 0.006), and with prostate cancer-specific mortality among prostate cancer patients with body mass index <25 but not among those with body mass index ≥25 (Pinteraction = 0.001).

Conclusion

Our study suggests that reducing ultra-processed food consumption before cancer diagnosis may improve the overall survival of patients with lung or prostate cancer, and the cancer-specific survival of certain subgroups of patients with colorectal or prostate cancer.

Ultraprocessed Foods and Obesity Risk: A Critical Review of Reported Mechanisms

Epidemiologic evidence supports a positive association between ultraprocessed food (UPF) consumption and body mass index. This has led to recommendations to avoid UPFs despite very limited evidence establishing causality. Many mechanisms have been proposed, and this review critically aimed to evaluate selected possibilities for specificity, clarity, and consistency related to food choice (i.e., low cost, shelf-life, food packaging, hyperpalatability, and stimulation of hunger/suppression of fullness); food composition (i.e., macronutrients, food texture, added sugar, fat and salt, energy density, low-calorie sweeteners, and additives); and digestive processes (i.e., oral processing/eating rate, gastric emptying time, gastrointestinal transit time, and microbiome). For some purported mechanisms (e.g., fiber content, texture, gastric emptying, and intestinal transit time), data directly contrasting the effects of UPF and non-UPF intake on the indices of appetite, food intake, and adiposity are available and do not support a unique contribution of UPFs. In other instances, data are not available (e.g., microbiome and food additives) or are insufficient (e.g., packaging, food cost, shelf-life, macronutrient intake, and appetite stimulation) to judge the benefits versus the risks of UPF avoidance. There are yet other evoked mechanisms in which the preponderance of evidence indicates ingredients in UPFs actually moderate body weight (e.g., low-calorie sweetener use for weight management; beverage consumption as it dilutes energy density; and higher fat content because it reduces glycemic responses). Because avoidance of UPFs holds potential adverse effects (e.g., reduced diet quality, increased risk of food poisoning, and food wastage), it is imprudent to make recommendations regarding their role in diets before causality and plausible mechanisms have been verified.

Ultra-processed food consumption and increased risk of metabolic syndrome: a systematic review and meta-analysis of observational studies

Background

Although higher consumption of ultra-processed food (UPF) has been linked to a higher risk of metabolic syndrome (MetS), the results remain controversial. Herein, we performed a systematic review and meta-analysis of observational studies to clarify the relationship between UPF consumption defined by the NOVA framework and risk of MetS.

Methods

An extensive literature search on PubMed, ISI Web of Science, EBSCO and China National Knowledge Infrastructure (CNKI) databases was conducted to search for the relevant articles published priori to January 2023, and newly published articles between January 2023 and March 2023 were re-searched. Random-effects or fixed-effects models were adopted to calculate the pooled relative risks (RRs) and 95% confidence intervals (CIs). The between-study heterogeneity was explored using the Cochran's Q test and I-square (I²). Publication bias was investigated using the visual inspection of asymmetry in funnel plots and Begg's and Egger's tests.

Results

Nine studies (six cross-sectional and three prospective cohort studies) totaling 23,500 participants with 6,192 MetS cases were included in the final analysis. The pooled effect size for the highest vs. lowest categories of UPF consumption indicated a positive association with the risk of MetS (RR: 1.25, 95%CI: 1.09-1.42, P < 0.0001). Subgroup analyses revealed a positive association between consumption of UPF and MetS risk in cross-sectional studies (RR: 1.47, 95%CI: 1.16-1.87, P = 0.002), and no significant association in cohort studies (RR: 1.10, 95%CI: 0.96-1.27, P = 0.104), respectively. In addition, a more significant association between UPF consumption and increased risk of MetS was found in the subgroups of study quality <7 (RR: 2.22; 95%CI: 1.28-3.84, P = 0.004) than study quality ≥7 (RR: 1.20; 95%CI: 1.06-1.36, P = 0.005). Similarly, when we performed analyses separately by sample size, there was a significant association between UPF consumption and MetS risk in sample size ≥5,000 (RR: 1.19; 95%CI: 1.11-1.27, P < 0.0001), and in sample size <5,000 (RR: 1.43; 95%CI: 1.08-1.90, P = 0.013), respectively.

Conclusions

Our findings suggest that higher consumption of UPF is significantly associated with an increased risk of MetS. Further longitudinal studies are needed to confirm the effect of UPF consumption on MetS.

Increased ultra-processed food consumption is associated with worsening of cardiometabolic risk factors in adults with metabolic syndrome: Longitudinal analysis from a randomized trial

BACKGROUND AND AIMS

The association between changes in ultra-processed food (UPF) consumption and cardiometabolic risk (CMR) factors remains understudied. We evaluated the association between changes in UPF consumption over 12 months of follow-up and changes in CMR factors in adults diagnosed with metabolic syndrome.

METHODS

We analysed data from 5373 adults (aged 55-75 years) participating in the PREDIMED-Plus trial. Diet was evaluated at baseline, 6- and 12-month visits using a validated food frequency questionnaire, and UPF consumption (in grams/day and percentage of total daily dietary intake in grams) was categorized based on NOVA classification. We used mixed-effects linear models with repeated measurements at baseline, 6 and 12 months of follow-up to assess the associations between changes in UPF consumption and changes in CMR factors adjusting for sociodemographic and lifestyles variables.

RESULTS

In multivariable-adjusted models, when comparing the highest versus the lowest quartile of UPF consumption, positive associations were found for several CMR factors: weight (kg, β = 1.09; 95% confidence interval 0.91 to 1.26); BMI (kg/m², β = 0.39; 0.33 to 0.46); waist circumference (cm, β = 1.03; 0.81 to 1.26); diastolic blood pressure (mm Hg, β = 0.67; 0.29 to 1.06); fasting blood glucose (mg/dl, β = 1.66; 0.61 to 2.70); HbA1c (%, β = 0.04; 0.01 to 0.07); triglycerides (mg/dl, β = 6.79; 3.66 to 9.91) and triglycerides and glucose index (β = 0.06; 0.04 to 0.08).

