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da Silva BF, de Arruda Neta ADCP, de Alencar Rodrigues RE, de Araújo JM, Moreira PVL, Ferreira FELL, de Toledo Vianna RP, da Silva Neto JM, de Carli E, de Lima RLFC. Costs of obesity attributable to the consumption of sugar-sweetened beverages in Brazil. Sci Rep 2024; 14:13936. [PMID: 38886385 PMCID: PMC11183236 DOI: 10.1038/s41598-024-59991-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 04/17/2024] [Indexed: 06/20/2024] Open
Abstract
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.
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Affiliation(s)
- Bruna Farias da Silva
- Postgraduate Program in Nutrition Science, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | | | | | | | | | | | - Rodrigo Pinheiro de Toledo Vianna
- Postgraduate Program in Nutrition Science, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
- Department of Nutrition, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | | | - Eduardo de Carli
- Department of Nutrition, School of Public Health. University of São Paulo, São Paulo, Brazil
| | - Rafaela Lira Formiga Cavalcanti de Lima
- Postgraduate Program in Nutrition Science, Federal University of Paraíba, João Pessoa, Paraíba, Brazil.
- Department of Nutrition, Federal University of Paraíba, João Pessoa, Paraíba, Brazil.
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Schenkelaars N, van Rossem L, Willemsen SP, Faas MM, Schoenmakers S, Steegers-Theunissen RPM. The intake of ultra-processed foods and homocysteine levels in women with(out) overweight and obesity: The Rotterdam Periconceptional Cohort. Eur J Nutr 2024; 63:1257-1269. [PMID: 38383813 PMCID: PMC11139698 DOI: 10.1007/s00394-024-03334-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 01/20/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE Today's diet consists of a substantial proportion of ultra-processed foods (UPF), especially in women with overweight and obesity in the reproductive period. High UPF intake results in an inadequate and unbalanced diet leading to derangements of several metabolic pathways detrimental to pregnancy and birth outcomes. Therefore, we aim to investigate whether UPF intake in the periconceptional period affects total homocysteine plasma levels (tHcy). METHODS 1532 participants were included from the prospective Rotterdam Periconceptional Cohort. UPF intake was calculated using Food Frequency Questionnaires including items classified as 4 in the Nova classification, and tHcy was measured by using liquid chromatography-tandem mass spectrometry system, with an interassay coefficient of variation of < 5.5%. Multivariable linear regression modeling was used and adjusted for covariates and significant interaction terms. RESULTS Women with overweight or obesity showed significantly higher percentage of UPF intake (respectively, 50.3 and 51.3%) and higher tHcy (respectively, 6.6 and 6.3 µmol/L, Kruskal-Wallis test; respectively, p < 0.001 and p = 0.04) compared to women with normal BMI (UPF intake: 46.8%, tHcy: 6.1 µmol/L). A 10% higher intake of UPF was associated with an increase in tHcy (adjusted: β = 1.31, 95% CI = 0.38-2.23). Analysis stratified for BMI classification showed comparable associations in normal weight participants (adjusted: β = 1.07, 95% CI = 0.06-2.07); however, no significant association in participants with overweight (adjusted: β = 0.06, 95% CI = - 0.95-1.07) and obesity (adjusted: β = 1.70, 95% CI = - 0.52-3.92) was shown. CONCLUSION This study showed that a higher intake of UPF is associated with increased tHcy. Better knowledge and awareness of the nutritional quality of the diet in the periconceptional period may contribute to 1-CM and subsequently improve pregnancy course and outcome. TRIAL REGISTRATION NUMBER AND DATE NTR4356, November 2010.
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Affiliation(s)
- Nicole Schenkelaars
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Lenie van Rossem
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Sten P Willemsen
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Department of Biostatistics, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, 3000 CA, Rotterdam, The Netherlands
| | - Marijke M Faas
- Department of Pathology and Medical Biology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Sam Schoenmakers
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Régine P M Steegers-Theunissen
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
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Meine GC, Picon RV, Espírito Santo PA, Sander GB. Ultra-Processed Food Consumption and Gastrointestinal Cancer Risk: A Systematic Review and Meta-Analysis. Am J Gastroenterol 2024; 119:1056-1065. [PMID: 38832708 DOI: 10.14309/ajg.0000000000002826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 04/14/2024] [Indexed: 06/05/2024]
Abstract
INTRODUCTION Ultra-processed food (UPF) intake has been associated with a higher risk of obesity, hypertension, type 2 diabetes, and cardiovascular diseases. The initial data on the relationship between UPF consumption and cancer risk were derived from retrospective observational studies with conflicting results. This systematic review and meta-analysis of prospective cohort studies aimed to investigate the association between UPF consumption and gastrointestinal cancer risk. METHODS PubMed, Embase, and Cochrane databases were searched for prospective cohort studies that compared the highest vs the lowest level of UPF consumption according to NOVA food classification and reported the risk of gastrointestinal cancers by subsite. The association with cancer was quantified as hazard ratios (HR) using a random-effects model. RESULTS Five prospective cohort studies were included in this review comprising 1,128,243 participants (241,201 participants in the highest and 223,366 in the lowest levels of UPF consumption). The mean follow-up ranged from 5.4 to 28 years. The highest UPF consumption was significantly associated with an increased risk of colorectal cancer (HR 1.11; 95% confidence interval [CI] 1.03-1.21; P = 0.01; I2 = 31%), colon cancer (HR 1.12; 95% CI 1.02-1.23; P = 0.02; I2 = 0%), and non-cardia gastric cancer (HR 1.43; 95% CI 1.02-2.00; P = 0.04; I2 = 0%) compared with the lowest UPF intake. However, no association was found between high UPF consumption and hepatocellular, esophageal, pancreatic, gastric cardia, and rectal cancer. DISCUSSION The highest level of UPF consumption was significantly associated with colorectal and non-cardia gastric cancer.
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Affiliation(s)
- Gilmara Coelho Meine
- Program of Graduate Science in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Division of Gastroenterology, Department of Internal Medicine, Universidade Feevale, Novo Hamburgo, Brazil
| | - Rafael Veiga Picon
- Program of Graduate Science in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Guilherme Becker Sander
- Program of Graduate Science in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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de Medeiros JM, Silva-Neto LGR, Dos Santos TLF, Dos Santos Neto JE, de Menezes Toledo Florêncio TM. Higher consumption of ultra-processed foods is associated with obesity and abdominal obesity in socially vulnerable Brazilian women. NUTR BULL 2024; 49:199-208. [PMID: 38623590 DOI: 10.1111/nbu.12675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/22/2024] [Accepted: 04/02/2024] [Indexed: 04/17/2024]
Abstract
This study aimed to assess the consumption of ultra-processed foods (UPF) and identify their association with obesity and abdominal obesity in adult women of reproductive age living in situations of social vulnerability in Maceió, Northeastern Brazil. This was a cross-sectional study carried out between October 2020 and May 2021. An anthropometric evaluation was carried out to assess obesity and abdominal obesity. A dietary assessment was also conducted using a 24-h food recall to determine the calorie intake from UPF. To estimate intra-individual variability in food consumption, the probabilistic Multiple Source Method was used. These data in the form of tertiles were used to analyse the association between the consumption of UPF and obesity and abdominal obesity. Logistic regressions were used to analyse the association. A directed acyclic graph (DAG) was created for this analysis. This study included 1702 women of which 53.7% were 31 years old or older, and 74.2% lived in poverty. It identified that 36.5% and 38.1% of the women had obesity and abdominal obesity, respectively, and that an average of 33.8% of calories consumed came from UPF. In the analysis of association guided by the DAG, it was observed that women with a high-calorie intake from UPF had a 1.3 times higher probability of being obese. It was also observed that women with a moderate and high-calorie intake from UPF were 1.4 and 1.3 times more likely, respectively, to have abdominal obesity. Thus, it can be concluded that socially vulnerable women in Brazil have a relatively high consumption of UPF and that this condition increases the probability of obesity in this population group.
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Affiliation(s)
- Jocione Mara de Medeiros
- Programa de Pós-Graduação em Nutrição, Faculdade de Nutrição, Universidade Federal de Alagoas, Maceio, Brazil
| | | | - Thays Lane Ferreira Dos Santos
- Programa de Pós-Graduação em Nutrição, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - João Eudes Dos Santos Neto
- Hospital Universitário Alcides Carneiro, Empresa Brasileira de Serviços Hospitalares, Campina Grande, Brazil
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Dal N, Bilici S. Dietary Modulations in Preventing Cardiometabolic Risk in Individuals with Type 2 Diabetes. Curr Nutr Rep 2024:10.1007/s13668-024-00541-z. [PMID: 38767826 DOI: 10.1007/s13668-024-00541-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE OF REVIEW Type 2 diabetes mellitus (T2DM) is a complex health issue include obesity, high cholesterol, high blood pressure, and chronic inflammation that increase the risk of cardiovascular diseases (CVDs). CVDs are of great concern in the disease progression and prognosis of T2DM. This review is a comprehensive examination of the literature on the relationship between T2DM and cardiovascular risk, nutrition-related cardiometabolic risk (CMR) factors, and impact of dietary modulations on CMR. RECENT FINDINGS In recent years the researches has been focus on the importance of a comprehensive treatment approach like dietary modulations to address multiple cardiovascular risk reductions, including hypertension and dyslipidemia. Modulation of dietary patterns are the most promising interventions to prevent CMR factors and T2DM via affecting the body weight, glucose control, and microbial diversity of individuals. Current evidence suggests that high-quality dietary patterns such as the Dietary Approaches to Stop Hypertension (DASH) eating plan and the Mediterranean diet is important in the metabolic control processes of T2DM with anti-inflammatory and antioxidant compounds, glucagon-like peptide agonist compounds, and intestinal microbiota changes. Nutrition plays a critical role in preventing and improving CVD outcomes in patients with T2DM. Dietary modulations should be planned considering individual differences in responses to dietary composition and nutritional changes, personal preferences, eating behaviors and gut microbiota differences.
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Affiliation(s)
- Nursel Dal
- Department of Nutrition and Dietetics, Bandirma Onyedi Eylul University, Balikesir, Turkey.
| | - Saniye Bilici
- Department of Nutrition and Dietetics, Gazi University, Ankara, Turkey
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Pourmotabbed A, Talebi S, Mehrabani S, Babaei A, Khosroshahi RA, Bagheri R, Wong A, Ghoreishy SM, Amirian P, Zarpoosh M, Hojjati Kermani MA, Moradi S. The association of ultra-processed food intake with neurodegenerative disorders: a systematic review and dose-response meta-analysis of large-scale cohorts. Nutr Neurosci 2024:1-14. [PMID: 38753992 DOI: 10.1080/1028415x.2024.2351320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
OBJECTIVES Our systematic review and meta-analysis aimed to uncover the relationship between UPFs intake and neurodegenerative disorders, including multiple sclerosis (MS), Parkinson's disease (PD), Alzheimer's disease (AD), cognitive impairment, and dementia. SETTING A systematic search was conducted using the Scopus, PubMed/MEDLINE, and ISI Web of Science databases without any limitation until June 24, 2023. Relative risk (RR) and 95% confidence interval (CI) were pooled by using a random-effects model, while validated methods examined quality and publication bias via Newcastle-Ottawa Scale, Egger's regression asymmetry, and Begg's rank correlation tests, respectively. RESULTS Analysis from 28 studies indicated that a higher UPFs intake was significantly related to an enhanced risk of MS (RR = 1.15; 95% CI: 1.00, 1.33; I2 = 37.5%; p = 0.050; n = 14), PD (RR = 1.56; 95% CI: 1.21, 2.02; I2 = 64.1%; p = 0.001; n = 15), and cognitive impairment (RR = 1.17; 95% CI: 1.06, 1.30; I2 = 74.1%; p = 0.003; n = 17), although not AD or dementia. We observed that a 25 g increment in UPFs intake was related to a 4% higher risk of MS (RR = 1.04; 95% CI: 1.01, 1.06; I2 = 0.0%; p = 0.013; n = 7), but not PD. The non-linear dose-response relationship indicated a positive non-linear association between UPF intake and the risk of MS (Pnonlinearity = 0.031, Pdose-response = 0.002). This association was not observed for the risk of PD (Pnonlinearity = 0.431, Pdose-response = 0.231). CONCLUSION These findings indicate that persistent overconsumption of UPFs may have an adverse impact on neurodegenerative conditions, potentially leading to a decline in quality of life and reduced independence as individuals age.
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Affiliation(s)
- Ali Pourmotabbed
- Department of Physiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sepide Talebi
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sanaz Mehrabani
- Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Ira
| | - Atefeh Babaei
- Department of Physiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Reza Amiri Khosroshahi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Bagheri
- Department of Exercise Physiology, University of Isfahan, Isfahan, Iran
| | - Alexei Wong
- Department of Health and Human Performance, Marymount University, Arlington, VA, USA
| | - Seyed Mojtaba Ghoreishy
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Student research committee, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Parsa Amirian
- General Practitioner, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
| | - Mahsa Zarpoosh
- General Practitioner, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
| | - Mohammad Ali Hojjati Kermani
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sajjad Moradi
- Department of Nutrition and Food Sciences, Research Center for Evidence-Based Health Management, Maragheh University of Medical Sciences, Maragheh, Iran
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Talebi S, Mehrabani S, Ghoreishy SM, Wong A, Moghaddam A, Feyli PR, Amirian P, Zarpoosh M, Kermani MAH, Moradi S. The association between ultra-processed food and common pregnancy adverse outcomes: a dose-response systematic review and meta-analysis. BMC Pregnancy Childbirth 2024; 24:369. [PMID: 38750456 PMCID: PMC11097443 DOI: 10.1186/s12884-024-06489-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/07/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVES Given the increasing incidence of negative outcomes during pregnancy, our research team conducted a dose-response systematic review and meta-analysis to investigate the relationship between ultra-processed foods (UPFs) consumption and common adverse pregnancy outcomes including gestational diabetes mellitus (GDM), preeclampsia (PE), preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA) infants. UPFs are described as formulations of food substances often modified by chemical processes and then assembled into ready-to-consume hyper-palatable food and drink products using flavors, colors, emulsifiers, and other cosmetic additives. Examples include savory snacks, reconstituted meat products, frozen meals that have already been made, and soft drinks. METHODS A comprehensive search was performed using the Scopus, PubMed, and Web of Science databases up to December 2023. We pooled relative risk (RR) and 95% confidence intervals (CI) using a random-effects model. RESULTS Our analysis (encompassing 54 studies with 552,686 individuals) revealed a significant association between UPFs intake and increased risks of GDM (RR = 1.19; 95% CI: 1.10, 1.27; I2 = 77.5%; p < 0.001; studies = 44; number of participants = 180,824), PE (RR = 1.28; 95% CI: 1.03, 1.59; I2 = 80.0%; p = 0.025; studies = 12; number of participants = 54,955), while no significant relationships were found for PTB, LBW and SGA infants. Importantly, a 100 g increment in UPFs intake was related to a 27% increase in GDM risk (RR = 1.27; 95% CI: 1.07, 1.51; I2 = 81.0%; p = 0.007; studies = 9; number of participants = 39,812). The non-linear dose-response analysis further indicated a positive, non-linear relationship between UPFs intake and GDM risk Pnonlinearity = 0.034, Pdose-response = 0.034), although no such relationship was observed for PE (Pnonlinearity = 0.696, Pdose-response = 0.812). CONCLUSION In summary, both prior to and during pregnancy, chronic and excessive intake of UPFs is associated with an increased risk of GDM and PE. However, further observational studies, particularly among diverse ethnic groups with precise UPFs consumption measurement tools, are imperative for a more comprehensive understanding.
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Affiliation(s)
- Sepide Talebi
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sanaz Mehrabani
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyed Mojtaba Ghoreishy
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Student research committee, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Alexei Wong
- Department of Health and Human Performance, Marymount University, Arlington, VA, USA
| | - Aliasghar Moghaddam
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Razi University, Kermanshah, Iran
| | - Peyman Rahimi Feyli
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Razi University, Kermanshah, Iran
| | - Parsa Amirian
- General Practitioner, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
| | - Mahsa Zarpoosh
- General Practitioner, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
| | - Mohammad Ali Hojjati Kermani
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sajjad Moradi
- Department of Nutrition and Food Sciences, Research Center for Evidence-Based Health Management, Maragheh University of Medical Sciences, Maragheh, Iran.