CONCLUSIONS

Higher UPF consumption was associated with adverse evolution in objectively measured CMR factors after 12 months of follow-up in adults with metabolic syndrome. Further research is needed to explore whether these changes persist for longer periods.

Association between Ultra-Processed Food Consumption and Metabolic Syndrome among Adults in China-Results from the China Health and Nutrition Survey

The prevalence of metabolic syndrome (MetS) is increasing and the relationship between ultra-processed food (UPF) consumption and MetS remains uncertain in Chinese adults. This study aimed to examine the longitudinal association of UPF consumption with the risk of MetS and its components in Chinese adults. Adults aged 18 years and above who participated in at least two waves of the China Health and Nutrition Survey (CHNS) in 2009, 2015, and 2018 were included in this analysis. Dietary intake data were collected by three consecutive 24 h dietary recalls and weighing household foods and condiments. Depending on the purpose and extent of food processing, UPFs were classified using the NOVA food classification system. A multivariate Cox proportional risk model was used to explore the association between UPF consumption (grouped by quartile: quartile 1 (Q1), quartile 2 (Q2), quartile 3 (Q3), and quartile 4 (Q4)) and risk of MetS and its components. A total of 5147 adults were included. During a median (IQR) 6.0 (3.0, 9.0) year follow-up with 31,878 person-years, 1712 MetS cases were identified, with an incidence of 33.26%. After multivariable adjustment, the risk of MetS was increased by 17% in the highest quartile with UPF consumption (HR: 1.17, 95% CI: 1.01-1.35, p trend: 0.047), with the lowest quartile as a reference. For the components of MetS, the risk of central obesity, raised triglycerides (TG), reduced high-density lipoprotein cholesterol (HDL-C), and raised blood pressure (BP) was increased by 33% (HR: 1.33, 95% CI: 1.18-1.51, p trend: <0.001), 26% (HR: 1.26, 95% CI: 1.08-1.48, p trend: 0.003), 25% (HR: 1.25, 95% CI: 1.07-1.46, p trend: 0.007), and 16% (HR: 1.16, 95% CI: 1.03-1.32, p trend: 0.018) in the highest quartile with UPF consumption, respectively. Adults aged 45-59 years and living in urban areas with higher UPF consumption had higher odds of MetS. These results indicate that higher long-term UPF consumption was associated with an increased risk of MetS in Chinese adults. Further studies such as intervention trials are needed to confirm the mechanism of correlation between UPF consumption and health-related outcomes. Nutritional education actions are warranted to promote a balanced diet and improve the overall dietary quality of residents to reduce the risk of MetS effectively.

Premature Deaths Attributable to the Consumption of Ultraprocessed Foods in Brazil

INTRODUCTION

Ultraprocessed foods have been associated with an increased risk of noncommunicable diseases, such as diabetes, cardiovascular diseases, and cancer as well as all-cause mortality. The study aimed to estimate premature deaths attributable to the consumption of ultraprocessed food in Brazil.

METHODS

A comparative risk assessment model was developed on the basis of RRs from a recent meta-analysis, national food consumption for 2017-2018, and demographic and mortality data for 2019. Population attributable fractions for all-cause mortality were then estimated within each sex and age stratum according to the distribution of the ultraprocessed food contribution to the total energy of the diet. Analysis was conducted in February 2022-April 2022.

RESULTS

The contribution of ultraprocessed foods to the total energy intake of the diet across sex and age stratum of Brazilian adults ranged from 13% to 21% of the total energy intake. A total of 541,160 adults aged 30‒69 years died in 2019. The consumption of ultraprocessed foods was responsible for approximately 57,000 premature deaths (95% uncertainty interval=33,493, 82,570) or 10.5% of all premature deaths in adults aged 30‒69 years. Reducing the contribution of ultraprocessed foods to the total energy intake by 10%‒50% could potentially prevent 5,900 deaths (95% uncertainty interval=2,910, 10,613) to 29,300 deaths (95% uncertainty interval=16,514, 44,226), respectively.

CONCLUSIONS

The consumption of ultraprocessed foods represents a significant cause of premature death in Brazil. Reducing ultraprocessed food intake would promote substantial health gains for the population and should be a food policy priority to reduce premature mortality.

The influence of dough kneading time and flour particle size distribution on white bread structure, glycemic response and aspects of appetite

BACKGROUND & AIMS

White bread is widely consumed in many countries despite being a high-glycemic index (GI) food. It has been shown that the "food matrix effect" may help with diabetes and obesity management through lowering GI and appetite. This study aimed at investigating the effects of dough kneading time and flour particle size on white bread structure, glycemic response, and aspects of appetite.

METHODS

A two-phase randomized cross-over design was used in 10 healthy subjects over the course of 2 h. In phase 1, Texture Profile Analysis (TPA) attributes, Scanning Electron Microscope (SEM) image, glycemic response, and appetite aspects of white bread made with a 15-min dough kneading time (K15) were compared with white bread made with a 10-min dough kneading time (K10). In phase 2, TPA, SEM image, glycemic response, and satiety score of white bread made with coarse flour (CF) were compared to white bread made with fine flour (FF).

RESULT

With increasing hardness (force required to compress a food between the molars to a given deformation), total blood glucose IAUC in K15 (IAUC = 119 ± 12; GI = 66) was significantly (p < 0.05) lower than in K10 (IAUC = 154 ± 10; GI = 81). No marked difference was observed between K15 and K10 on aspects of appetite except for hunger. There was no significant (p > 0.05) difference in glycemic response between CF (IAUC = 126 ± 18; GI = 64) and FF (IAUC = 147 ± 12; GI = 81). Similarly, no discernible difference in satiety between CF and FF.