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Lima da Silva JM, Oliveira JS, Casagrande Borges D, Honório OS, Mendes LL, Canuto R. Social inequities in food deserts and food swamps in a northeastern Brazilian capital. J Biosoc Sci 2024; 56:493-503. [PMID: 38415307 DOI: 10.1017/s0021932024000087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
This study identified food deserts and swamps, investigating their associations with socioeconomic and demographic conditions. This ecological study was conducted using data from urban census tracts in the city of Recife, which were considered the unit of analysis. Information on food retail was obtained from government sources in 2019. Census tracts below the 25th percentile in the density of healthy food retail (i.e., those that predominantly sell natural or minimally processed foods, mixed businesses, and super- and hypermarkets) were classified as food deserts. Census tracts above the 25th percentile in the density of unhealthy food retail (i.e., those selling primarily ultra-processed foods) were considered food swamps. The socioeconomic and demographic conditions of the census tracts were evaluated using variables from the 2010 census (per capita income, average income, race, literacy of the head of household, and the availability of essential services) and the Health Vulnerability Index. Census tracts considered food deserts (28.5%) were more vulnerable, characterized by lower income and access to essential services, more illiterate residents and more minorities (Black/Indigenous/mixed race). Food swamps (73.47%) were more prevalent in less vulnerable neighbourhoods characterized by higher percentages of literate residents and Whites, greater purchasing power, and better basic sanitation. The characteristics of Recife's food deserts and swamps demonstrate social inequalities in the food environment. Public facilities could play a vital role in promoting healthy eating within food deserts. Additionally, future implementation of taxes on ultra-processed foods and the provision of tax subsidies to natural or minimally processed food sellers might contribute to fostering healthier dietary choices.
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Affiliation(s)
| | | | | | | | | | - Raquel Canuto
- Program in Nutrition, Universidade Federal de Pernambuco, Brazil
- Program in Food, Nutrition and Health, Universidade Federal do Rio Grande do Sul, Brazil
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Zhang Z, Jackson SL, Steele EM, Hayes DK, Yang Q. Relationship Between Ultra-Processed and Minimally Processed Food Intake and Cardiovascular Health Among US Women of Reproductive Age. J Womens Health (Larchmt) 2024; 33:613-623. [PMID: 38386796 DOI: 10.1089/jwh.2023.0739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
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.
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Affiliation(s)
- Zefeng Zhang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Euridice Martinez Steele
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | - Donald K Hayes
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Quanhe Yang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Busse KR, Lee Mayol NR, Ammerman AS, Avery CL, Martin SL, Adair LS. Ultraprocessed Food Intake during the Transition to Adulthood Varies According to Sociodemographic Characteristics and Maternal Intake in Cebu, Philippines. J Nutr 2024:S0022-3166(24)00235-9. [PMID: 38697516 DOI: 10.1016/j.tjnut.2024.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/05/2024] Open
Abstract
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.
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Affiliation(s)
- Kyle R Busse
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States.
| | - Nanette R Lee Mayol
- USC-Office of Population Studies Foundation, University of San Carlos, Cebu City, Philippines
| | - Alice S Ammerman
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States; Center for Health Promotion and Disease Prevention, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States
| | - Christy L Avery
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States; Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States
| | - Stephanie L Martin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States; Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States
| | - Linda S Adair
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States; Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States
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11
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Oliveira RKG, Domingos IR, Leal VS, Oliveira JS, de Lira PIC, de Souza NP. Consumption of in natura and ultra-processed foods in adults: an analysis of social, metabolic, and lifestyle determinants. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2024; 27:e240018. [PMID: 38695431 PMCID: PMC11057841 DOI: 10.1590/1980-549720240018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 12/04/2023] [Accepted: 02/06/2024] [Indexed: 05/06/2024] Open
Abstract
OBJECTIVE To assess the social, metabolic, and lifestyle determinants of consumption of fruits, vegetables, and greens (FVG) and ultra-processed food (ULT) in adults from Pernambuco. METHODS Cross-sectional and analytical study, conducted in 2015/2016. In addition to sociodemographic variables, the determinants of lifestyle were level of physical activity, alcohol consumption, tobacco use, and metabolic variables were self-reported hypertension, blood glucose, and Body Mass Index (BMI). Consumption was measured by the Food Frequency Questionnaire, then created the Frequency of Consumption Index (SFI) of the mean intake of ULT and FVG foods. The indices of FVG and ULT consumption were transformed into quartiles and these variables were included in the multinomial logistic regression, considering their determinants when p<0.05. RESULTS The sample was representative of the state, with 1,067 people being interviewed, whose intake of ULT was higher than that of FVG in the lowest and highest quartile of the consumption index. Consumption of fruit and vegetables was higher in higher consumption of alcoholic beverages (p=0.031) and BMI>25 kg/m2 (p=0.047); and lower in the lowest income (p=0.001). ULT intake was higher in young adults (p=0.005), lower income (p=0.044), and controlled blood glucose (p=0.021). Rural areas were 52% less exposed to medium-high ULT consumption (p<0.006). CONCLUSION Higher rate of ULT consumption in relation to fresh foods, with income as a common determinant, inversely associated with ULT intake and directly related to FVG, which demands structuring policies.
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Affiliation(s)
- Renata Kelly Gomes Oliveira
- Universidade Federal de Pernambuco, Centro Acadêmico de Vitória, Nutrition Center – Vitória de Santo Antão (PE), Brazil
| | - Ivanildo Ribeiro Domingos
- Universidade Federal de Pernambuco, Health Sciences Center, Department of Nutrition – Recife (PE), Brazil
| | - Vanessa Sá Leal
- Universidade Federal de Pernambuco, Centro Acadêmico de Vitória, Nutrition Center – Vitória de Santo Antão (PE), Brazil
| | - Juliana Souza Oliveira
- Universidade Federal de Pernambuco, Centro Acadêmico de Vitória, Nutrition Center – Vitória de Santo Antão (PE), Brazil
| | | | - Nathália Paula de Souza
- Universidade Federal de Pernambuco, Centro Acadêmico de Vitória, Nutrition Center – Vitória de Santo Antão (PE), Brazil
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12
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Juul F, Bere E. Ultra-processed foods - a scoping review for Nordic Nutrition Recommendations 2023. Food Nutr Res 2024; 68:10616. [PMID: 38720949 PMCID: PMC11077402 DOI: 10.29219/fnr.v68.10616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 01/05/2024] [Accepted: 02/22/2024] [Indexed: 05/12/2024] Open
Abstract
Ultra-processed foods (UPFs) are increasingly consumed worldwide and have been linked to several chronic diseases. This paper aims to describe the totality of the available evidence regarding UPFs in relation to health-related outcomes as a basis for setting food-based dietary guidelines for the Nordic Nutrition Recommendations 2023. Systematic literature searches were conducted to identify systematic reviews, meta-analyses, randomized controlled trials (RCTs), and prospective cohort studies examining the association between UPF intake and non-communicable diseases or mortality. A total of 12 systematic reviews (including five meta-analyses) and 44 original research studies (43 prospective cohort studies and one RCT) were included. All original research studies were deemed to be of good methodological quality. The current evidence supports that greater consumption of UPFs is associated with weight gain and increased risk of obesity, cardiovascular disease, type 2 diabetes, and all-cause mortality. The available literature also supports an association between UPFs and hypertension, cancer, and depression; however, the limited number of studies and subjects investigated preclude strong conclusions. Due to the highly diverse nature of UPFs, additional studies are warranted, with special emphasis on disentangling mediating mechanisms, whether nutritional or non-nutrient based. Nevertheless, the available evidence regarding UPFs in relation to weight gain, CVD, type 2 diabetes, and all-cause mortality is considered strong enough to support dietary recommendations to limit their consumption.
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Affiliation(s)
- Filippa Juul
- School of Global Public Health, New York University, New York, NY, USA
- Center for Epidemiological Studies in Health and Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Elling Bere
- Department of Sports Science and Physical Education, University of Agder, Kristiansand, Norway
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13
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Zhang Z, Zhang J, Jiao H, Tian W, Zhai X. Genetically predicted dietary macronutrient intakes and atrial fibrillation risk: a Mendelian randomization study. Eur J Med Res 2024; 29:227. [PMID: 38609963 PMCID: PMC11010414 DOI: 10.1186/s40001-024-01781-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/10/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND AND AIM Previous observational investigations have indicated a potential association between relative dietary macronutrient intakes and atrial fibrillation and flutter (AF) risk. In this study, we employed Mendelian Randomization (MR) to evaluate the presence of causality and to elucidate the specific causal relationship. METHODS We employed six, five, and three single nucleotide polymorphisms (SNPs) as instrumental variables for relative carbohydrate, protein, and fat intake, identified from a genome-wide association study that included 268,922 individuals of European descent. Furthermore, we acquired summary statistics for genome-wide association studies on AF from the FinnGen consortium, which involved 22,068 cases and 116,926 controls. To evaluate the causal estimates, we utilized the random effect inverse variance weighted method (IVW) and several other MR methods, including MR-Egger, weighted median, and MR-PRESSO, to confirm the robustness of our findings. RESULTS Our analysis indicates a convincing causal relationship between genetically predicted relative carbohydrate and protein intake and reduced AF risk. Inverse variance weighted analysis results for carbohydrates (OR = 0.29; 95% CI (0.14, 0.59); P < 0.001) and protein (OR = 0.47; 95% CI (0.26, 0.85); P = 0.01) support this association. Our MR analysis did not identify a significant causal relationship between relative fat intake and AF risk. CONCLUSION Our study provides evidence supporting a causal relationship between higher relative protein and carbohydrate intake and a lower risk of atrial fibrillation (AF).
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Affiliation(s)
- Zhuoya Zhang
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Jiale Zhang
- Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Haoyang Jiao
- Institute of Documentation, China Academy of Chinese Medical Sciences, Beijing, China
| | - Wei Tian
- Gaoyang County Hospital, Baoding, 071599, Hebei Province, China.
| | - Xu Zhai
- Guanganmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
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14
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Maruyama C, Uchiyama M, Umezawa A, Tokunaga A, Yasuda A, Chibai K, Fukuda C, Ichiki R, Kameyama N, Shinohara M. A Cross-Sectional Pilot Study on Association of Ready-to-Eat and Processed Food Intakes with Metabolic Factors, Serum Trans Fat and Phospholipid Fatty Acid Compositions in Healthy Japanese Adults. Nutrients 2024; 16:1032. [PMID: 38613065 PMCID: PMC11013905 DOI: 10.3390/nu16071032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/21/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Frequently consuming processed and ready-to-eat (RTE) foods is regarded as unhealthy, but evidence on the relationships with circulating metabolic parameters is lacking. Japanese residents of a metropolitan area, 20 to 50 years of age, were studied in terms of anthropometric and biochemical parameters, including circulating trans fat and serum phospholipid fatty acid levels. Processed foods, except drinks and dairy items, were categorized according to requirements for additional ingredients and cooking before eating. Processed and RTE foods were divided according to fat and/or oil content into non-fatty or fatty foods. The participants were grouped into tertiles based on the energy percent (En%) derived from fatty-RTE foods. Fatty-RTE En% showed negative associations with fish, soybean and soybean products, dairy, eggs, vegetables, seaweed/mushrooms/konjac, fruit and non-oily seasonings reflecting lower dietary fiber, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and mineral and vitamin intakes, while the associations with fat/oil, confectionaries, and sweet beverages were positive. Fatty-RTE En% consumption was positively associated with alkaline phosphatase, leucine aminopeptidase, direct bilirubin, elaidic acid, and C18:2 but inversely associated with HDL cholesterol, C15:0, C17:0, EPA, and DHA. A higher fatty-RTE food intake was suggested to contribute to unbalanced nutrient intakes, as reflected in lipid metabolic parameters. Further large-scale studies are needed to evaluate the quality and impacts of RTE foods.
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Affiliation(s)
- Chizuko Maruyama
- Division of Food and Nutrition, Graduate School of Human Sciences and Design, Japan Women’s University, Tokyo 112-8681, Japan;
- Department of Food and Nutrition, Faculty of Human Sciences and Design, Japan Women’s University, Tokyo 112-8681, Japan; (A.U.); (N.K.)
| | - Miya Uchiyama
- Division of Food and Nutrition, Graduate School of Human Sciences and Design, Japan Women’s University, Tokyo 112-8681, Japan;
| | - Ariko Umezawa
- Department of Food and Nutrition, Faculty of Human Sciences and Design, Japan Women’s University, Tokyo 112-8681, Japan; (A.U.); (N.K.)
| | - Aoi Tokunaga
- Department of Food and Nutrition, Faculty of Human Sciences and Design, Japan Women’s University, Tokyo 112-8681, Japan; (A.U.); (N.K.)
| | - Akari Yasuda
- Department of Food and Nutrition, Faculty of Human Sciences and Design, Japan Women’s University, Tokyo 112-8681, Japan; (A.U.); (N.K.)
| | - Kanako Chibai
- Department of Food and Nutrition, Faculty of Human Sciences and Design, Japan Women’s University, Tokyo 112-8681, Japan; (A.U.); (N.K.)
| | - Chieko Fukuda
- Department of Food and Nutrition, Faculty of Human Sciences and Design, Japan Women’s University, Tokyo 112-8681, Japan; (A.U.); (N.K.)
| | - Rina Ichiki
- Department of Food and Nutrition, Faculty of Human Sciences and Design, Japan Women’s University, Tokyo 112-8681, Japan; (A.U.); (N.K.)
| | - Noriko Kameyama
- Department of Food and Nutrition, Faculty of Human Sciences and Design, Japan Women’s University, Tokyo 112-8681, Japan; (A.U.); (N.K.)
| | - Masakazu Shinohara
- The Integrated Center for Mass Spectrometry, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan;
- Division of Molecular Epidemiology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
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15
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Mehrabani S, Shoaei N, Shateri Z, Askarpour M, Nouri M, Keshani P, Honarvar B, Homayounfar R. Consumption of ultra-processed foods could influence the metabolic syndrome odds: A cross-sectional study. Food Sci Nutr 2024; 12:2567-2577. [PMID: 38628179 PMCID: PMC11016394 DOI: 10.1002/fsn3.3938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/13/2023] [Accepted: 12/20/2023] [Indexed: 04/19/2024] Open
Abstract
Metabolic syndrome (MetS) prevalence has augmented globally during recent decades. Over the past years, the consumption of ultra-processed foods (UPFs) has grown significantly worldwide. So, the present research investigated the association between UPFs and MetS in an Iranian sample. This cross-sectional research was conducted on people (n = 8841) in the Fasa cohort study, Fars province, Iran. The participants' dietary consumption over a year, UPF consumption, and MetS diagnosis were evaluated through a 125-item modified food frequency questionnaire, the NOVA food group classification, and the Adult Treatment Panel III of the National Cholesterol Education Program, respectively. The association between the quartiles (Q) of UPF intake and the odds of MetS was estimated using the backward LR method of multivariate analysis. In the multivariate model, after adjusting potential confounders, the association between UPF intake and the odds of MetS was significant (Q4: odds ratio (OR = 3.27; 95% confidence interval (CI): 2.76-3.89). Also, the odds of increasing triglycerides (TG), blood pressure, and fasting blood sugar (FBS) and decreasing high-density lipoprotein cholesterol (HDL-C) were significantly higher in the last quartile compared to the first quartile of UPFs (TG: OR = 1.71; 95% CI: 1.49-1.97, blood pressure: OR = 1.53; 95% CI: 1.30-1.79, FBS: OR = 1.30; 95% CI: 1.10-1.54, and HDL-C: OR = 1.22; 95% CI: 1.08-1.39). The current research found a relationship between UPF intake and MetS and its components, indicating a diet-containing UPFs can be related to the occurrence of noncommunicable diseases.
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Affiliation(s)
- Sanaz Mehrabani
- Health Policy Research Center, Institute of HealthShiraz University of Medical SciencesShirazIran
- Department of Clinical Nutrition, School of Nutrition and Food ScienceIsfahan University of Medical SciencesIsfahanIran
| | - Niloofar Shoaei
- Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Zainab Shateri
- Department of Nutrition and Biochemistry, Faculty of MedicineIlam University of Medical SciencesIlamIran
| | - Moein Askarpour
- Department of Clinical Nutrition, School of Nutritional Sciences and DieteticsShiraz University of Medical SciencesShirazIran
- Students' Research Committee, School of Nutrition and Food ScienceShiraz University of Medical SciencesShirazIran
| | - Mehran Nouri
- Health Policy Research Center, Institute of HealthShiraz University of Medical SciencesShirazIran
- Students' Research Committee, School of Nutrition and Food ScienceShiraz University of Medical SciencesShirazIran
- Department of Community Nutrition, School of Nutrition and Food SciencesShiraz University of Medical SciencesShirazIran
| | - Parisa Keshani
- Health Policy Research Center, Institute of HealthShiraz University of Medical SciencesShirazIran
| | - Behnam Honarvar
- Health Policy Research Center, Institute of HealthShiraz University of Medical SciencesShirazIran
| | - Reza Homayounfar
- National Nutrition and Food Technology Research InstituteShahid Beheshti University of Medical SciencesTehranIran
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16
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Pant A, Gribbin S, Machado P, Hodge A, Wasfy JH, Moran L, Marschner S, Chow CK, Zaman S. Ultra-processed foods and incident cardiovascular disease and hypertension in middle-aged women. Eur J Nutr 2024; 63:713-725. [PMID: 38147150 PMCID: PMC10948520 DOI: 10.1007/s00394-023-03297-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/28/2023] [Indexed: 12/27/2023]
Abstract
PURPOSE Ultra-processed food (UPF) intake has increased in recent decades, yet limited knowledge of long-term effects on cardiovascular health persists and sex-specific data is scant. We determined the association of UPF intake with incident cardiovascular disease (CVD) and/or hypertension in a population-based cohort of women. METHODS In the Australian Longitudinal Study on Women's Health, women aged 50-55 years were prospectively followed (2001-2016). UPFs were identified using NOVA classification and contribution of these foods to total dietary intake by weight was estimated. Primary endpoint was incident CVD (self-reported heart disease/stroke). Secondary endpoints were self-reported hypertension, all-cause mortality, type 2 diabetes mellitus, and/or obesity. Logistic regression models assessed associations between UPF intake and incident CVD, adjusting for socio-demographic, medical comorbidities, and dietary variables. RESULTS We included 10,006 women (mean age 52.5 ± 1.5; mean UPF intake 26.6 ± 10.2% of total dietary intake), with 1038 (10.8%) incident CVD, 471 (4.7%) deaths, and 4204 (43.8%) hypertension cases over 15 years of follow-up. In multivariable-adjusted models, the highest [mean 42.0% total dietary intake] versus the lowest [mean 14.2% total dietary intake] quintile of UPF intake was associated with higher incident hypertension [odds ratio (OR) 1.39, 95% confidence interval (CI) 1.10-1.74; p = 0.005] with a linear trend (ptrend = 0.02), but not incident CVD [OR 1.22, 95% CI 0.92-1.61; p = 0.16] or all-cause mortality (OR 0.80, 95% CI 0.54-1.20; p = 0.28). Similar results were found after multiple imputations for missing values. CONCLUSION In women, higher UPF intake was associated with increased hypertension, but not incident CVD. These findings may support minimising UPFs within a healthy diet for women.
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Affiliation(s)
- Anushriya Pant
- Westmead Applied Research Centre and Faculty of Medicine and Health, University of Sydney, Westmead, NSW, 2145, Australia.
| | - Sarah Gribbin
- Department of General Medicine, The Alfred Hospital, Alfred Health, Melbourne, VIC, Australia
| | - Priscila Machado
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Allison Hodge
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Melbourne, VIC, Australia
| | - Jason H Wasfy
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Lisa Moran
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC, Australia
| | - Simone Marschner
- Westmead Applied Research Centre and Faculty of Medicine and Health, University of Sydney, Westmead, NSW, 2145, Australia
| | - Clara K Chow
- Westmead Applied Research Centre and Faculty of Medicine and Health, University of Sydney, Westmead, NSW, 2145, Australia
| | - Sarah Zaman
- Westmead Applied Research Centre and Faculty of Medicine and Health, University of Sydney, Westmead, NSW, 2145, Australia
- Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia
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17
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Gonzales Santos M, Rosenthal A, Beatriz Araujo Martins I, de Alcantara M, Almeida Lima M, de Assis Carvalho R, Deliza R. Exploring the role of the general interest in health on the perceptions of Healthy, Industrialized, and Ultra-processed foods among Brazilians. Food Res Int 2024; 181:113992. [PMID: 38448090 DOI: 10.1016/j.foodres.2024.113992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/02/2024] [Accepted: 01/08/2024] [Indexed: 03/08/2024]
Abstract
Food processing includes operations that transform raw materials into new products, ensuring the preservation and supply of safe food; however, this view is not always understood by consumers who tend to associate any type of processing with something negative and harmful to health. Given this, the objective of this study was to explore the associations of Brazilian consumers in relation to healthy foods, industrialized foods, and ultra-processed foods, as well as to evaluate the role of socio-demographic characteristics and interest in health in these associations. To this end, 512 Brazilians completed a word association task on these three concepts and then answered a questionnaire about interest in health and socio-demographic issues. In general, participants associated "Healthy food" mainly with "Unprocessed products." Conversely, "Industrialized foods" and "Ultra-processed foods" were associated with "Processed products," "Negative perceptions," "Health harm," and "Industry". Despite this, it was found that "Industrialized foods" were also perceived positively, mainly due to convenience. Consumer associations were influenced (p ≤ 0.05) both by interest in health and by socio-demographic profile. Individuals with a high interest in health mainly associated "Industrialized foods" and "Ultra-processed foods" with the presence of preservatives, additives, and pesticides, and with diseases. As for those with low interest in health, there was a greater lack of knowledge of the concepts. Doubts and lack of knowledge were observed for "Industrialized foods" and "Ultra-processed foods," mainly among consumers with low educational level. The results indicate the need to develop communication strategies that reach consumers to facilitate understanding and, in this way, help them to make more conscious food choices.
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Affiliation(s)
- Mario Gonzales Santos
- Graduate Program of Food Science and Technology, Universidade Federal Rural do Rio de Janeiro, Rodovia BR 456, km 7, Seropédica, RJ, Brazil; Faculty of Technological Sciences, Universidad Nacional de Agricultura, Carretera a Dulce Nombre de Culmí, km 215, Barrio El Espino, Catacamas, Honduras.
| | - Amauri Rosenthal
- Embrapa Agroindústria de Alimentos, Av. das Américas 29501, CEP 23.020-470 Rio de Janeiro, RJ, Brazil
| | | | - Marcela de Alcantara
- PDJ/Faperj/Embrapa Agroindústria de Alimentos, Av. das Américas 29501 CEP 23.020-470 Rio de Janeiro, RJ, Brazil
| | - Mariah Almeida Lima
- Graduate Program of Food Science and Technology, Universidade Federal Rural do Rio de Janeiro, Rodovia BR 456, km 7, Seropédica, RJ, Brazil
| | - Raíssa de Assis Carvalho
- Graduate Program of Food Science and Technology, Universidade Federal Rural do Rio de Janeiro, Rodovia BR 456, km 7, Seropédica, RJ, Brazil
| | - Rosires Deliza
- Embrapa Agroindústria de Alimentos, Av. das Américas 29501, CEP 23.020-470 Rio de Janeiro, RJ, Brazil
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18
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Jalali M, Bahadoran Z, Mirmiran P, Khalili D, Symonds ME, Azizi F, Faghih S. Higher ultra-processed food intake is associated with an increased incidence risk of cardiovascular disease: the Tehran lipid and glucose study. Nutr Metab (Lond) 2024; 21:14. [PMID: 38504359 PMCID: PMC10949749 DOI: 10.1186/s12986-024-00788-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/13/2024] [Indexed: 03/21/2024] Open
Abstract
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.
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Affiliation(s)
- Mohammad Jalali
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Razi Ave, Shiraz, Iran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Shahid-Erabi St., Yeman St., Velenjak, Tehran, Iran
| | - Zahra Bahadoran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Shahid-Erabi St., Yeman St., Velenjak, Tehran, Iran.
| | - Parvin Mirmiran
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, No. 24, Shahid-Erabi St., Yeman St., Velenjak, Tehran, Iran
| | - Davood Khalili
- Department of Epidemiology and Biostatistics, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Michael E Symonds
- Centre for Perinatal Research, Academic Unit of Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shiva Faghih
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Razi Ave, Shiraz, Iran.
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Salehi Z, Malmir H, Ghosn B, Onvani S, Ardestani ME, Feizi A, Esmaillzadeh A, Azadbakht L. Exploring the association between ultra-processed foods and COPD: a case-control study. BMC Pulm Med 2024; 24:124. [PMID: 38459450 PMCID: PMC10924350 DOI: 10.1186/s12890-024-02903-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 02/08/2024] [Indexed: 03/10/2024] Open
Abstract
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.
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Affiliation(s)
- Zahra Salehi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, P.O. Box 14155-6117, Iran
| | - Hanieh Malmir
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Batoul Ghosn
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, P.O. Box 14155-6117, Iran
| | - Shokouh Onvani
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Emami Ardestani
- Division of Pulmonology, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Department of Epidemiology and Biostatistics, Endocrinology and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Esmaillzadeh
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Community Nutrition, School of Nutritional Science and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Azadbakht
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, P.O. Box 14155-6117, Iran.
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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20
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Machado SP, Bezerra IN, Silva MA, D’oran MHL, Cunha DB, Moreno LA, Sichieri R. Evolution of adolescents' dietary patterns in Northeast Brazil from 2008 to 2018. Rev Saude Publica 2024; 58:05. [PMID: 38381895 PMCID: PMC10878684 DOI: 10.11606/s1518-8787.2024058005090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 08/29/2023] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVE To evaluate the evolution of the dietary patterns of adolescents in the northeast region of Brazil. METHODS Secondary analysis of data from the Pesquisa de Orçamentos Familiares (POF - Household Budget Surveys), collected by the Brazilian Institute of Geography and Statistics (IBGE) in the years 2008-2009 and 2017-2018. A total of 3,095 adolescents were evaluated in 2008-2009 and 3,015 in 2017-2018. Food consumption was assessed using two dietary records in 2008-2009 and two 24-hour recalls in 2017-2018, applied on non-consecutive days. Based on these data, principal components factor analysis (PCFA) was performed, followed by orthogonal rotation of the varimax type, to derive dietary patterns, stratified by sex. The results were described as means or percentage frequencies, with their respective 95% confidence intervals. RESULTS Three main dietary patterns were identified among adolescents from the northeast region of Brazil. Among boys, in 2008-2009, the patterns were called snacks, traditional Brazilian, and coffee; and in 2017-2018, traditional Brazilian, snacks, and mixed, in this order of representativeness of the group's eating habits. Among female adolescents, in 2008-2009, the patterns were snacks, traditional Brazilian, and coffee; and in 2017-2018, traditional Brazilian, snacks, and processed meats. CONCLUSION The dietary patterns identified in 2008-2009 and 2017-2018 were similar in both genders; however, the snacks pattern, which explained most of the data variability in 2008-2009, was replaced by the traditional Brazilian.
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Affiliation(s)
- Soraia Pinheiro Machado
- Universidade Estadual do CearáCentro de Ciências da SaúdeFortalezaCEBrazil Universidade Estadual do Ceará. Centro de Ciências da Saúde. Fortaleza, CE, Brazil
| | - Ilana Nogueira Bezerra
- Universidade Estadual do CearáCentro de Ciências da SaúdeFortalezaCEBrazil Universidade Estadual do Ceará. Centro de Ciências da Saúde. Fortaleza, CE, Brazil
| | - Mariane Alves Silva
- Universidade Federal de Mato GrossoFaculdade de NutriçãoCuiabáMTBrazil Universidade Federal de Mato Grosso. Faculdade de Nutrição. Cuiabá, MT, Brazil
| | - Maria Helena Lima D’oran
- Universidade Estadual do CearáCentro de Ciências da SaúdeFortalezaCEBrazil Universidade Estadual do Ceará. Centro de Ciências da Saúde. Fortaleza, CE, Brazil
| | - Diana Barbosa Cunha
- Universidade do Estado do Rio de JaneiroDepartamento de EpidemiologiaRio de JaneiroRJBrazil Universidade do Estado do Rio de Janeiro. Departamento de Epidemiologia. Rio de Janeiro, RJ, Brazil
| | - Luis Alberto Moreno
- Universidad de ZaragozaFacultad de Ciencias de la SaludZaragozaSpain Universidad de Zaragoza. Facultad de Ciencias de la Salud. Zaragoza, Spain
| | - Rosely Sichieri
- Universidade do Estado do Rio de JaneiroDepartamento de EpidemiologiaRio de JaneiroRJBrazil Universidade do Estado do Rio de Janeiro. Departamento de Epidemiologia. Rio de Janeiro, RJ, Brazil
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Andreeva VA, Perez-Jimenez J, St-Onge MP. A Systematic Review of the Bidirectional Association Between Consumption of Ultra-processed Food and Sleep Parameters Among Adults. Curr Obes Rep 2023; 12:439-452. [PMID: 37477854 PMCID: PMC11165373 DOI: 10.1007/s13679-023-00512-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE OF REVIEW We summarized research on the bidirectional association between intake of ultra-processed food (UPF) and sleep. RECENT FINDINGS Sleep contributes to cardiometabolic health in part via food intake patterns. Restricting sleep increases intakes of high-carbohydrate/high-fat foods, a profile representative of UPF. This systematic review covers the association of UPF intake, as an exposure or an outcome, and sleep. UPF was defined as NOVA Group 4. MEDLINE and EMBASE were searched through April 2023 for epidemiological studies with general-population adult samples. Fifteen studies met the inclusion criteria; all were cross-sectional, published between 2016 and 2023, with samples from Brazil (n = 8), Spain (n = 2), Italy (n = 1), the UK (n = 1), Paraguay (n = 1), Iran (n = 1) and China (n = 1). Thirteen studies examined UPF intake as the exposure whereas two tested UPF intake as the outcome. UPF intakes were determined using food frequency questionnaires (73%) or 24-h recalls (27%). Two studies assessed sleep via accelerometry; the remaining studies relied on self-reports of sleep quality, duration, anxiety-induced insomnia, and napping, with 60% using a single question. The average methodological quality across the studies was deemed "fair". Six of the 13 studies that examined UPF consumption as the exposure revealed inverse associations with sleep outcomes in adjusted (n = 5) or bivariate (n = 1) analyses. Both studies addressing UPF consumption as the outcome and sleep as the exposure showed significant inverse associations. Evidence for UPF-sleep associations is accumulating, although sleep assessment limitations are apparent. This review can provide impetus for research using comprehensive and validated sleep measures and nudge policymakers towards refining dietary guidelines worldwide.
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Affiliation(s)
- Valentina A Andreeva
- Nutritional Epidemiology Research Group, INSERM U1153/INRAE U1125/CNAM, Epidemiology and Statistics Research Center (CRESS), Sorbonne Paris Nord University, 93017, Bobigny, France
- Division of General Medicine and Center of Excellence for Sleep & Circadian Research, Department of Medicine, Columbia University, New York, NY, 10032, USA
| | - Jara Perez-Jimenez
- Institute of Food Science, Technology and Nutrition, Spanish Research Council (ICTAN-CSIC), 28040, Madrid, Spain
- Division of General Medicine and Center of Excellence for Sleep & Circadian Research, Department of Medicine, Columbia University, New York, NY, 10032, USA
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), ISCIII, 28029, Madrid, Spain
| | - Marie-Pierre St-Onge
- Division of General Medicine and Center of Excellence for Sleep & Circadian Research, Department of Medicine, Columbia University, New York, NY, 10032, USA.