CONCLUSION

Changes in processing conditions can improve blood glucose response relalated to white bread consumption.

The estimated burden of ultra-processed foods on cardiovascular disease outcomes in Brazil: A modeling study

Introduction

Ultra-processed foods (UPF) have been associated with an increased risk of cardiovascular diseases (CVD). This study aimed to estimate CVD premature deaths, incident cases, and disability adjusted life-years (DALYs) attributable to the consumption of UPF in Brazilian adults in 2019.

Methods

A validated a comparative risk assessment model was adapted to estimate the burden of major CVD outcomes (coronary heart disease and stroke) attributable to the consumption of UPF in Brazilian adults aged 30 to 69 years. The model inputs included nationally representative data of the UPF contribution to the total energy of the diet, national official demographic records, CVD outcomes (incidence, deaths and DALYs) from the Global Burden of Disease study for 2019, and relative risks from meta-analysis studies.

Results

We estimated that approximately 19,200 premature deaths (95% uncertainty intervals - UI, 7,097 to 32,353), 74,900 new cases (95% UI, 25,983 to 128,725), and 883,000 DALYs/year (95% UI, 324,279 to 1,492,593) from CVD were attributable to the consumption of UPF in Brazil, corresponding to about 22% of the premature deaths from CVD and to 33% of the total premature all-cause deaths attributable to UPF intake among Brazilian adults. Reducing UPF consumption by 10% in the adult population would avert approximately 11% of the premature CVD deaths, equivalent to 2,100 deaths/year (95% UI, 697 to 4,511). A 20% reduction in UPF intake would avert approximately 21% of the premature CVD deaths or 4,100 deaths (95% UI, 1,413 to 8,047), and a 50% reduction in UPF intake would avert about 52% of the premature CVD deaths, corresponding to 9,900 deaths/year (95% UI, 3,682 to 17,820). If UPF consumption among adults was reduced to that of the first quintile of UPF intake in the baseline scenario, approximately 81% of the premature CVD deaths would be averted, corresponding to some 15,600 deaths/year (95% UI, 5,229 to 27,519).

Conclusion

Our study estimated a high burden of premature CVD outcomes attributable to the consumption of UPF in Brazil. Our findings support food policies aimed at reducing the consumption of UPF, such as fiscal and regulatory policies, which are imperative to prevent CVD in Brazil.

Ultra-processed food consumption and its association with nutritional, functional, and health characteristics in Brazilian elders

Aims: to estimate the dietary energy contribution of ultra-processed foods and the association on nutritional dietary profile, nutritional status, chronic disease, and functional capacity of Brazilian elders. Methods: we performed an epidemiology cross-sectional study conducted with 332 participants (≥60 years old). Food consumption was measured by three 24-h food recall. Foods were classified according to NOVA classification as in natura/minimally processed foods, processed culinary ingredients, processed foods, and ultra-processed foods. Anthropometric variables were used to assess nutritional status, and scales of activities of daily living to assess functional capacity. Chronic diseases were self-reported. Results: the average daily consumption of energy was 2433,96 kcal, being 10.44% from ultra-processed foods. Elders with higher ultra-processed foods intake showed higher consumption of energy, added sugar, total and saturated fat, and fewer consumption of proteins, fibres, potassium, magnesium, iron, zinc, copper, selenium, B6 vitamin e folate. Most participants were independent for functional capacity, overweight, and very high risk for cardiovascular disease, but no statistical significance was observed. No association was found between ultra-processed foods and nutritional dietary profile, nutritional status, chronic disease, and functional capacity. Conclusions: elders who had the highest ultra-processed foods consumption had lower diet quality, although no influences on nutritional status and health variables assessed were observed in this sample. 

Is there any putative mediatory role of inflammatory markers on the association between ultra-processed foods and resting metabolic rate?

The resting metabolic rate (RMR) represents the largest component of total daily energy expenditure. The sale of ultra-processed foods (UPF) is increasing globally; however, UPF can have many adverse effects, including increasing inflammatory markers and altering RMRs. This cross-sectional study included 285 healthy overweight and obese women. Anthropometric measurements were evaluated using a bioelectrical impedance analyzer InBody 770 scanner. High-sensitivity C-reactive protein (hs-CRP), plasminogen activator-1 (PAI-1), monocyte chemoattractant protein (MCP-1), and interleukin-1 beta (IL-1β) blood levels were measured after a 12-h fasting. Indirect calorimetry was used to evaluate the RMR by using the Weir equation, and RMR deviation (RMR estimated - RMR actual), RMR per body mass index (BMI), and free fat mass (FFM) were estimated. A validated food frequency questionnaire (FFQ) was used, and seven groups of UPFs were extracted based on the NOVA method. A negative association between the RMR [β = -0.159, 95% confidence interval (CI): -0.471, -0.052, P = 0.044], RMR per BMI (β = -0.014, 95% CI: -0.025, -0.006, P = 0.036), and RMR per FFM (β = -0.241, 95% CI: -0.006, -0.000, P = 0.041) using the NOVA score was observed after adjusting for confounders. This association disappeared after inclusion of each inflammatory marker. All the markers may inversely mediate the relationship between the mentioned variables and the NOVA score. hs-CRP and MCP-1 also had a negative effect on the relationship between the NOVA score and RMR deviation. Finally, UPF intake is likely related with the RMR, mediated through changes in the production of hs-CRP, PAI-1, MCP-1, and IL-1β.