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22
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Cortes C, Brandão JM, Cunha DB, Paravidino VB, Sichieri R. Blood pressure variation and ultra-processed food consumption in children with obesity. Eur J Pediatr 2023; 182:4077-4085. [PMID: 37401980 DOI: 10.1007/s00431-023-05076-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/07/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023]
Abstract
To investigate the influence of ultra-processed food (UPF) consumption on systolic (SBP) and diastolic (DBP) blood pressure in children with obesity, using dietary and urinary markers. We conducted a secondary analysis of a randomized clinical trial involving children with obesity, aged 7 to 12 years. Over a period of six months, the children and their guardians attended monthly individual consultations and educational activities aimed at promoting a reduction in UPF consumption. During each visit, measurements of blood pressure, body weight, height, and 24-h dietary recall were recorded. Additionally, spot urine samples were collected at baseline, and at the second and fifth-month follow-ups. A total of 96 children were included in the analysis. Energy intake, UPF intake and blood pressure showed a quadratic pattern of change, with a decrease in the first two months and an increase thereafter. There was an association between UPF consumption and DBP. The intake of UPF was correlated with the urinary sodium-to-potassium (Na/K) ratio (r = 0.29; p = 0.008) and the dietary Na/K ratio (r = 0.40; p < 0.001). For every 100 g increase in UPF, DBP increased by 0.28 mmHg (p-value = 0.01). After further adjustment for changes in body mass index (BMI), and physical activity, the increase in DBP was 0.22 mmHg. Conclusion: Our findings indicate that reducing UPF consumption may have an impact on blood pressure in children with obesity. Additional adjustment for BMI and physical activity did not influence the results. Therefore, reducing UPF consumption can be considered as a strategy against hypertension. What is Known: • Ultra-processed food consumption is associated with an increased risk of cardiovascular disease; however, this evidence is still limited in children. • Intake of calories from ultra-processed food in relation to the total calories is increasing worldwide. What is New: • Ultra-processed food consumption has an effect on the diastolic blood pressure, independent of changes in weight. • The intake of ultra-processed food was correlated to the dietary sodium-to-potassium ratio (r = 0.40; p < 0.001).
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Affiliation(s)
- Caroline Cortes
- Department of Epidemiology, Hésio Cordeiro Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Joana Maia Brandão
- Department of Epidemiology, Hésio Cordeiro Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Diana Barbosa Cunha
- Department of Epidemiology, Hésio Cordeiro Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Vitor Barreto Paravidino
- Department of Epidemiology, Hésio Cordeiro Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Department of Physical Education and Sports, Naval Academy - Brazilian Navy, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rosely Sichieri
- Department of Epidemiology, Hésio Cordeiro Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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23
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Watso JC, Fancher IS, Gomez DH, Hutchison ZJ, Gutiérrez OM, Robinson AT. The damaging duo: Obesity and excess dietary salt contribute to hypertension and cardiovascular disease. Obes Rev 2023; 24:e13589. [PMID: 37336641 PMCID: PMC10406397 DOI: 10.1111/obr.13589] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/08/2023] [Accepted: 05/24/2023] [Indexed: 06/21/2023]
Abstract
Hypertension is a primary risk factor for cardiovascular disease. Cardiovascular disease is the leading cause of death among adults worldwide. In this review, we focus on two of the most critical public health challenges that contribute to hypertension-obesity and excess dietary sodium from salt (i.e., sodium chloride). While the independent effects of these factors have been studied extensively, the interplay of obesity and excess salt overconsumption is not well understood. Here, we discuss both the independent and combined effects of excess obesity and dietary salt given their contributions to vascular dysfunction, autonomic cardiovascular dysregulation, kidney dysfunction, and insulin resistance. We discuss the role of ultra-processed foods-accounting for nearly 60% of energy intake in America-as a major contributor to both obesity and salt overconsumption. We highlight the influence of obesity on elevated blood pressure in the presence of a high-salt diet (i.e., salt sensitivity). Throughout the review, we highlight critical gaps in knowledge that should be filled to inform us of the prevention, management, treatment, and mitigation strategies for addressing these public health challenges.
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Affiliation(s)
- Joseph C. Watso
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, Florida, USA
| | - Ibra S. Fancher
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| | - Dulce H. Gomez
- School of Kinesiology, Auburn University, Auburn, Alabama, USA
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | - Orlando M. Gutiérrez
- Division of Nephrology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Ansari S, Mohammadifard N, Haghighatdoost F, Zarepur E, Mahmoudi S, Nouri F, Nouhi F, Alikhasi H, Sharifianjazi F, Tavamaishvili K, Shirani S, Kazemi T, Azdaki N, Salehi N, Lotfizadeh M, Solati K, Ghaffari S, Javanmardi E, Salari A, Dehghani M, Cheraghi M, Assareh A, Haybar H, Namayandeh SM, Madadi R, Sarrafzadegan N. The relationship between ultra processed food consumption and premature coronary artery disease: Iran premature coronary artery disease study (IPAD). Front Nutr 2023; 10:1145762. [PMID: 37476400 PMCID: PMC10354702 DOI: 10.3389/fnut.2023.1145762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/27/2023] [Indexed: 07/22/2023] Open
Abstract
Background Ultra-processed foods (UPF) consumption may affect the risk of PCAD through affecting cardio metabolic risk factors. This study aimed to evaluate the association between UPFs consumption and premature coronary artery disease (PCAD). Methods A case-control study was conducted on 2,354 Iranian adults (≥ 19 years). Dietary intake was assessed using a validated 110-item food frequency questionnaire (FFQ) and foods were classified based on the NOVA system, which groups all foods according to the nature, extent and purposes of the industrial processes they undergo. PCAD was defined as having an stenosis of at least single coronary artery equal and above 75% or left main coronary of equal or more than 50% in women less than 70 and men less than 60 years, determined by angiography. The odds of PCAD across the tertiles of UPFs consumption were assessed by binary logistic regression. Results After adjustment for potential confounders, participants in the top tertile of UPFs were twice as likely to have PCAD compared with those in the bottom tertile (OR: 2.52; 95% CI: 1.97-3.23). Moreover, those in the highest tertile of the UPFs consumption had more than two times higher risk for having severe PCAD than those in the first tertile (OR: 2.64; 95% CI: 2.16-3.22). In addition, there was a significant upward trend in PCAD risk and PCAD severity as tertiles increased (P-trend < 0.001 for all models). Conclusion Higher consumption of UPFs was related to increased risk of PCAD and higher chance of having severe PCAD in Iranian adults. Although, future cohort studies are needed to confirm the results of this study, these findings indicated the necessity of reducing UPFs intake.
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Affiliation(s)
- Shakila Ansari
- Department of Community Nutrition, Nutrition and Food Security Research Center, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Noushin Mohammadifard
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fahimeh Haghighatdoost
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ehsan Zarepur
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Cardiology, Medicine School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shirin Mahmoudi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Nouri
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fereidoon Nouhi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Iranian Network of Cardiovascular Research (INCVR), Tehran, Iran
| | - Hassan Alikhasi
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | | | - Shahin Shirani
- Department of Cardiology, Tehran University of Medical Science, Dr Ali Shariati Hospital, Tehran, Iran
| | - Tooba Kazemi
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Nahid Azdaki
- Clinical Research Development Unit, Razi Hospital, Birjand University of Medical Sciences, Birjand, Iran
| | - Nahid Salehi
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Lotfizadeh
- Social Determinants of Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Kamal Solati
- Department of Psychiatry, Shahrekord University of Medical Science, Shahrekord, Iran
| | - Samad Ghaffari
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elmira Javanmardi
- Department of Cardiovascular Medicine, Amiralmomenin Hospital, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Arsalan Salari
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mostafa Dehghani
- Department of Cardiovascular Research Center, Shahid Rahimi Hospital, Lorestan University of Medical Science, Khorramabad, Iran
| | - Mostafa Cheraghi
- Department of Cardiovascular Research Center, Shahid Rahimi Hospital, Lorestan University of Medical Science, Khorramabad, Iran
| | - Ahmadreza Assareh
- Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Habib Haybar
- Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyedeh M. Namayandeh
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Science, Yazd, Iran
- Center for Healthcare Data Modeling, Departments of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Reza Madadi
- Zanjan University of Medical Sciences, Zanjan, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Su D, Chen J, Du S, Kim H, Yu B, Wong KE, Boerwinkle E, Rebholz CM. Metabolomic Markers of Ultra-Processed Food and Incident CKD. Clin J Am Soc Nephrol 2023; 18:327-336. [PMID: 36735499 PMCID: PMC10103271 DOI: 10.2215/cjn.0000000000000062] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/22/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND High ultra-processed food consumption is associated with higher risk of CKD. However, there is no biomarker for ultra-processed food, and the mechanism through which ultra-processed food is associated with CKD is not clear. Metabolomics can provide objective biomarkers of ultra-processed food and provide important insights into the mechanisms by which ultra-processed food is associated with risk of incident CKD. Our objective was to identify serum metabolites associated with ultra-processed food consumption and investigate whether ultra-processed food-associated metabolites are prospectively associated with incident CKD. METHODS We used data from 3751 Black and White men and women (aged 45-64 years) in the Atherosclerosis Risk in Communities study. Dietary intake was assessed using a semiquantitative 66-item food frequency questionnaire, and ultra-processed food was classified using the NOVA classification system. Multivariable linear regression models were used to identify the association between 359 metabolites and ultra-processed food consumption. Cox proportional hazards models were used to investigate the prospective association of ultra-processed food-associated metabolites with incident CKD. RESULTS Twelve metabolites (saccharine, homostachydrine, stachydrine, N2, N2-dimethylguanosine, catechol sulfate, caffeine, 3-methyl-2-oxovalerate, theobromine, docosahexaenoate, glucose, mannose, and bradykinin) were significantly associated with ultra-processed food consumption after controlling for false discovery rate <0.05 and adjusting for sociodemographic factors, health behaviors, eGFR, and total energy intake. The 12 ultra-processed food-related metabolites significantly improved the prediction of ultra-processed food consumption (difference in C statistics: 0.069, P <1×10 -16 ). Higher levels of mannose, glucose, and N2, N2-dimethylguanosine were associated with higher risk of incident CKD after a median follow-up of 23 years. CONCLUSIONS We identified 12 serum metabolites associated with ultra-processed food consumption and three of them were positively associated with incident CKD. Mannose and N2, N2-dimethylguanosine are novel markers of CKD that may explain observed associations between ultra-processed food and CKD. PODCAST This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/CJASN/2023_03_08_CJN08480722.mp3.
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Affiliation(s)
- Donghan Su
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jingsha Chen
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Shutong Du
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Hyunju Kim
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Bing Yu
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston, Houston, Texas
| | | | - Eric Boerwinkle
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Casey M. Rebholz
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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26
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Barbosa LB, Vasconcelos NBR, dos Santos EA, dos Santos TR, Ataide-Silva T, Ferreira HDS. Ultra-processed food consumption and metabolic syndrome: a cross-sectional study in Quilombola communities of Alagoas, Brazil. Int J Equity Health 2023; 22:14. [PMID: 36650595 PMCID: PMC9847020 DOI: 10.1186/s12939-022-01816-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/22/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The processing of food can cause changes that turn them into risk factors for chronic diseases. A higher degree of food processing is associated with the development of chronic non-communicable diseases (NCDs), including the metabolic syndrome (MetS). The objective of this study was to analyze the relationship between ultra-processed food (UPF) consumption and the prevalence of MetS and its risk factors, focusing on a population group especially subjected to precarious living conditions and food insecurity. METHOD Cross-sectional population-based study with women (19 to 59 years) from Quilombola communities of Alagoas. The socioeconomic, demographic, anthropometric, health status, lifestyle, and food intake (24-h recall) variables were analyzed. The dependent variable was the MetS, defined using the harmonization criteria of the Joint Interim Statement, and its components. The foods consumed were categorized according to the Nova Classification, assuming the highest UPF consumption as risk exposure. The measure of association was the prevalence ratio (PR) and respective 95%CI, calculated by Poisson regression with robust variance. We also analyzed the association with the Nova score of UPF consumption. RESULTS We investigated 895 women (38.9 ± 11.0 years), of whom 48.3% had MetS. On average, 15.9% of the total energy intake came from UPF. Lower Nova scores were associated with a lower prevalence of diabetes and low HDL. Higher UPF consumption was associated with a 30% higher prevalence of hypertension (PR = 1.30; 95%CI: 1.06-1.61). CONCLUSION The highest UPF consumption was positively associated with the prevalence of hypertension, while a lower Nova score was a protective factor against diabetes and low HDL. UPF consumption in Quilombola communities is important but lower than that observed in the Brazilian population in general. It is suggested that public health programs be implemented to promote healthy eating while valuing the existing eating habits and traditions among the remaining Brazilian Quilombola people.
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Affiliation(s)
- Lídia Bezerra Barbosa
- grid.411179.b0000 0001 2154 120XPostgraduate Program in Health Sciences of the Institute of Biological and Health Sciences, Federal University of Alagoas, Campus A. C. Simões, BR 104, km 14, Tabuleiro dos Martins, Maceió, Alagoas 57072-970 Brazil ,grid.411179.b0000 0001 2154 120XFaculty of Nutrition of the Federal University of Alagoas, Campus A. C. Simões, BR 104, km 14, Tabuleiro dos Martins, Maceió, Alagoas 57072-970. Brazil
| | - Nancy Borges Rodrigues Vasconcelos
- grid.411179.b0000 0001 2154 120XPostgraduate Program in Health Sciences of the Institute of Biological and Health Sciences, Federal University of Alagoas, Campus A. C. Simões, BR 104, km 14, Tabuleiro dos Martins, Maceió, Alagoas 57072-970 Brazil
| | - Ewerton Amorim dos Santos
- grid.411179.b0000 0001 2154 120XFaculty of Medicine of the Federal University of Alagoas, Campus A. C. Simões, BR 104, km 14, Tabuleiro dos Martins, Maceió, Alagoas 57072-970. Brazil
| | - Tamara Rodrigues dos Santos
- grid.411179.b0000 0001 2154 120XPostgraduate Program in Health Sciences of the Institute of Biological and Health Sciences, Federal University of Alagoas, Campus A. C. Simões, BR 104, km 14, Tabuleiro dos Martins, Maceió, Alagoas 57072-970 Brazil
| | - Thays Ataide-Silva
- grid.411179.b0000 0001 2154 120XFaculty of Nutrition of the Federal University of Alagoas, Campus A. C. Simões, BR 104, km 14, Tabuleiro dos Martins, Maceió, Alagoas 57072-970. Brazil
| | - Haroldo da Silva Ferreira
- grid.411179.b0000 0001 2154 120XFaculty of Nutrition of the Federal University of Alagoas, Campus A. C. Simões, BR 104, km 14, Tabuleiro dos Martins, Maceió, Alagoas 57072-970. Brazil
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Zyla-Jackson K, Walton DA, Plafker KS, Kovats S, Georgescu C, Brush RS, Tytanic M, Agbaga MP, Plafker SM. Dietary protection against the visual and motor deficits induced by experimental autoimmune encephalomyelitis. Front Neurol 2023; 14:1113954. [PMID: 36937529 PMCID: PMC10017782 DOI: 10.3389/fneur.2023.1113954] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction Five to eight percent of the world population currently suffers from at least one autoimmune disorder. Despite multiple immune modulatory therapies for autoimmune demyelinating diseases of the central nervous system, these treatments can be limiting for subsets of patients due to adverse effects and expense. To circumvent these barriers, we investigated a nutritional intervention in mice undergoing experimental autoimmune encephalomyelitis (EAE), a model of autoimmune-mediated demyelination that induces visual and motor pathologies similar to those experienced by people with multiple sclerosis (MS). Methods EAE was induced in female and male mice and the impact of limiting dietary carbohydrates by feeding a ketogenic diet (KD) enriched in medium chain triglycerides (MCTs), alpha-linolenic acid (an omega-3 fatty acid), and fiber was evaluated in both a preventive regimen (prior to immunization with MOG antigen) and an interventional regimen (following the onset of symptoms). Motor scores were assigned daily and visual acuity was measured using optokinetic tracking. Immunohistochemical analyses of optic nerves were done to assess inflammatory infiltrates and myelination status. Fatty acid and cytokine profiling from blood were performed to evaluate systemic inflammatory status. Results The KD was efficacious when fed as a preventive regimen as well as when initiated as an interventional regimen following symptom onset. The KD minimally impacted body weight during the experimental time course, increased circulating ketones, prevented motor and ocular deficits, preserved myelination of the optic nerve, and reduced infiltration of immune cells to optic nerves. The KD also increased anti-inflammatory-associated omega-3 fatty acids in the plasma and reduced select cytokines in the circulation associated with EAE-mediated pathological inflammation. Discussion In light of ongoing clinical trials using dietary strategies to treat people with MS, these findings support that a KD enriched in MCTs, omega-3 fatty acids, and fiber promotes a systemic anti-inflammatory milieu and ameliorates autoimmune-induced demyelinating visual and motor deficits.