Changes in Obesity Prevalence Attributable to Ultra-Processed Food Consumption in Brazil Between 2002 and 2009

Objectives: To quantify the impact of temporal changes in the consumption of ultra-processed foods on obesity trends in Brazil between 2002 and 2009. Methods: We analyzed data from two Household Budget Surveys carried out in 2002/2003 (n = 182,333) and 2008/2009 (n = 190,159), which provided information on household food acquisition and individuals' weight and height. We examined the association between ultra-processed foods consumption and obesity and quantified the fraction of increase in obesity prevalence attributable to the rise in the consumption of ultra-processed foods. Results: From 2002 to 2009, there was an increase in the obesity prevalence from 9.9% (95% CI 9.3; 10.4) to 13.2% (12.8; 13.7) while the contribution of ultra-processed foods to total energy consumption raised from 14.3% (13.4; 15.1) to 17.3% (16.5; 18.1). Ultra-processed foods consumption was positively associated with obesity prevalence. More than one quarter (28.6%) of the increase in obesity prevalence was attributable to the rise in the consumption of ultra-processed foods in the period. Conclusion: We found that the rise in the consumption of ultra-processed foods played a major role on the increase of obesity epidemic in Brazil.

Perspective: Soy-based Meat and Dairy Alternatives, Despite Classification as Ultra-processed Foods, Deliver High-quality Nutrition on Par with Unprocessed or Minimally Processed Animal-based Counterparts

In many non-Asian countries, soy is consumed via soy-based meat and dairy alternatives, in addition to the traditional Asian soyfoods, such as tofu and miso. Meat alternatives are typically made using concentrated sources of soy protein, such as soy protein isolate (SPI) and soy protein concentrate (SPC). Therefore, these products are classified as ultra-processed foods (UPFs; group 4) according to NOVA, an increasingly widely used food-classification system that classifies all foods into 1 of 4 groups according to the processing they undergo. Furthermore, most soymilks, even those made from whole soybeans, are also classified as UPFs because of the addition of sugars and emulsifiers. Increasingly, recommendations are being made to restrict the consumption of UPFs because their intake is associated with a variety of adverse health outcomes. Critics of UPFs argue these foods are unhealthful for a wide assortment of reasons. Explanations for the proposed adverse effects of UPFs include their high energy density, high glycemic index (GI), hyper-palatability, and low satiety potential. Claims have also been made that UPFs are not sustainably produced. However, this perspective argues that none of the criticisms of UPFs apply to soy-based meat and dairy alternatives when compared with their animal-based counterparts, beef and cow milk, which are classified as unprocessed or minimally processed foods (group 1). Classifying soy-based meat and dairy alternatives as UPFs may hinder their public acceptance, which could detrimentally affect personal and planetary health. In conclusion, the NOVA classification system is simplistic and does not adequately evaluate the nutritional attributes of meat and dairy alternatives based on soy.

Food Innovation in the Frame of Circular Economy by Designing Ultra-Processed Foods Optimized for Sustainable Nutrition

Despite the large debate about the relationship between ultra-processed foods and the prevalence of some diet-related diseases, the innovative potential of various processing technologies has been evidenced in pathways that could lead to modifications of the food matrix with beneficial health effects. Many efforts have been directed toward the conjugation of a healthy diet and sustainable exploitation of natural resources for the preparation of accessible foods. This minireview highlights the possible links between processing, sustainability, and circular economy through the valorization of by-products that could be exploited to prepare nutrient-rich ingredients at lower economic and environmental costs. The assessment of the quality and safety of functional foods based on ingredients derived from food waste requires a more robust validation by means of the food-omics approach, which considers not only the composition of the final products but also the structural characterization of the matrix, as the bioaccessibility and the bioavailability of nutrients are strictly dependent on the functional characteristics of the innovative ingredients.

The Role of Diet Quality in Mediating the Association between Ultra-Processed Food Intake, Obesity and Health-Related Outcomes: A Review of Prospective Cohort Studies

Prospective cohort studies show that higher intakes of ultra-processed food (UPF) increase the risk of obesity and obesity-related outcomes, including cardiovascular disease, cancer and type 2 diabetes. Whether ultra-processing itself is detrimental, or whether UPFs just have a lower nutritional quality, is debated. Higher UPF intakes are inversely associated with fruit, vegetables, legumes and seafood consumption. Therefore, the association between UPFs and poor health could simply be from excess nutrient intake or from a less healthful dietary pattern. If so, adjustment for dietary quality or pattern should explain or greatly reduce the size of the significant associations between UPFs and health-related outcomes. Here, we provide an overview of the literature and by using a novel approach, review the relative impact of adjusting for diet quality/patterns on the reported associations between UPF intake and health-related outcomes in prospective cohort studies. We find that the majority of the associations between UPFs, obesity and health-related outcomes remain significant and unchanged in magnitude after adjustment for diet quality or pattern. Our findings suggest that the adverse consequences of UPFs are independent of dietary quality or pattern, questioning the utility of reformulation to mitigate against the obesity pandemic and wider negative health outcomes of UPFs.

Ultra-processed foods increase noncommunicable chronic disease risk

Several studies have associated the food processing classification - NOVA - and health, but this is not true for all noncommunicable chronic diseases (NCDs). This study aimed to systematically review the association between the intake of NOVA food groups and NCDs. We hypothesized that ultra-processed foods and drinks (UPFD) and processed foods (PF) could increase the risk of NCDs, and that unprocessed (UPF) and minimally processed foods (MPF) may provide protection. We carried out a systematic review of observational studies in January 2021. Searches were performed in SCOPUS, MEDLINE (via PubMed), EMBASE, WEB OF SCIENCE, SCIELO, related articles, hand-searching of reference lists, and direct author contact. In all, 2217 citations were identified and 38 articles met the eligibility criteria for inclusion in this systematic review. Among the analyzed food groups, higher UPFD consumption was positively associated with obesity and associated with the development of all NCDs, mainly hypertension, diabetes and dyslipidemia. However, only a few studies have demonstrated the protective effect of natural foods and MPF consumption on the occurrence of NCDs. In conclusion, UPF may increase the risk of NCDs, and natural foods and MPF may reduce it. Our results reinforce the need for the implementation of policies to mitigate the intake of UPF by the population, as it would improve the quality of the dietary patterns, and directly impact on the incidence of NCDs.