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Affiliation(s)
- Katarzyna Zyla-Jackson
- Aging and Metabolism Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
- Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Dorothy A. Walton
- Aging and Metabolism Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
| | - Kendra S. Plafker
- Aging and Metabolism Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
| | - Susan Kovats
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Constantin Georgescu
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
| | - Richard S. Brush
- Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Madison Tytanic
- Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Martin-Paul Agbaga
- Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Scott M. Plafker
- Aging and Metabolism Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
- Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- *Correspondence: Scott M. Plafker
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28
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Huybrechts I, Rauber F, Nicolas G, Casagrande C, Kliemann N, Wedekind R, Biessy C, Scalbert A, Touvier M, Aleksandrova K, Jakszyn P, Skeie G, Bajracharya R, Boer JMA, Borné Y, Chajes V, Dahm CC, Dansero L, Guevara M, Heath AK, Ibsen DB, Papier K, Katzke V, Kyrø C, Masala G, Molina-Montes E, Robinson OJK, Santiuste de Pablos C, Schulze MB, Simeon V, Sonestedt E, Tjønneland A, Tumino R, van der Schouw YT, Verschuren WMM, Vozar B, Winkvist A, Gunter MJ, Monteiro CA, Millett C, Levy RB. Characterization of the degree of food processing in the European Prospective Investigation into Cancer and Nutrition: Application of the Nova classification and validation using selected biomarkers of food processing. Front Nutr 2022; 9:1035580. [PMID: 36590209 PMCID: PMC9800919 DOI: 10.3389/fnut.2022.1035580] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022] Open
Abstract
Background Epidemiological studies have demonstrated an association between the degree of food processing in our diet and the risk of various chronic diseases. Much of this evidence is based on the international Nova classification system, which classifies food into four groups based on the type of processing: (1) Unprocessed and minimally processed foods, (2) Processed culinary ingredients, (3) Processed foods, and (4) "Ultra-processed" foods (UPF). The ability of the Nova classification to accurately characterise the degree of food processing across consumption patterns in various European populations has not been investigated so far. Therefore, we applied the Nova coding to data from the European Prospective Investigation into Cancer and Nutrition (EPIC) in order to characterize the degree of food processing in our diet across European populations with diverse cultural and socio-economic backgrounds and to validate this Nova classification through comparison with objective biomarker measurements. Methods After grouping foods in the EPIC dataset according to the Nova classification, a total of 476,768 participants in the EPIC cohort (71.5% women; mean age 51 [standard deviation (SD) 9.93]; median age 52 [percentile (p)25-p75: 58-66] years) were included in the cross-sectional analysis that characterised consumption patterns based on the Nova classification. The consumption of food products classified as different Nova categories were compared to relevant circulating biomarkers denoting food processing, measured in various subsamples (N between 417 and 9,460) within the EPIC cohort via (partial) correlation analyses (unadjusted and adjusted by sex, age, BMI and country). These biomarkers included an industrial transfatty acid (ITFA) isomer (elaidic acid; exogenous fatty acid generated during oil hydrogenation and heating) and urinary 4-methyl syringol sulfate (an indicator for the consumption of smoked food and a component of liquid smoke used in UPF). Results Contributions of UPF intake to the overall diet in % grams/day varied across countries from 7% (France) to 23% (Norway) and their contributions to overall % energy intake from 16% (Spain and Italy) to >45% (in the UK and Norway). Differences were also found between sociodemographic groups; participants in the highest fourth of UPF consumption tended to be younger, taller, less educated, current smokers, more physically active, have a higher reported intake of energy and lower reported intake of alcohol. The UPF pattern as defined based on the Nova classification (group 4;% kcal/day) was positively associated with blood levels of industrial elaidic acid (r = 0.54) and 4-methyl syringol sulfate (r = 0.43). Associations for the other 3 Nova groups with these food processing biomarkers were either inverse or non-significant (e.g., for unprocessed and minimally processed foods these correlations were -0.07 and -0.37 for elaidic acid and 4-methyl syringol sulfate, respectively). Conclusion These results, based on a large pan-European cohort, demonstrate sociodemographic and geographical differences in the consumption of UPF. Furthermore, these results suggest that the Nova classification can accurately capture consumption of UPF, reflected by stronger correlations with circulating levels of industrial elaidic acid and a syringol metabolite compared to diets high in minimally processed foods.
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Affiliation(s)
- Inge Huybrechts
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
| | - Fernanda Rauber
- Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Research in Nutrition and Health, University of São Paulo, São Paulo, Brazil
| | - Geneviève Nicolas
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
| | - Corinne Casagrande
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
| | - Nathalie Kliemann
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
| | - Roland Wedekind
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
| | - Carine Biessy
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
| | - Augustin Scalbert
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
| | - Mathilde Touvier
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University Paris Cité (CRESS), Paris, France
| | - Krasimira Aleksandrova
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology (BIPS), Bremen, Germany
- Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Paula Jakszyn
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
- Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain
| | - Guri Skeie
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | | | - Jolanda M. A. Boer
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Yan Borné
- Department of Clinical Sciences Malmö, Faculty of Medicine, Nutritional Epidemiology, Lund University, Lund, Sweden
| | - Veronique Chajes
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Lucia Dansero
- Department of Clinical and Biological Sciences, Centre for Biostatistics, Epidemiology, and Public Health (C-BEPH), University of Turin, Turin, Italy
| | - Marcela Guevara
- Instituto de Salud Pública de Navarra, Pamplona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Alicia K. Heath
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Daniel B. Ibsen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus, Denmark
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
| | - Keren Papier
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Verena Katzke
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Cecilie Kyrø
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Giovanna Masala
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Esther Molina-Montes
- Department of Nutrition and Food Science, Campus of Cartuja, University of Granada, Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Biomedical Research Centre, Institute of Nutrition and Food Technology (INYTA) “José Mataix”, University of Granada, Granada, Spain
| | - Oliver J. K. Robinson
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Carmen Santiuste de Pablos
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - Matthias B. Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
| | - Vittorio Simeon
- Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Vanvitelli University, Naples, Italy
| | - Emily Sonestedt
- Department of Clinical Sciences Malmö, Faculty of Medicine, Nutritional Epidemiology, Lund University, Lund, Sweden
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Rosario Tumino
- Hyblean Association for Epidemiological Research, AIRE ONLUS, Ragusa, Italy
| | - Yvonne T. van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - W. M. Monique Verschuren
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Beatrice Vozar
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
| | - Anna Winkvist
- Sustainable Health, Department Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marc J. Gunter
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
| | - Carlos A. Monteiro
- Center for Epidemiological Research in Nutrition and Health, University of São Paulo, São Paulo, Brazil
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Christopher Millett
- Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Renata Bertazzi Levy
- Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Research in Nutrition and Health, University of São Paulo, São Paulo, Brazil
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29
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Li M, Shi Z. Ultra-Processed Food Consumption Associated with Incident Hypertension among Chinese Adults-Results from China Health and Nutrition Survey 1997-2015. Nutrients 2022; 14:nu14224783. [PMID: 36432470 PMCID: PMC9692874 DOI: 10.3390/nu14224783] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: Ultra-processed food (UPF) has been shown to increase the cardiometabolic health risks. We aimed to determine the association between UPF intake based on the NOVA classification and the risk of hypertension incidence during 1997−2015. Methods: Data from 15,054 adults aged ≥ 20 years (47.4% males) attending the China Nutrition and Health Survey (CNHS) were used. Food intake at each survey was assessed by a 3-day 24 h dietary recall and weighed food record method between 1997−2011. Cox regression was used to assess the association between UPF intake and incident hypertension. Results: During a mean average of 9.5 years (SD 5.5) of follow up, 4329 hypertension incident cases were identified. The incident rates (per 1000) for non-consumers and 1−49, 50−99, and ≥100 g/day of UPF intake were 29.5 and 29.5, 33.4, and 36.3, respectively. Compared with non-consumers, the hazard ratios (95% CI) for UPF intake of 1−49, 50−99, and >100 g/day were 1.00 (0.90−1.12), 1.17 (1.04−1.33), and 1.20 (1.06−1.35), respectively, (p = 0.001) after adjusting for potential confounding factors. There was a significant interaction between UPF intake and age with a higher risk in the younger group (<40 years) than in the older one. Conclusion: UPF consumption was dose-responsively associated with increased risk of hypertension among Chinese adults, especially in younger groups.
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Affiliation(s)
- Ming Li
- Centre for Population Health Research, Division of Health Sciences, University of South Australia, Adelaide, SA 5005, Australia
- Correspondence:
| | - Zumin Shi
- Human Nutrition Department, College of Health Sciences, QU Health, Qatar University, Doha 2713, Qatar
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30
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Kong W, Xie Y, Zhong J, Cao C. Ultra-processed foods and allergic symptoms among children and adults in the United States: A population-based analysis of NHANES 2005-2006. Front Public Health 2022; 10:1038141. [PMID: 36407984 PMCID: PMC9670314 DOI: 10.3389/fpubh.2022.1038141] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
Design There is a strong correlation between dietary intake and allergic diseases. Ultra-processed foods (UPFs) are gradually becoming dominant worldwide and causing health problems for children and adults. We hope to determine whether links exist between UPFs and allergic symptoms. Methods We investigated data from 2,736 children (16-19 years) and 4,256 adults (≥20 years) from the National Health and Nutritional Examination Survey (NHANES) 2005-2006. The associations between the mean UPFs contribution to total energy intake and all allergic symptoms (IgE, current asthma, allergy, rash, sneeze, wheeze, eczema, and hay fever) were estimated by weighted multivariate logistic regression. Results Logistic regression analysis showed UFPs were negatively associated with IgE levels in children. Those with higher quartiles had a reduced risk from 16% (OR, 0.84, 95%CI, 0.55 to 1.28) to 34% (OR, 0.66, 95%CI, 0.49 to 0.89), p for trend = 0.006. UPFs were also positively related to current asthma in children with an increased risk of 11% (OR, 1.11, 95%CI, 0.79 to 1.56) to 76% (OR, 1.76, 95%CI, 1.10 to 2.82), p for trend = 0.0393. UPFs were also associated with eczema in girls. But there was no association observed between UPFs and allergic symptoms in adults. Conclusion Our results suggested that UPFs assessed by the NOVA system were associated with IgE, current asthma in children, and eczema in girls. These results further support the need to test the association of modern dietary patterns with allergic symptoms.
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31
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Cubas-Basterrechea G, Elío I, Alonso G, Otero L, Gutiérrez-Bardeci L, Puente J, Muñoz-Cacho P. Adherence to the Mediterranean Diet Is Inversely Associated with the Prevalence of Metabolic Syndrome in Older People from the North of Spain. Nutrients 2022; 14:nu14214536. [PMID: 36364798 PMCID: PMC9657522 DOI: 10.3390/nu14214536] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/17/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The aim of this study was to relate adherence to the Mediterranean diet (MedDiet) to the prevalence of metabolic syndrome (MetS) in an elderly population from the north of Spain. Methods: We carried out an observational, descriptive, cross-sectional, and correlational study involving 556 non-institutionalised individuals aged 65 to 79 years. The MEDAS-14 questionnaire score was used to define the degree of adherence to the Mediterranean diet. The diagnosis of MetS was conducted using the International Diabetes Federation (IDF) criteria. Results: In 264 subjects with an average age of 71.9 (SD: ±4.2), 39% of whom were men, 36.4% had good adherence (score ≥ 9 in MEDAS-14), with no differences by gender or age. The prevalence of MetS was 40.2%, with 47.6% in men and 35.4% in women (p < 0.05). The prevalence of MetS was 2.4 times more frequent among individuals who consumed less than two servings (200 g) of vegetables daily compared with those who consumed two or more servings of vegetables daily (OR: 2.368, 95%CI: 1.141−4.916, p = 0.021). Low adherence to the MedDiet (MEDAS-14 score ≤ 8) was associated with an 82% higher prevalence of MetS (OR: 1.817, 95%CI: 1.072−3.081, p = 0.027). Conclusion: An inverse relationship was established between adherence to the MedDiet and the prevalence of MetS.
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Affiliation(s)
- Gloria Cubas-Basterrechea
- Dietetic Section, Hospital Universitario “Marqués de Valdecilla”, 39008 Santander, Spain
- Correspondence: ; Tel.: +34-617-597-045
| | - Iñaki Elío
- Research Group on Foods, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, 39011 Santander, Spain
- Department of Health, Nutrition and Sport, Iberoamerican International University, Campeche 24560, Mexico
| | | | - Luis Otero
- Primary Care Center Puertochico, 39004 Santander, Spain
| | | | - Jesús Puente
- Compass Group, Department VITArest, 28054 Madrid, Spain
| | - Pedro Muñoz-Cacho
- Teaching Department of Primary Care Management, Cantabrian Health Service, IDIVAL, 39011 Santander, Spain
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32
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Atzeni A, Martínez MÁ, Babio N, Konstanti P, Tinahones FJ, Vioque J, Corella D, Fitó M, Vidal J, Moreno-Indias I, Pertusa-Martinez S, Álvarez-Sala A, Castañer O, Goday A, Damas-Fuentes M, Belzer C, Martínez-Gonzalez MÁ, Hu FB, Salas-Salvadó J. Association between ultra-processed food consumption and gut microbiota in senior subjects with overweight/obesity and metabolic syndrome. Front Nutr 2022; 9:976547. [PMID: 36299993 PMCID: PMC9589409 DOI: 10.3389/fnut.2022.976547] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/21/2022] [Indexed: 12/14/2022] Open
Abstract
The production and consumption of ultra-processed foods (UPF) has increased considerably during the last years worldwide. Collective evidence shows the association between UPF consumption and adverse health outcomes, including inflammatory gastro-intestinal disorders and obesity. The gut microbiota has been suggested as potential mediator of the effects of UPF consumption on metabolism and health. However, few studies have been conducted in order to elucidate these aspects. Therefore, the aim of the present study was to assess the cross-sectional associations between UPF consumption and gut microbiota in a population of senior subjects (n = 645) within the frame of the PREDIMED-Plus trial. Eligible participants were men and women (aged 55-75 years), without documented history of cardiovascular disease at enrollment, with overweight/obesity (body mass index ≤ 27 and <40 kg/m2) and metabolic syndrome. Using the information of food frequency questionnaires, the consumption of UPF, expressed as a percentage of total dietary energy intake in kcal/day, was calculated considering those food items classified in group 4 of NOVA system. Population was categorized according to tertiles of UPF consumption. Taxonomic fecal microbiota information, along with blood biochemical parameters, anthropometric measurements and clinical data were obtained. Bioinformatics analysis was performed to study the association between fecal microbiota composition and UPF consumption. We observed that subjects allocated in the highest tertile of UPF consumption (21.4 ± 5.0 % kcal/day) presented lower adherence to MedDiet (p < 0.001) and higher total energy intake (p < 0.001). The taxonomic analysis of the fecal microbiota revealed a significant (Benjamini-Hochberg adjusted p < 0.2) positive association between specific taxa and tertiles (T) of UPF consumption: Alloprevotella (p = 0.041 vs. T2; p = 0.065 vs. T3), Negativibacillus (p = 0.096 vs. T3), Prevotella (p = 0.116 vs. T3), and Sutterella (p = 0.116 vs. T2). UPF consumption was positively associated with lower adherence to MedDiet and higher total energy intake in senior subjects with overweight obesity and metabolic syndrome. In addition, positive association with specific fecal microbiota taxa related to inflammatory gastro-intestinal diseases and low consumption of fruits and vegetables, was observed.