A Multidisciplinary Perspective of Ultra-Processed Foods and Associated Food Processing Technologies: A View of the Sustainable Road Ahead

Ultra-processed foods (UPFs) are negatively perceived by part of the scientific community, the public, and policymakers alike, to the extent they are sometimes referred to as not "real food". Many observational surveys have linked consumption of UPFs to adverse health outcomes. This narrative synthesis and scientific reappraisal of available evidence aims to: (i) critically evaluate UPF-related scientific literature on diet and disease and identify possible research gaps or biases in the interpretation of data; (ii) emphasize the innovative potential of various processing technologies that can lead to modifications of the food matrix with beneficial health effects; (iii) highlight the possible links between processing, sustainability and circular economy through the valorisation of by-products; and (iv) delineate the conceptual parameters of new paradigms in food evaluation and classification systems. Although greater consumption of UPFs has been associated with obesity, unfavorable cardiometabolic risk factor profiles, and increased risk for non-communicable diseases, whether specific food processing techniques leading to ultra-processed formulations are responsible for the observed links between UPFs and various health outcomes remains elusive and far from being understood. Evolving technologies can be used in the context of sustainable valorisation of food processing by-products to create novel, low-cost UPFs with improved nutritional value and health potential. New paradigms of food evaluation and assessment should be funded and developed on several novel pillars-enginomics, signalling, and precision nutrition-taking advantage of available digital technologies and artificial intelligence. Research is needed to generate required scientific knowledge to either expand the current or create new food evaluation and classification systems, incorporating processing aspects that may have a significant impact on health and wellness, together with factors related to the personalization of foods and diets, while not neglecting recycling and sustainability aspects. The complexity and the predicted immense size of these tasks calls for open innovation mentality and a new mindset promoting multidisciplinary collaborations and partnerships between academia and industry.

Consumption of Ultra-Processed Foods Increases the Likelihood of Having Obesity in Korean Women

This study aimed to determine the association between consumption of ultra-processed foods and obesity among Korean adults. We used the data of 7364 participants (men 3219, women 4145) aged 19-64 years from the Korea National Health and Nutrition Examination Survey (KNHANES), 2016-2018. Food items were classified using the NOVA food classification system, depending on the extent and purpose of food processing: (1) unprocessed or minimally processed foods, (2) processed culinary ingredients, (3) processed foods, and (4) ultra-processed foods. Consumption of ultra-processed foods accounted for 26.8% of the total energy intake. After adjusting for potential confounders including sociodemographic and lifestyle characteristics, subjects with the highest consumption of ultra-processed foods (fourth quartile of % energy intake from ultra-processed foods) had 0.61 kg/m² higher body mass index (BMI; 95% confidence interval [CI] 0.23-0.99, p-trend 0.0047), 1.34 cm higher waist circumference (WC; 95% CI 0.35-2.34, p-trend 0.0146), 51% higher odds of being obese (BMI > 25 kg/m²; odds ratio [OR] 1.51, 95% CI 1.14-1.99, p-trend 0.0037), and 64% higher odds of abdominal obesity (men: WC ≥ 90 cm, women: WC ≥ 85 cm; OR 1.64, 95% CI 1.24-2.16, p-trend 0.0004) than those with the lowest consumption (first quartile) among women. However, no association was found in men. These findings provide evidence that high consumption of ultra-processed foods is positively associated with obesity in Korean women. Further studies with a large-scale cohort or intervention trial are needed to identify the mechanism of associations between consumption of ultra-processed foods and health-related outcomes including obesity in Korea.

Ultra-processed food consumption and obesity in the Australian adult population

Background

Rapid simultaneous increases in ultra-processed food sales and obesity prevalence have been observed worldwide, including in Australia. Consumption of ultra-processed foods by the Australian population was previously shown to be systematically associated with increased risk of intakes of nutrients outside levels recommended for the prevention of obesity. This study aims to explore the association between ultra-processed food consumption and obesity among the Australian adult population and stratifying by age group, sex and physical activity level.

Methods

A cross-sectional analysis of anthropometric and dietary data from 7411 Australians aged ≥20 years from the National Nutrition and Physical Activity Survey 2011–2012 was performed. Food consumption was evaluated through 24-h recall. The NOVA system was used to identify ultra-processed foods, i.e. industrial formulations manufactured from substances derived from foods and typically added of flavours, colours and other cosmetic additives, such as soft drinks, confectionery, sweet or savoury packaged snacks, microwaveable frozen meals and fast food dishes. Measured weight, height and waist circumference (WC) data were used to calculate the body mass index (BMI) and diagnosis of obesity and abdominal obesity. Regression models were used to evaluate the association of dietary share of ultra-processed foods (quintiles) and obesity indicators, adjusting for socio-demographic variables, physical activity and smoking.

Results

Significant (P-trend ≤ 0.001) direct dose–response associations between the dietary share of ultra-processed foods and indicators of obesity were found after adjustment. In the multivariable regression analysis, those in the highest quintile of ultra-processed food consumption had significantly higher BMI (0.97 kg/m²; 95% CI 0.42, 1.51) and WC (1.92 cm; 95% CI 0.57, 3.27) and higher odds of having obesity (OR = 1.61; 95% CI 1.27, 2.04) and abdominal obesity (OR = 1.38; 95% CI 1.10, 1.72) compared with those in the lowest quintile of consumption. Subgroup analyses showed that the trend towards positive associations for all obesity indicators remained in all age groups, sex and physical activity level.

Conclusion

The findings add to the growing evidence that ultra-processed food consumption is associated with obesity and support the potential role of ultra-processed foods in contributing to obesity in Australia.

Ultra-processed foods and the nutrition transition: Global, regional and national trends, food systems transformations and political economy drivers

Understanding the drivers and dynamics of global ultra-processed food (UPF) consumption is essential, given the evidence linking these foods with adverse health outcomes. In this synthesis review, we take two steps. First, we quantify per capita volumes and trends in UPF sales, and ingredients (sweeteners, fats, sodium and cosmetic additives) supplied by these foods, in countries classified by income and region. Second, we review the literature on food systems and political economy factors that likely explain the observed changes. We find evidence for a substantial expansion in the types and quantities of UPFs sold worldwide, representing a transition towards a more processed global diet but with wide variations between regions and countries. As countries grow richer, higher volumes and a wider variety of UPFs are sold. Sales are highest in Australasia, North America, Europe and Latin America but growing rapidly in Asia, the Middle East and Africa. These developments are closely linked with the industrialization of food systems, technological change and globalization, including growth in the market and political activities of transnational food corporations and inadequate policies to protect nutrition in these new contexts. The scale of dietary change underway, especially in highly populated middle-income countries, raises serious concern for global health.

World Heart Federation Policy Brief: Front-Of-Pack Labelling: Unhealthy Changes in the Global Food System

On World Food Day, the World Heart Federation calls on governments to implement mandatory front-of-pack food labels. The World Heart Federation (WHF) has developed a new policy brief on front-of-pack labelling (FOPL) aimed at improving global standards on nutrition and creating healthy food environments. Poor diet is responsible for more deaths worldwide than any other risk factor, and is a leading cause of obesity, type 2 diabetes, and cardiovascular disease (CVD). Global estimates suggest that almost 2.3 billion children and adults are overweight. The growing availability of ultra-processed foods, which contain high levels of sugars, sodium, saturated fats and refined carbohydrates, is a key contributor to the current obesity epidemic, which is increasingly impacting low- and middle-income countries. The WHF Front-of-Pack Labelling Policy Brief highlights front-of-pack labelling as a way to create environments where consumers are able to make better informed, healthier food choices for themselves and their families. Currently, a wide variety of front-of-pack labelling systems have been implemented by governments and food manufacturers around the world, with varying levels of success. The new WHF Policy Brief provides evidence-based, practical guidance that can be adapted to local contexts. It highlights that in order the be implemented successfully, FOPL systems must take into account consumer literacy and prevailing cultural norms around food and nutrition. FOPL must be mandatory, government-led, and accompanied by broad public nutrition education initiatives. The WHF Policy Brief includes a set of policy recommendations to give governments the tools they need to select the FOPL system that will best meet the needs of their populations, including recommendations on how to develop an effective FOPL programme, how to implement it successfully, and how to monitor and evaluate outcomes.

Ultra-processed foods and binge eating: A retrospective observational study

OBJECTIVES

There is increasing evidence of the impact of ultra-processed foods on multiple metabolic and neurobiological pathways, including those involved in eating behaviors, both in animals and in humans. In this study we aimed to explore ultra-processed foods and their link with disordered eating in a clinical sample.

METHODS

This was a single site, retrospective observational study in a specialist eating disorder service using self-report on the electronic health records. Patients with a Diagnostic and Statistical Manual of Mental Disorders (fifth edition) diagnosis of anorexia nervosa (AN), bulimia nervosa (BN), or binge eating disorder (BED) were randomly selected from the service database in Oxford from 2017 to 2019. The recently introduced NOVA classification was used to determine the degree of industrial food processing in each patient's diet. Frequencies of ultra-processed foods were analyzed for each diagnosis at each mealtime and during episodes of binging.

RESULTS

A total of 70 female and 3 male patients were included in the study; 22 had AN, 25 BN, and 26 BED. Patients with AN reported consuming 55% NOVA-4 foods, as opposed to approximately 70% in BN and BED patients. Foods that were consumed in a binge pattern were 100% ultra-processed.

CONCLUSION

Further research into the metabolic and neurobiological effects of ultra-processed food intake on disordered eating, particularly on binging, is needed.

How to protect both health and food system sustainability? A holistic 'global health'-based approach via the 3V rule proposal

OBJECTIVE

To define a generic diet to protect human health and food system sustainability based on three dimensions: animal:plant ratio, degree of food processing and food diversity.

DESIGN/SETTING

The percentages of maximum animal and ultra-processed energy content were evaluated from scientific papers (Web of Science database) and reports from international scientific institutions. Then, a weekly French standard diet, including these percentages and food diversity (≥42 different foods), was designed to calculate adequacy to nutritional needs.

RESULTS

Based on traditional and scientifically based healthy diets, and on foresight scenarios for sustainable diets at horizon 2050, a median daily animal energy content intake of 15 % was found to be protective towards both human health and environment. Based on epidemiological studies associating ultra-processed energy consumption with increased overweight/obesity risk, a precautionary threshold of approximately 15 % ultra-processed energy content was observed. The French diet allows addressing all nutritional needs and other nutritional indicators such as maximum salt and simple sugar consumption, α-linolenic acid:linoleic acid ratio and essential amino acids. This diet was named the '3V rule' for Végétal (plant), Vrai (real) and Varié (varied, if possible organic, local and seasonal). This generic diet can be adapted according to regional traditions and environmental characteristics. Excluding only one dimension of it would threaten both health and food system sustainability.

CONCLUSIONS

Tending towards a 3V-based diet, while respecting local constraints, should allow preserving human health, environment (greenhouse gas emissions, pollution, deforestation, etc.), small farmers, animal welfare and biodiversity, culinary traditions and socioeconomics (including an alleviation of public health cost).

Ultra-Processed Foods and Food System Sustainability: What Are the Links?