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Affiliation(s)
- Alessandro Atzeni
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain.,Universitat Rovira i Virgili, Department de Bioquímica i Biotecnologia, Unitat de Nutrició, Reus, Spain.,Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - María Ágeles Martínez
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain.,Universitat Rovira i Virgili, Department de Bioquímica i Biotecnologia, Unitat de Nutrició, Reus, Spain.,Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Nancy Babio
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain.,Universitat Rovira i Virgili, Department de Bioquímica i Biotecnologia, Unitat de Nutrició, Reus, Spain.,Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Prokopis Konstanti
- Laboratory of Microbiology, Wageningen University, Wageningen, Netherlands
| | - Francisco J Tinahones
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain.,Department of Endocrinology and Nutrition, Instituto de Investigación Biomédica de Málaga - IBIMA, Hospital Universitario Virgen de la Vic, Málaga, Spain
| | - Jesús Vioque
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernández (ISABIAL-UMH), Alicante, Spain
| | - Dolores Corella
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain.,Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - Montserrat Fitó
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain.,Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal d'Investigació Médica (IMIM), Barcelona, Spain
| | - Josep Vidal
- CIBER Diabetes y Enfermedades Metabólicas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Department of Endocrinology, Institut d'Investigacions Biomédiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Isabel Moreno-Indias
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain.,Department of Endocrinology and Nutrition, Instituto de Investigación Biomédica de Málaga - IBIMA, Hospital Universitario Virgen de la Vic, Málaga, Spain
| | | | - Andrea Álvarez-Sala
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain.,Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - Olga Castañer
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain.,Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal d'Investigació Médica (IMIM), Barcelona, Spain
| | - Albert Goday
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain.,Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain.,IMIM, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Miguel Damas-Fuentes
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain.,Department of Endocrinology and Nutrition, Instituto de Investigación Biomédica de Málaga - IBIMA, Hospital Universitario Virgen de la Vic, Málaga, Spain
| | - Clara Belzer
- Laboratory of Microbiology, Wageningen University, Wageningen, Netherlands
| | - Miguel Á Martínez-Gonzalez
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain.,Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.,Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Frank B Hu
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States.,Channing Division for Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Jordi Salas-Salvadó
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain.,Universitat Rovira i Virgili, Department de Bioquímica i Biotecnologia, Unitat de Nutrició, Reus, Spain.,Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
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Tak M, Law C, Green R, Shankar B, Cornelsen L. Processed foods purchase profiles in urban India in 2013 and 2016: a cluster and multivariate analysis. BMJ Open 2022; 12:e062254. [PMID: 36207045 PMCID: PMC9558783 DOI: 10.1136/bmjopen-2022-062254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Sales of ultraprocessed foods (UPFs) and beverages are rising in low-income and middle-income countries. Such foods are often linked with weight gain, obesity, type 2 diabetes and hypertension-diseases that are on the rise in India. This paper analysed patterns in purchases of processed and UPF by urban Indian households. SETTING Panel data from Kantar -Worldpanel Division, India for 2013 and 2016. PARTICIPANTS 58 878 urban Indian households. METHODS We used K-mean partition clustering and multivariate regression to analyse patterns in processed food (PF) and UPF purchase for urban India. RESULTS Three-quarters of urban Indian households purchased over ten PF groups. Mean per person annual PF purchase was 150 kg. UPF purchase was low at 6.4 kg in 2016 but had grown by 6% since 2013. Cluster analysis identified three patterns of consumption, characterised by low (54% of the households in 2016), medium (36%) and high (10%) PF purchase quantities. High cluster households purchased over three times as much PFs and UPF as the low cluster households. Notably, salt purchases were persistently high across clusters in both years (>3.3 kg), while sweet snack and ready-to-eat food purchases grew consistently in all clusters between 2013 and 2016. A positive and significant association was found between household purchases of UPF and their socioeconomic status as well as ownership of durables, such as refrigerator, colour television and washing machine (all p<0.001). Spatial characteristics including size of town (p<0.05) in which the household is located were also positively associated with the purchase of UPF. CONCLUSION Results suggest the need for tailored regional and city level interventions to curb the low but growing purchase of UPF. New data on obesity and rise of non-communicable diseases, the results are concerning given the links between lifestyle changes and the speed of urbanisation in Indian cities.
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Affiliation(s)
- Mehroosh Tak
- Veterinary Epidemiology, Economics and Public Health, The Royal Veterinary College, London, UK
| | - Cherry Law
- Department of Agri-Food Economics and Marketing, School of Agriculture, Policy and Development, University of Reading, Reading, UK
| | - Rosemary Green
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Bhavani Shankar
- Institute for Sustainable Food, University of Sheffield, Sheffield, UK
| | - Laura Cornelsen
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
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Konieczna J, Fiol M, Colom A, Martínez-González MÁ, Salas-Salvadó J, Corella D, Soria-Florido MT, Martínez JA, Alonso-Gómez ÁM, Wärnberg J, Vioque J, López-Miranda J, Estruch R, Bernal-López MR, Lapetra J, Serra-Majem L, Bueno-Cavanillas A, Tur JA, Martín Sánchez V, Pintó X, Gaforio JJ, Matía-Martín P, Vidal J, Vázquez C, Daimiel L, Ros E, Bes-Rastrollo M, Pascual M, Sorlí JV, Goday A, Zulet MÁ, Moreno-Rodriguez A, Carmona González FJ, Valls-Enguix R, Janer JM, Garcia-Rios A, Casas R, Gomez-Perez AM, Santos-Lozano JM, Basterra-Gortari FJ, Martínez MÁ, Ortega-Azorin C, Bayó J, Abete I, Salaverria-Lete I, Ruiz-Canela M, Babio N, Carres L, Romaguera D. Does Consumption of Ultra-Processed Foods Matter for Liver Health? Prospective Analysis among Older Adults with Metabolic Syndrome. Nutrients 2022; 14:nu14194142. [PMID: 36235794 PMCID: PMC9570694 DOI: 10.3390/nu14194142] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/22/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) includes a spectrum of liver alterations that can result in severe disease and even death. Consumption of ultra-processed foods (UPF) has been associated with obesity and related comorbidities. However, the link between UPF and NAFLD has not been sufficiently assessed. We aimed to investigate the prospective association between UPF consumption and liver health biomarkers. Methods: We followed for 1 year 5867 older participants with overweight/obesity and metabolic syndrome (MetS) from the PREDIMED-Plus trial. A validated 143-item semi-quantitative food frequency questionnaire was used to evaluate consumption of UPF at baseline, 6, and 12 months. The degree of processing for foods and beverages (g/day) was established according to the NOVA classification system. The non-invasive fatty liver index (FLI) and hepatic steatosis index (HSI) were used to evaluate liver health at three points in time. The associations between changes in UPF consumption (percentage of total daily dietary intake (g)) and liver biomarkers were assessed using mixed-effects linear models with repeated measurements. Results: In this cohort, UPF consumption at baseline was 8.19% (SD 6.95%) of total daily dietary intake in grams. In multivariable models, each 10% daily increment in UPF consumption in 1 year was associated with significantly greater FLI (β 1.60 points, 95% CI 1.24;1.96 points) and HSI (0.43, 0.29; 0.57) scores (all p-values < 0.001). These associations persisted statistically significant after adjusting for potential dietary confounders and NAFLD risk factors. Conclusions: A higher UPF consumption was associated with higher levels of NAFLD-related biomarkers in older adults with overweight/obesity and MetS.
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Affiliation(s)
- Jadwiga Konieczna
- Research Group on Nutritional Epidemiology & Cardiovascular Physiopathology (NUTRECOR), Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases (HUSE), 07120 Palma de Mallorca, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-871-20-5050 (ext. 64527)
| | - Miguel Fiol
- Research Group on Nutritional Epidemiology & Cardiovascular Physiopathology (NUTRECOR), Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases (HUSE), 07120 Palma de Mallorca, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
| | - Antoni Colom
- Research Group on Nutritional Epidemiology & Cardiovascular Physiopathology (NUTRECOR), Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases (HUSE), 07120 Palma de Mallorca, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
| | - Miguel Ángel Martínez-González
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Department of Preventive Medicine and Public Health, IDISNA, University of Navarra, 31008 Pamplona, Spain
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Jordi Salas-Salvadó
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició, 43201 Reus, Spain
- University Hospital of Sant Joan de Reus, Nutrition Unit, 43204 Reus, Spain
- Institut d’Investigació Sanitària Pere Virgili (IISPV), 43204 Reus, Spain
| | - Dolores Corella
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Department of Preventive Medicine, University of Valencia,46010 Valencia, Spain
| | - María Trinidad Soria-Florido
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal d’Investigació Médica (IMIM), 08003 Barcelona, Spain
| | - J. Alfredo Martínez
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Department of Nutrition, Food Sciences, and Physiology, University of Navarra, IDISNA, 31008 Pamplona, Spain
- Precision Nutrition and Cardiometabolic Health Program, IMDEA Food, CEI UAM + CSIC, 28049 Madrid, Spain
| | - Ángel M. Alonso-Gómez
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Bioaraba Health Research Institute, Cardiovascular, Respiratory and Metabolic Area, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, 01009 Vitoria-Gasteiz, Spain
| | - Julia Wärnberg
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Department of Nursing, University of Málaga, Institute of Biomedical Research in Malaga (IBIMA), 29016 Málaga, Spain
| | - Jesús Vioque
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL-UMH), 03010 Alicante, Spain
| | - José López-Miranda
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14004 Cordoba, Spain
| | - Ramon Estruch
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Department of Internal Medicine, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, 08007 Barcelona, Spain
| | - M. Rosa Bernal-López
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Department of Internal Medicine, Regional University Hospital of Malaga, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, 29009 Málaga, Spain
| | - José Lapetra
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Department of Family Medicine, Research Unit, Distrito Sanitario Atención Primaria Sevilla, 41013 Sevilla, Spain
| | - Lluís Serra-Majem
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria & Centro Hospitalario Universitario Insular Materno Infantil (CHUIMI), Canarian Health Service, 35001 Las Palmas de Gran Canaria, Spain
| | - Aurora Bueno-Cavanillas
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, 18011 Granada, Spain
| | - Josep A. Tur
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Research Group on Community Nutrition & Oxidative Stress, University of Balearic Islands, 07122 Palma de Mallorca, Spain
| | - Vicente Martín Sánchez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Institute of Biomedicine (IBIOMED), University of León, 24071 León, Spain
| | - Xavier Pintó
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge Idibell-UB, Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - José J. Gaforio
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Departamento de Ciencias de la Salud, Centro de Estudios Avanzados en Olivar y Aceites de Oliva, Universidad de Jaén, 23071 Jaén, Spain
| | - Pilar Matía-Martín
- Department of Endocrinology and Nutrition, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Josep Vidal
- CIBER Diabetes y Enfermedades Metabólicas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Department of Endocrinology, Institut d’ Investigacions Biomédiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, 08007 Barcelona, Spain
| | - Clotilde Vázquez
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital Fundación Jimenez Díaz, Instituto de Investigaciones Biomédicas IISFJD, University Autonoma, 28040 Madrid, Spain
| | - Lidia Daimiel
- Nutritional Control of the Epigenome Group, Precision Nutrition and Obesity Program, IMDEA Food, CEI UAM + CSIC, 28049 Madrid, Spain
| | - Emilio Ros
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Lipid Clinic, Department of Endocrinology and Nutrition, IDIBAPS, Hospital Clínic, 08036 Barcelona, Spain
| | - Maira Bes-Rastrollo
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Department of Preventive Medicine and Public Health, IDISNA, University of Navarra, 31008 Pamplona, Spain
| | - María Pascual
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició, 43201 Reus, Spain
- University Hospital of Sant Joan de Reus, Nutrition Unit, 43204 Reus, Spain
- Institut d’Investigació Sanitària Pere Virgili (IISPV), 43204 Reus, Spain
| | - Jose V. Sorlí
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Department of Preventive Medicine, University of Valencia,46010 Valencia, Spain
| | - Albert Goday
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal d’Investigació Médica (IMIM), 08003 Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - María Ángeles Zulet
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Department of Nutrition, Food Sciences, and Physiology, University of Navarra, IDISNA, 31008 Pamplona, Spain
| | - Anai Moreno-Rodriguez
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Bioaraba Health Research Institute, Cardiovascular, Respiratory and Metabolic Area, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, 01009 Vitoria-Gasteiz, Spain
| | - Francisco Jesús Carmona González
- Unidad de Gestión Clínica Torrequebrada, Distrito de Atención Primaria Costa del Sol, Servicio Andaluz de Salud, 29640 Benalmádena, Spain
| | | | - Juana M. Janer
- Research Group on Nutritional Epidemiology & Cardiovascular Physiopathology (NUTRECOR), Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases (HUSE), 07120 Palma de Mallorca, Spain
- Centro de Salud Camp Redó (UBS Son Sardina) Gerència Atenció Primària de Mallorca, 07010 Palma de Mallorca, Spain
| | - Antonio Garcia-Rios
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14004 Cordoba, Spain
| | - Rosa Casas
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Department of Internal Medicine, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, 08007 Barcelona, Spain
| | - Ana M. Gomez-Perez
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Virgen de la Victoria Hospital, Department of Endocrinology, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, 29071 Málaga, Spain
| | - José Manuel Santos-Lozano
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Department of Family Medicine, Research Unit, Distrito Sanitario Atención Primaria Sevilla, 41013 Sevilla, Spain
| | - F. Javier Basterra-Gortari
- Department of Preventive Medicine and Public Health, IDISNA, University of Navarra, 31008 Pamplona, Spain
- Servicio de Endocrinología. Complejo Hospitalario de Navarra, Servicio Navarro de Salud, 31003 Pamplona, Spain
| | - María Ángeles Martínez
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició, 43201 Reus, Spain
- University Hospital of Sant Joan de Reus, Nutrition Unit, 43204 Reus, Spain
- Institut d’Investigació Sanitària Pere Virgili (IISPV), 43204 Reus, Spain
| | - Carolina Ortega-Azorin
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Department of Preventive Medicine, University of Valencia,46010 Valencia, Spain
| | - Joan Bayó
- CAP El Clot, Institut Català de la Salut, 08018 Barcelona, Spain
| | - Itziar Abete
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Department of Nutrition, Food Sciences, and Physiology, University of Navarra, IDISNA, 31008 Pamplona, Spain
| | - Itziar Salaverria-Lete
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Bioaraba Health Research Institute, Cardiovascular, Respiratory and Metabolic Area, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, 01009 Vitoria-Gasteiz, Spain
| | - Miguel Ruiz-Canela
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Department of Preventive Medicine and Public Health, IDISNA, University of Navarra, 31008 Pamplona, Spain
| | - Nancy Babio
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició, 43201 Reus, Spain
- University Hospital of Sant Joan de Reus, Nutrition Unit, 43204 Reus, Spain
- Institut d’Investigació Sanitària Pere Virgili (IISPV), 43204 Reus, Spain
| | - Lourdes Carres
- Atención Primaria Sant Martí, Institut Català de la Salut, 08020 Barcelona, Spain
| | - Dora Romaguera
- Research Group on Nutritional Epidemiology & Cardiovascular Physiopathology (NUTRECOR), Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases (HUSE), 07120 Palma de Mallorca, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
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Dietary Risk Factors and Eating Behaviors in Peripheral Arterial Disease (PAD). Int J Mol Sci 2022; 23:ijms231810814. [PMID: 36142725 PMCID: PMC9504787 DOI: 10.3390/ijms231810814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/10/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022] Open
Abstract
Dietary risk factors play a fundamental role in the prevention and progression of atherosclerosis and PAD (Peripheral Arterial Disease). The impact of nutrition, however, defined as the process of taking in food and using it for growth, metabolism and repair, remains undefined with regard to PAD. This article describes the interplay between nutrition and the development/progression of PAD. We reviewed 688 articles, including key articles, narrative and systematic reviews, meta-analyses and clinical studies. We analyzed the interaction between nutrition and PAD predictors, and subsequently created four descriptive tables to summarize the relationship between PAD, dietary risk factors and outcomes. We comprehensively reviewed the role of well-studied diets (Mediterranean, vegetarian/vegan, low-carbohydrate ketogenic and intermittent fasting diet) and prevalent eating behaviors (emotional and binge eating, night eating and sleeping disorders, anorexia, bulimia, skipping meals, home cooking and fast/ultra-processed food consumption) on the traditional risk factors of PAD. Moreover, we analyzed the interplay between PAD and nutritional status, nutrients, dietary patterns and eating habits. Dietary patterns and eating disorders affect the development and progression of PAD, as well as its disabling complications including major adverse cardiovascular events (MACE) and major adverse limb events (MALE). Nutrition and dietary risk factor modification are important targets to reduce the risk of PAD as well as the subsequent development of MACE and MALE.
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Sinha S, Haque M. Obesity, Diabetes Mellitus, and Vascular Impediment as Consequences of Excess Processed Food Consumption. Cureus 2022; 14:e28762. [PMID: 36105908 PMCID: PMC9441778 DOI: 10.7759/cureus.28762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2022] [Indexed: 12/15/2022] Open
Abstract
Regular intake of ready-to-eat meals is related to obesity and several noninfectious illnesses, such as cardiovascular diseases, hypertension, diabetes mellitus (DM), and tumors. Processed foods contain high calories and are often enhanced with excess refined sugar, saturated and trans fat, Na+ andphosphate-containing taste enhancers, and preservatives. Studies showed that monosodium glutamate (MSG) induces raised echelons of oxidative stress, and excessive hepatic lipogenesis is concomitant to obesity and type 2 diabetes mellitus (T2DM). Likewise, more than standard salt intake adversely affects the cardiovascular system, renal system, and central nervous system (CNS), especially the brain. Globally, excessive utilization of phosphate-containing preservatives and additives contributes unswervingly to excessive phosphate intake through food. In addition, communities and even health experts, including medical doctors, are not well-informed about the adverse effects of phosphate preservatives on human health. Dietary phosphate excess often leads to phosphate toxicity, ultimately potentiating kidney disease development. The mechanisms involved in phosphate-related adverse effects are not explainable. Study reports suggested that high blood level of phosphate causes vascular ossification through the deposition of Ca2+ and substantially alters fibroblast growth factor-23 (FGF23) and calcitriol.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an update on the available data regarding the associations of Ultra-processed food (UPF) consumption with food intake and possible underlying mechanisms relating UPF consumption to weight gain and co-morbidities. RECENT FINDINGS In primarily observational studies, UPF consumption is consistently associated with an increased risk for weight gain among adults and children and increased risk for adiposity-related co-morbidities in adults. In a single mechanistic study, consumption of UPFs led to increased energy intake and weight gain relative to whole foods. UPFs tend to be more energy-dense than nutrient-dense, and UPF consumption is associated with increased adiposity and co-morbidity risk. These data suggest that recommendations to limit UPF consumption may be beneficial to health - though further mechanistic studies are needed.
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Affiliation(s)
- Anthony Crimarco
- Stanford Prevention Research Center, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Matthew J Landry
- Stanford Prevention Research Center, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Christopher D Gardner
- Stanford Prevention Research Center, School of Medicine, Stanford University, Palo Alto, CA, USA.
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Ruedlinger J, Cid-Ossandón V, Huidobro A, Van De Wyngard V, Vargas C, Ferreccio C. Processed meat consumption and associated factors in Chile: A cross-sectional study nested in the MAUCO cohort. Front Public Health 2022; 10:960997. [PMID: 36062116 PMCID: PMC9436317 DOI: 10.3389/fpubh.2022.960997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/01/2022] [Indexed: 01/24/2023] Open
Abstract
Processed meat consumption is increasing in Latin America. While in developed countries processed meat consumption has been associated with cardiovascular diseases and cancer, our region lacks data associated to its consumption and health impact. We characterized processed meat intake and associated factors in a population-based cohort of a Chilean agricultural county, MAUCO. We analyzed baseline dietary data of 7,841 participants, 4,358 women and 3,483 men (38-77 years), who answered an adapted Mediterranean index food frequency questionnaire. Eight percent of the participants presented high processed meat consumption (≥5 times per week). We explored associations of processed meat consumption with participant characteristics using multinomial logistic regression models. Main factors associated with higher consumption were being men, younger and currently employed, and having a high intake (>4 times per week) of red meat (Odds ratio, 2.71, 95% CI 2.10-3.48), butter/cream (1.96, 1.60-2.41), whole-fat dairy products (1.32, 1.04-1.67) and a high intake (≥1 time per day) of sugary snacks/sweets (2.49, 2.04-3.03) and sugary drinks (1.97, 1.63-2.38). Processed meat consumption associated to chronic diseases, particularly cardiovascular disease (Prevalence ratio, 2.28, 95% CI 1.58-3.29). Obesity mediated this association in a proportion of 5.0%, whereas for diabetes the proportion was 13.9%. In this population, processed meat was associated with other unhealthy dietary and lifestyle factors, as well as with chronic diseases, particularly cardiovascular disease.
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Affiliation(s)
- Jenny Ruedlinger
- Facultad de Medicina, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Advanced Center for Chronic Diseases, Universidad de Chile and Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Vicente Cid-Ossandón
- Facultad de Medicina, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Advanced Center for Chronic Diseases, Universidad de Chile and Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Andrea Huidobro
- Advanced Center for Chronic Diseases, Universidad de Chile and Pontificia Universidad Católica de Chile, Santiago, Chile
- Facultad de Medicina, School of Medicine, Universidad Católica del Maule, Talca, Chile
| | - Vanessa Van De Wyngard
- Facultad de Medicina, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Advanced Center for Chronic Diseases, Universidad de Chile and Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudio Vargas
- Advanced Center for Chronic Diseases, Universidad de Chile and Pontificia Universidad Católica de Chile, Santiago, Chile
- Departamento de Matemáticas y Ciencias de la Computación, Facultad de Ciencias, Universidad de Santiago de Chile, Santiago, Chile
| | - Catterina Ferreccio
- Facultad de Medicina, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Advanced Center for Chronic Diseases, Universidad de Chile and Pontificia Universidad Católica de Chile, Santiago, Chile
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Geographical and Temporal Variability of Ultra-Processed Food Consumption in the Spanish Population: Findings from the DRECE Study. Nutrients 2022; 14:nu14153223. [PMID: 35956398 PMCID: PMC9370340 DOI: 10.3390/nu14153223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022] Open
Abstract
The consumption of ultra-processed foods (UPFs) has increased in recent decades, worldwide. Evidence on the negative impacts of food processing on health outcomes has also been steadily increasing. The aim of this study is to describe changes in consumption patterns of ultra-processed foods in the Spanish population over time and their geographical variability. Data from four representative cohorts of the Spanish population were used (1991−1996−2004−2008). Dietary information was collected using a validated frequency questionnaire and categorized using the NOVA classification. A total increase of 10.8% in UPF consumption between 1991 and 2008 was found in Spain (p-value < 0.001). The products contributing most to UPF consumption were sugar-sweetened beverages, processed meats, dairy products, and sweets. Those who consumed more ultra-processed foods were younger (p-value < 0.001) and female (p-value = 0.01). Significant differences between the different geographical areas of Spain were found. The eastern part of Spain was the area with the lowest UPF consumption, whereas the north-western part was the area with the highest increase in UPF consumption. Given the negative effect that the consumption of ultra-processed foods has on health, it is necessary to implement public health policies to curb this increase in UPF consumption.
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El Kinany K, Huybrechts I, Hatime Z, El Asri A, Boudouaya HA, Deoula MMS, Kampman E, El Rhazi K. Food processing groups and colorectal cancer risk in Morocco: evidence from a nationally representative case-control study. Eur J Nutr 2022; 61:2507-2515. [PMID: 35211850 DOI: 10.1007/s00394-022-02820-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/25/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the association between the consumption of foods and drinks from different food processing categories using the NOVA classification and CRC risk among Moroccan adults. METHODS 1453 cases and 1453 matched controls aged at least 18 years and recruited from the 5 greater Moroccan regions were interviewed by trained investigators about their habitual diet using a standardized food frequency questionnaire (FFQ). Foods were categorized according to their degree of processing by the NOVA classification. Intakes of each food processing group were categorized into tertiles based on the distribution of controls with the lowest tertile considered as the reference category. Multivariable conditional logistic regression models were used to assess the association between each group and CRC risk (Odds Ratio (OR) and 95% Confidence Intervals (CI)), taking relevant confounders into account. RESULTS High consumption of unprocessed or minimally processed foods (NOVA group 1) was significantly inversely (OR = 0.82, 95%CI = 0.72-0.93), while high consumption of ultra-processed foods and drink products (NOVA group 4) was significantly positively (OR = 1.40, 95% CI = 1.22-1.61) associated with CRC risk as compared to the lowest intake group. These results were similar for colon and rectum sub-sites. CONCLUSION This is the first study to evaluate the association between the NOVA classification groups and CRC risk in an African country. Our results suggest that the consumption of ultra-processed foods and drink products may be associated with an increased risk of developing CRC, but longitudinal studies are needed to confirm these results.
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Affiliation(s)
- Khaoula El Kinany
- Department of Epidemiology and Public Health, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez. Km 2, 200 Sidi Harazem Road, 1893, Fez, Morocco
| | - Inge Huybrechts
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Zineb Hatime
- Department of Epidemiology and Public Health, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez. Km 2, 200 Sidi Harazem Road, 1893, Fez, Morocco
| | - Achraf El Asri
- Department of Epidemiology and Public Health, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez. Km 2, 200 Sidi Harazem Road, 1893, Fez, Morocco
| | - Hanae Abir Boudouaya
- Department of Epidemiology and Public Health, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez. Km 2, 200 Sidi Harazem Road, 1893, Fez, Morocco
| | - Meimouna Mint Sidi Deoula
- Department of Epidemiology and Public Health, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez. Km 2, 200 Sidi Harazem Road, 1893, Fez, Morocco
| | - Ellen Kampman
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Karima El Rhazi
- Department of Epidemiology and Public Health, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez. Km 2, 200 Sidi Harazem Road, 1893, Fez, Morocco.
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Sato PDM, Leite FHM, Khandpur N, Martins APB, Mais LA. “I Like the One With Minions”: The Influence of Marketing on Packages of Ultra-Processed Snacks on Children's Food Choices. Front Nutr 2022; 9:920225. [PMID: 35942170 PMCID: PMC9356306 DOI: 10.3389/fnut.2022.920225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This study aimed to assess the most consumed school snacks using the free listing and understand how marketing strategies on food labels influenced children's perceptions of snacks via focus groups. Design The study design involved free lists and semi-structured focus group interviews. Setting São Paulo, Brazil. Participants A total of 69 children were involved in this study. Phenomenon of Interest Children's perceptions of food labels. Analysis Food groups mentioned on the free lists were analyzed for their frequency and priority of occurrence. The focus groups were analyzed through content analysis. Results Juices and chips were the most salient snacks, with availability and flavor as reasons for their consumption. Children found images on labels appealing, which created a desire for the food, although could be deceptive. Snacks perceived as healthy were encouraged by parents, and children could more easily convince them to buy snacks with health claims. Colors and brands were important to catch children's attention and make the snack recognizable. Television commercials and mascots reinforced marketing strategies on labels. Conclusions and Implications Our results point to the need for public health strategies to deal with the obesity epidemic through creating and implementing specific legislation to regulate food labels to discourage the consumption of unhealthy snacks and prohibit food marketing targeted at children.
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Affiliation(s)
- Priscila de Morais Sato
- Department of Nutrition Sciences, Federal University of Bahia (UFBA), Salvador, Brazil
- *Correspondence: Priscila de Morais Sato
| | | | - Neha Khandpur
- Department of Nutrition, University of São Paulo (USP), São Paulo, Brazil
| | | | - Laís Amaral Mais
- Brazilian Institute for Consumer Defense (Idec), São Paulo, Brazil
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Rodríguez-Cano AM, González-Ludlow I, Suárez-Rico BV, Montoya-Estrada A, Piña-Ramírez O, Parra-Hernández SB, Reyes-Muñoz E, Estrada-Gutierrez G, Calzada-Mendoza CC, Perichart-Perera O. Ultra-Processed Food Consumption during Pregnancy and Its Association with Maternal Oxidative Stress Markers. Antioxidants (Basel) 2022; 11:antiox11071415. [PMID: 35883909 PMCID: PMC9312096 DOI: 10.3390/antiox11071415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/15/2022] [Accepted: 07/20/2022] [Indexed: 02/04/2023] Open
Abstract
Ultra-processed food (UPF) consumption during gestation may lead to increased oxidative stress (OS) and could affect pregnancy outcomes. This study aims to evaluate the association of UPF consumption during pregnancy with circulating levels of OS markers. Diet was assessed (average of three assessments) in 119 pregnant women enrolled in the OBESO perinatal cohort (Mexico), obtaining quantitative data and the percentage of energy that UPFs (NOVA) contributed to the total diet. Sociodemographic, clinical (pregestational body-mass index and gestational weight gain) and lifestyle data were collected. Maternal circulating levels of OS markers (malondialdehyde (MDA), protein carbonylation (PC), and total antioxidant capacity (TAC)) were determined at the third trimester of pregnancy. Adjusted linear regression models were performed to analyze the association between UPFs and OS markers. UPFs represented 27.99% of the total energy intake. Women with a lower UPF consumption (<75 percentile°) presented a higher intake of fiber, ω-3, ω-6, and a lower ω-6/3 ratio. Linear regression models showed that UPFs were inversely associated with TAC and MDA. Fiber intake was associated with PC. UPF intake during pregnancy may result in an increase in oxidative stress. When providing nutrition care, limiting or avoiding UPFs may be an intervention strategy that could promote a better antioxidant capacity in the body.
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Affiliation(s)
- Ameyalli M. Rodríguez-Cano
- Section for Postgraduate Studies and Research, Higher School of Medicine, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón s/n, Casco de Santo Tomas, Miguel Hidalgo, Mexico City 11340, Mexico; (A.M.R.-C.); (C.C.C.-M.)