Global food systems are no longer sustainable for health, the environment, animal biodiversity and wellbeing, culinary traditions, socioeconomics, or small farmers. The increasing massive consumption of animal foods has been identified as a major determinant of unsustainability. However, today, the consumption of ultra-processed foods (UPFs) is also questioned. The main objective of this review is therefore to check the validity of this new hypothesis. We first identified the main ingredients/additives present in UPFs and the agricultural practices involved in their provision to agro-industrials. Overall, UPF production is analysed regarding its impacts on the environment, biodiversity, animal wellbeing, and cultural and socio-economic dimensions. Our main conclusion is that UPFs are associated with intensive agriculture/livestock and threaten all dimensions of food system sustainability due to the combination of low-cost ingredients at purchase and increased consumption worldwide. However, low-animal-calorie UPFs do not produce the highest greenhouse gas emissions (GHGEs) compared to conventional meat and dairy products. In addition, only reducing energy dense UPF intake, without substitution, might substantially reduce GHGEs. Therefore, significant improvement in food system sustainability requires urgently encouraging limiting UPF consumption to the benefit of mildly processed foods, preferably seasonal, organic, and local products.

Ultra-Processed Foods and Health Outcomes: A Narrative Review

The nutrition literature and authoritative reports increasingly recognise the concept of ultra-processed foods (UPF), as a descriptor of unhealthy diets. UPFs are now prevalent in diets worldwide. This review aims to identify and appraise the studies on healthy participants that investigated associations between levels of UPF consumption and health outcomes. This involved a systematic search for extant literature; integration and interpretation of findings from diverse study types, populations, health outcomes and dietary assessments; and quality appraisal. Of 43 studies reviewed, 37 found dietary UPF exposure associated with at least one adverse health outcome. Among adults, these included overweight, obesity and cardio-metabolic risks; cancer, type-2 diabetes and cardiovascular diseases; irritable bowel syndrome, depression and frailty conditions; and all-cause mortality. Among children and adolescents, these included cardio-metabolic risks and asthma. No study reported an association between UPF and beneficial health outcomes. Most findings were derived from observational studies and evidence of plausible biological mechanisms to increase confidence in the veracity of these observed associations is steadily evolving. There is now a considerable body of evidence supporting the use of UPFs as a scientific concept to assess the 'healthiness' of foods within the context of dietary patterns and to help inform the development of dietary guidelines and nutrition policy actions.

Brazilian Children's Dietary Intake in Relation to Brazil's New Nutrition Guidelines: a Systematic Review

PURPOSE OF REVIEW

This systematic review reports the latest scientific evidence, from cross-sectional and cohort studies, describing the dietary intake of children and adolescents from Brazil. The goal of the review was to describe intakes according to Brazil's new food classification system (NOVA) which classifies foods according to the degree of processing, i.e., unprocessed/minimally processed, processed culinary ingredients, processed food, and ultra-processed food. Due to a paucity of data using the NOVA classification system, studies with other intake descriptors were included.

RECENT FINDINGS

Results using the NOVA system showed a somewhat high intake of (ultra-)processed items, than of minimally processed items. Studies using other methods of dietary assessment showed not only high intake of sources rich in fat, sugar, and sodium, most of them processed items (e.g., savory snacks and sweets) but also intake of fruit, vegetables, and whole grains. Overall, the literature was marred by inconsistencies and variation in study definitions and methods making it hard to make firm conclusions regarding the dietary intake of Brazilian children. The development of tools to evaluate the complexities of dietary intake is much needed. Such a tool needs to be accepted and adopted by numerous study groups, to describe dietary status among Brazilian children and devise the most effective, and to evaluate the success of nutrition education programs.

The holistico-reductionist Siga classification according to the degree of food processing: an evaluation of ultra-processed foods in French supermarkets

The Siga classification of foods according to degree of processing showed that two-thirds of 24 932 packaged foods collected in French supermarkets are ultra-processed at various degrees.

Association of the glycaemic index and glycaemic load with colorectal cancer in the population of Córdoba (Argentina): results of a case-control study using a multilevel modelling approach

The glycaemic index (GI) and glycaemic load (GL) are involved in the aetiology of different diseases, and they could be related to the development of colorectal cancer (CRC). The aim of this study was to evaluate the association between the quality and quantity indicators of carbohydrates consumed by the population of Córdoba (Argentina) and the odds of developing CRC in 2008-2016 period. A case-control study was conducted with 492 participants (161/331 cases/controls), interviewed through a validated FFQ. Multilevel logistic regression models were used to assess the effect of GI, GL and the quantity or weekly intake of high-GI foods on CRC occurrence, following adjustment for individual/first-level covariates, and using level of urbanisation as the contextual variable. The models were stratified by sex. Participants in the highest v. lowest tertile of dietary GL and weekly intake of high-GI foods had increased odds of CRC presence in the entire sample (OR 1·64, 95 % CI 1·16, 2·34 and OR 1·11, 95 % CI 1·09, 1·14, respectively) and in women (OR 1·98, 95 % CI 1·24, 3·18 and OR 1·41, 95 % CI 1·09, 1·83, respectively). In men, the second tertile of GL and weekly intake of high-GI foods were associated with CRC (OR 1·44, 95 % CI 1·04, 1·99 and OR 1·48, 95 % CI 1·32, 1·65, respectively). Also, GI was associated with CRC in women (highest v. lowest tertile OR 2·12, 95 % CI 1·38, 3·27). In addition to the quantity and quality of carbohydrates intake, it is important to consider the frequency of consumption of high-GI foods in CRC prevention.

Processed Foods and Nutrition Transition in the Pacific: Regional Trends, Patterns and Food System Drivers

BACKGROUND

The role of processed foods in nutrition transition in the Pacific is receiving some attention in the context of a significant obesity and diet-related noncommunicable disease health burden. However, trends, patterns and underlying drivers of processed food markets in the Pacific are not well understood. The aim of this study was to investigate recent trends and patterns of processed food markets in the region and interpret the findings by engaging key literature on relevant food systems drivers.

METHODS

We conducted a mixed-methods approach involving two steps; (1) We analysed Euromonitor market sales data for processed food and beverage products sold from 2004-2018 for 16 countries differentiated by income level, and (2) guided by a food systems conceptual framework, we drew upon key literature to understand the likely drivers of our observations.

RESULTS

We observed plateaus and declines in processed food sales in some high-income countries but increases in upper-middle and lower-middle income countries, and most rapidly in the latter. Beverage markets appear to be stagnating across all income groups. Carbonated soft drinks, baked goods, vegetable oils, processed meats, noodles and sweet biscuits made up the majority of sales in transitioning countries. These observations are likely a result of income growth, urbanising populations, trade and globalisation, and various policies implemented by Pacific governments.

CONCLUSIONS

A processed foods nutrition transition is well underway in the Pacific region and accelerating most prominently in lower-middle income countries.

Perspective: Reductionist Nutrition Research Has Meaning Only within the Framework of Holistic and Ethical Thinking

Today, it seems that nutrition is in a state of great confusion, especially for the general public. For decades, some nutrients (e.g., cholesterol, saturated fats, sugars, gluten, salt) and food groups (e.g., dairy, cereals, meats) have been regularly denigrated. In this position paper, we hypothesize that such a state of confusion is mainly the result of the reductionist paradigm applied to nutrition research for more than a century, and by being pushed to its extreme, this perspective has led to accusations about some nutrients and foods. However, the real issue is about foods taken as a whole and therefore about their degree of processing, which affects both the food matrix and composition. Indeed, we eat whole foods, not nutrients. Therefore, the objectives of this article are to emphasize the need for more holistic approaches in nutrition to preserve our health, animal welfare, and planet. We propose to first redefine the food health potential on a holistic basis and then to show that reductionism and holism are interconnected approaches that should coexist. Then, we try to explain how extreme reductionism has been disconnected from reality and ethical considerations and has ultimately led to environmental degradation and loss of biodiversity, notably through very specific crops, and to an increased prevalence of chronic diseases. Furthermore, to address the confusion of the general public and to simplify nutritional messages, we propose 3 holistic golden rules based on scientific evidence to protect human health, animal welfare, and the environment (climate and biodiversity). Finally, we try to show how these 3 rules can be easily applied worldwide while respecting the environment, cultural traditions, and heritage.

Characterization of the Degree of Food Processing in Relation With Its Health Potential and Effects

Up today technological processes are intended to produce safe and palatable food products. Yet, it is also expected that processing produces healthy and sustainable foods. However, due to the dramatic increase of chronic diseases prevalence worldwide, i.e., obesity, type 2 diabetes, cardiovascular diseases, and some cancers, ultraprocessing has been pointed out as producing unhealthy foods, rich in energy and poor in protective micronutrients and fiber, i.e., "empty" calories. Indeed the 1980s saw massive arrivals of ultraprocessed foods in supermarkets, i.e., fractionated-recombined foods with added ingredients and/or additives. Epidemiological studies clearly emphasized that populations adhering the most to ultraprocessed foods, e.g., processed meat, refined grains, ultraprocessed plant-based foods, and/or sweetened beverages, exhibited the higher prevalence of chronic diseases. This prompted researchers to classify foods according to their degree of processing as with the international NOVA classification (i.e., un/minimally processed, processed, and ultraprocessed foods). More and more studies showed that such a classification makes sense for health. Overall one distinguishes three categories of processes: mechanical, thermal, and fermentative treatments, this latter being the more favorable to food health potential. This chapter has therefore several ambitions: (1) to review association between degree of food processing and chronic disease risk prevalence; (2) to explore the impact of technological processes on food health potential considering both matrix and compositional effects; (3) to discuss the need for classifying food according to their degree of processing in future epidemiological studies; and (4) to analyze consequences of adhering to a more holistic paradigm in both food processing and nutrition.

Processing of oat: the impact on oat's cholesterol lowering effect

Epidemiological and interventional studies have clearly demonstrated the beneficial impact of consuming oat and oat-based products on serum cholesterol and other markers of cardiovascular disease. The cholesterol-lowering effect of oat is thought to be associated with the β-glucan it contains. However, not all food products containing β-glucan seem to lead to the same health outcome. Overall, highly processed β-glucan sources (where the oat tissue is highly disrupted) appear to be less effective at reducing serum cholesterol, but the reasons are not well understood. Therefore, the mechanisms involved still need further clarification. The purpose of this paper is to review current evidence of the cholesterol-lowering effect of oat in the context of the structure and complexity of the oat matrix. The possibility of a synergistic action and interaction between the oat constituents promoting hypocholesterolaemia is also discussed. A review of the literature suggested that for a similar dose of β-glucan, (1) liquid oat-based foods seem to give more consistent, but moderate reductions in cholesterol than semi-solid or solid foods where the results are more variable; (2) the quantity of β-glucan and the molecular weight at expected consumption levels (∼3 g day-1) play a role in cholesterol reduction; and (3) unrefined β-glucan-rich oat-based foods (where some of the plant tissue remains intact) often appear more efficient at lowering cholesterol than purified β-glucan added as an ingredient.

Beyond nutrient-based food indices: a data mining approach to search for a quantitative holistic index reflecting the degree of food processing and including physicochemical properties

Processing has major impacts on both the structure and composition of food and hence on nutritional value.

Expectations of food satiation and satiety reviewed with special focus on food properties

Expectations of satiation are beliefs about the extent to which food is expected to deliver fullness and expectation of satiety relates to the extent to which food is expected to give respite from hunger and to inhibit further eating.