- Nutrition and Bioprogramming Coordination, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Montes Urales 800, Lomas de Virreyes, Miguel Hidalgo, Mexico City 11000, Mexico;
| | - Isabel González-Ludlow
- Nutrition and Bioprogramming Coordination, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Montes Urales 800, Lomas de Virreyes, Miguel Hidalgo, Mexico City 11000, Mexico;
| | - Blanca V. Suárez-Rico
- Community Interventions Research Branch, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Montes Urales 800, Lomas de Virreyes, Miguel Hidalgo, Mexico City 11000, Mexico;
| | - Araceli Montoya-Estrada
- Gynecological and Perinatal Endocrinology Coordination, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Montes Urales 800, Lomas de Virreyes, Miguel Hidalgo, Mexico City 11000, Mexico; (A.M.-E.); (E.R.-M.)
| | - Omar Piña-Ramírez
- Bioinformatics and Statistical Analysis Department, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Montes Urales 800, Lomas de Virreyes, Miguel Hidalgo, Mexico City 11000, Mexico;
| | - Sandra B. Parra-Hernández
- Immunobiochemistry Department, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Montes Urales 800, Lomas de Virreyes, Miguel Hidalgo, Mexico City 11000, Mexico;
| | - Enrique Reyes-Muñoz
- Gynecological and Perinatal Endocrinology Coordination, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Montes Urales 800, Lomas de Virreyes, Miguel Hidalgo, Mexico City 11000, Mexico; (A.M.-E.); (E.R.-M.)
| | - Guadalupe Estrada-Gutierrez
- Research Division, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Montes Urales 800, Lomas de Virreyes, Miguel Hidalgo, Mexico City 11000, Mexico;
| | - Claudia C. Calzada-Mendoza
- Section for Postgraduate Studies and Research, Higher School of Medicine, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón s/n, Casco de Santo Tomas, Miguel Hidalgo, Mexico City 11340, Mexico; (A.M.R.-C.); (C.C.C.-M.)
| | - Otilia Perichart-Perera
- Nutrition and Bioprogramming Coordination, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Montes Urales 800, Lomas de Virreyes, Miguel Hidalgo, Mexico City 11000, Mexico;
- Correspondence:
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Niroumand Sarvandani M, Asadi M, Khosravi F, Gearhardt AN, Razmhosseini M, Soleimani M, Mohseni F, Garmabi B, Rafaiee R. Validation and Psychological Properties of the Persian Version of DSM 5 Yale Food Addiction Scale 2.0 (PYFAS 2.0) in Non-clinical Population. ADDICTION & HEALTH 2022; 14:175-184. [PMID: 36544977 PMCID: PMC9743828 DOI: 10.34172/ahj.2022.1283] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 06/26/2022] [Indexed: 12/24/2022]
Abstract
Background The Yale Food Addiction Scale version 2.0 (YFAS 2.0) is used for the assessment of food addiction (FA). This research intended to evaluate the validity of the Persian translation of the questionnaire and to investigate the psychological properties and the association between FA and anthropometric indices. Methods In a sample of 473 nonclinical participants, FA, binge eating, and objectively measured anthropometric indices were assessed. Internal consistency, convergent, and validity of the PYFAS 2.0 were examined. Also, the factor structure (confirmatory factor analysis following the 11 diagnostic indicators in addition to the significant distress) and the construct of the scale were evaluated. Findings The frequencies of mild, moderate, and severe FA based on PYFAS 2.0 were 0.2%, 10%, and 5.5%, respectively. The findings supported a one-factor structure. The confirmatory factor analysis revealed a good construct validity (RMSEA=0.043, χ2=76.38, df=41, χ2 (CMIN)/df=1.862, GFI=0.975, AGFI=0.957, IFI=0.986, RFI=0.958, ECVI=0.319, TLI=0.978). For both the diagnostic and symptom count versions, the PYFAS 2.0 presented acceptable internal consistency (IC) (Kuder-Richardson 20=0.99 and McDonald omega=0.91). Conclusion The PYFAS 2.0 was a psychometrically sound instrument in an Iranian non-clinical population. This questionnaire can be used to study FA in Persian non-clinical populations. Future research should study the psychometric characteristics of this scale in high-risk groups.
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Affiliation(s)
| | - Masoud Asadi
- Department of Psychology and Educational Sciences, Faculty of Humanities, Arak University, Arak, Iran
| | - Farideh Khosravi
- Student Research Committee, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ashley N. Gearhardt
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, United States
| | | | - Maryam Soleimani
- Department of Psychology and Counseling, Faculty of Humanities, University of Hormozgan, Bandar Abbas, Iran
| | - Fahimeh Mohseni
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Behzad Garmabi
- Study and Treatment of Circadian Rhythms Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Raheleh Rafaiee
- Department of Neuroscience, School of Advanced Technologies in Medicine, Mazandaran University of Medical Sciences, Sari, Iran,Corresponding Author: Raheleh Rafaiee, Department of Neuroscience, School of Advanced Technologies in Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
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Zhou M, Huang X, Li R, Zhang Z, Zhang L, Gao X, Yang H, Ma Y. Association of dietary patterns with blood uric acid concentration and hyperuricemia in northern Chinese adults. Nutr J 2022; 21:42. [PMID: 35739563 PMCID: PMC9219223 DOI: 10.1186/s12937-022-00789-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 05/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background Studies have shown that a direct association exists between the diet and blood uric acid concentrations. However, works on the association of dietary patterns with blood uric acid concentrations and hyperuricemia remain limited. Objective This study aims to evaluate the association of dietary patterns with blood uric acid concentrations and hyperuricemia. Methods The relationship between dietary patterns and hyperuricemia was explored through a nutritional epidemiological survey in China (n = 4855). Three statistical methods, including principal component analysis, reduced rank regression (RRR), and partial least squares regression, were used to extract dietary patterns. General linear regression and logistic regression analyses were utilized to explore the relationship of dietary patterns with blood uric acid concentrations and hyperuricemia. Results After adjusting for potential confounding factors, the score for the plant-based dietary pattern was found to be negatively correlated with blood uric acid levels (β = − 3.225) and that for the animal dietary pattern was discovered to be directly correlated with blood uric acid levels (β = 3.645). The participants in the highest quartile of plant-based dietary pattern scores were at a low risk of hyperuricemia (OR = 0.699; 95% CI: 0.561–0.870, P < 0.05), whereas those in the highest quartile of animal dietary pattern scores were at a high risk of hyperuricemia (OR = 1.401; 95% CI: 1.129–1.739, P < 0.05). The participants in the third quartile of scores for the RRR dietary pattern, which was characterized by the relatively high intake of poultry, sugary beverages, and animal organs and the low intake of desserts and snacks, had a significantly higher risk of hyperuricemia than those in the first quartile of scores for the RRR dietary pattern (OR = 1.421; 95% CI: 1.146–1.763, P < 0.05). Conclusions Our research indicated that plant-based dietary pattern analyzed by PCA was negatively associated with blood uric acid concentrations, while animal-based dietary pattern was directly associated with blood uric acid concentrations. The RRR dietary pattern may have the potential to induce elevations in blood uric acid concentrations. Supplementary Information The online version contains supplementary material available at 10.1186/s12937-022-00789-7.
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Affiliation(s)
- Meiqi Zhou
- Department of Nutrition and Food Hygiene, School of Public Health, Hebei Province Key Laboratory of Environment and Human Health, Hebei Medical University, 361 Zhongshan East Road, Hebei Province 050017, Shijiazhuang, China
| | - Xin Huang
- Department of Nutrition and Food Hygiene, School of Public Health, Hebei Province Key Laboratory of Environment and Human Health, Hebei Medical University, 361 Zhongshan East Road, Hebei Province 050017, Shijiazhuang, China.,Handan Center for Disease Control and Prevention, Handan, China
| | - Ruiqiang Li
- Department of Nutrition and Food Hygiene, School of Public Health, Hebei Province Key Laboratory of Environment and Human Health, Hebei Medical University, 361 Zhongshan East Road, Hebei Province 050017, Shijiazhuang, China
| | - Zechen Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Hebei Province Key Laboratory of Environment and Human Health, Hebei Medical University, 361 Zhongshan East Road, Hebei Province 050017, Shijiazhuang, China
| | - Limin Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Hebei Province Key Laboratory of Environment and Human Health, Hebei Medical University, 361 Zhongshan East Road, Hebei Province 050017, Shijiazhuang, China
| | - Xian Gao
- Department of Nutrition and Food Hygiene, School of Public Health, Hebei Province Key Laboratory of Environment and Human Health, Hebei Medical University, 361 Zhongshan East Road, Hebei Province 050017, Shijiazhuang, China
| | - Hui Yang
- Experimental Center, School of Public Health, Hebei Province Key Laboratory of Environment and Human Health, Hebei Medical University, 361 Zhongshan East Road, Hebei Province 050017, Shijiazhuang, China
| | - Yuxia Ma
- Department of Nutrition and Food Hygiene, School of Public Health, Hebei Province Key Laboratory of Environment and Human Health, Hebei Medical University, 361 Zhongshan East Road, Hebei Province 050017, Shijiazhuang, China.
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Dietary pH Enhancement Improves Metabolic Outcomes in Diet-Induced Obese Male and Female Mice: Effects of Beef vs. Casein Proteins. Nutrients 2022; 14:nu14132583. [PMID: 35807769 PMCID: PMC9268221 DOI: 10.3390/nu14132583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 02/01/2023] Open
Abstract
(1) Consumption of diets that are caloric dense but not nutrient dense have been implicated in metabolic diseases, in part through low-grade metabolic acidosis. Mitigation strategies through dietary intervention to alleviate acidosis have not been previously reported. Our objective is to determine the effects of pH enhancement (with ammonia) in high fat diet-induced obese mice that were fed beef or casein as protein sources compared to low fat diet-fed mice. (2) Methods: B6 male and female mice were randomized (n = 10) into eight diets that differ in protein source, pH enhancement of the protein, and fat content, and fed for 13 weeks: low fat (11% fat) casein (LFC), LF casein pH-enhanced (LFCN), LF lean beef (LFB), LFBN, high fat (46%) casein (HFC), HFCN, HF beef (HFB), and HFBN. Body weights and composition, and glucose tolerance tests were conducted along with terminal serum analyses. Three-way ANOVA was performed. (3) Results: A significant effect of dietary fat (LF vs. HF) was observed across all variables in both sexes (final body weight, fat mass, glucose clearance, and serum leptin). Importantly, pH enhancement significantly reduced adiposity (males only) and final body weights (females only) and significantly improved glucose clearance in both sexes. Lastly, clear sex differences were observed across all variables. (4) Conclusions: Our findings demonstrate metabolic benefits of increasing dietary pH using ammonia, while high fat intake per se (not protein source) is the major contributor to metabolic dysfunctions. Additional research is warranted to determine mechanisms underlying the beneficial effects of pH enhancement, and interactions with dietary fat content and proteins.
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Menezes-Júnior LAAD, Andrade ACDS, Coletro HN, Mendonça RDD, Menezes MCD, Machado-Coelho GLL, Meireles AL. Food consumption according to the level of processing and sleep quality during the COVID-19 pandemic. Clin Nutr ESPEN 2022; 49:348-356. [PMID: 35623836 PMCID: PMC8942582 DOI: 10.1016/j.clnesp.2022.03.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Consumption of ultra-processed foods is negatively associated with health outcomes, however, the contribution to sleep quality is limited. Therefore, the objective of this study was to evaluate the association between food intake by frequency and degree of processing and sleep quality in adults during the covid-19 pandemic. METHODS Population-based survey of adults from October to December 2020 in the Iron Quadrangle region, Brazil. The exposure variable was a food intake score that considered the frequency of consumption and food processing degree. The total score ranged from 0 (best) to 48 points (worst food quality), categorized into quartiles. Furthermore, we also evaluated whether individuals replaced their lunch and/or dinner based mostly on fresh/minimally processed foods for ultra-processed foods, for five or more days in the week. The outcome variable was sleep quality assessed with the Pittsburgh Sleep Quality Index. We constructed a contrasting directed acyclic graph (DAG) model to estimate the adjusted odds ratio of the association between score eating and sleep, by logistic regression. RESULTS Most of the 1762 individuals evaluated had poor sleep quality (52.5%). The minimum and maximum food scores were 0 and 30 points (mean 9.16; 95% CI 8.50, 9.81). The higher values of the score corresponded to lower consumption of fresh and minimally processed foods and higher consumption of ultraprocessed foods. In multivariate analysis, individuals in the third food consumption score had 71% greater odds of poor sleep quality (OR = 1.71; 95% CI: 1.03, 2.85) and in the fourth quartile 144% greater odds (OR = 2.44; 95% CI: 1.32, 2.44). Besides, replacing the dinner meal with ultra-processed foods five days or more in the week was also associated with poor sleep quality (OR = 2.01; 95%CI: 1.14, 3.57). CONCLUSION Higher consumption of ultra-processed foods concomitant with lower consumption of fresh and minimally processed foods is associated with a higher chance of poor sleep quality.
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Affiliation(s)
- Luiz Antônio Alves de Menezes-Júnior
- Postgraduate Program in Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil,Research and Study Group on Nutrition and Public Health (GPENSC), Federal University of Ouro Preto, Brazil
| | | | - Hillary Nascimento Coletro
- Postgraduate Program in Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil,Research and Study Group on Nutrition and Public Health (GPENSC), Federal University of Ouro Preto, Brazil
| | - Raquel de Deus Mendonça
- Postgraduate Program in Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil,Research and Study Group on Nutrition and Public Health (GPENSC), Federal University of Ouro Preto, Brazil,Department of Clinical and Social Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Mariana Carvalho de Menezes
- Postgraduate Program in Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil,Research and Study Group on Nutrition and Public Health (GPENSC), Federal University of Ouro Preto, Brazil,Department of Clinical and Social Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - George Luiz Lins Machado-Coelho
- Postgraduate Program in Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil,School of Medicine, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Adriana Lúcia Meireles
- Postgraduate Program in Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil,Research and Study Group on Nutrition and Public Health (GPENSC), Federal University of Ouro Preto, Brazil,Department of Clinical and Social Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil,Corresponding author. Federal University of Ouro Preto, R. Diogo de Vasconcelos, 122, Ouro Preto - MG, Brazil
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Healthy eating index 2015 and major dietary patterns in relation to incident hypertension; a prospective cohort study. BMC Public Health 2022; 22:734. [PMID: 35418042 PMCID: PMC9006467 DOI: 10.1186/s12889-022-13166-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/05/2022] [Indexed: 01/11/2023] Open
Abstract
Background Since hypertension (HTN) is responsible for more than half of all deaths from cardiovascular disease, it is vital to understand the nutritional factors that reduce its risk. Little information, however, is known about it in the Kurdish population. This study was aimed to evaluate the healthy eating index (HEI) 2015 and major dietary patterns concerning incident HTN. Methods This case-cohort study was designed using Ravansar non-communicable diseases (RaNCD) cohort study data (294 participants with incident HTN and 1295 participants as representative random sub-cohort). HEI 2015 and major dietary patterns were extracted using data from their dietary intake, and three major dietary patterns were identified, including plant-based, high protein, and unhealthy dietary patterns. To analyses the association between HEI 2015 and major dietary patterns with incident HTN Cox proportional hazards regression models were applied. Results There was a significant positive correlation between HEI 2015 and plant-based diet (r = 0.492). The participants in the highest quartile of HEI-2015 had a 39% and 30% lower risk of incident HTN, compared to participants in the first quartile in both crude and adjusted model (HR: 0.61; 95% CI: 0.46–0.82) and (HR: 0.70; 95% CI: 0.51–0.97), respectively. Furthermore, participants with the highest tertile of the plant-based dietary pattern were at lower risk of incident HTN in both crude and adjusted models (HR: 0.69; 95% CI: 0.54–0.9) and (HR: 0.70; 95% CI: 0.53–0.94), respectively. However, the other two identified dietary patterns showed no significant association with incident HTN. Conclusions We found evidence indicating higher adherence to HEI 2015 and plant- based diet had protective effects on incident HTN. The HEI 2015 emphasizes limited sodium intake and adequate intake of vegetables and fruits.
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Sansone NMS, Boschiero MN, Ortega MM, Ribeiro IA, Peixoto AO, Mendes RT, Marson FAL. Severe Acute Respiratory Syndrome by SARS-CoV-2 Infection or Other Etiologic Agents Among Brazilian Indigenous Population: An Observational Study from the First Year of Coronavirus Disease (COVID)-19 Pandemic. LANCET REGIONAL HEALTH. AMERICAS 2022; 8:100177. [PMID: 35018359 PMCID: PMC8739500 DOI: 10.1016/j.lana.2021.100177] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Indigenous peoples are vulnerable to pandemics, including to the coronavirus disease (COVID)-19, since it causes high mortality and specially, the loss of elderly Indigenous individuals. Methods The epidemiological data of severe acute respiratory syndrome (SARS) by SARS-CoV-2 infection or other etiologic agents (OEA) among Brazilian Indigenous peoples during the first year of COVID-19 pandemic was obtained from a Brazilian Ministry of Health open-access database to perform an observational study. Considering only Indigenous individuals diagnosed with SARS by COVID-19, the epidemiology data were also evaluated as risk of death. The type of sample collection for virus screening, demographic profile, clinical symptoms, comorbidities, and clinical evolution were evaluated. The primary outcome was considered the death in the Brazilian Indigenous individuals and the secondary outcome, the characteristics of Brazilian Indigenous infected by SARS-CoV-2 or OEA, as the need for intensive care unit admission or the need for mechanical ventilation support. The statistical analysis was done using Logistic Regression Model. Alpha of 0.05. Findings A total of 3,122 cases of Indigenous individuals with SARS in Brazil were reported during the first year of the COVID-19 pandemic. Of these, 1,994 were diagnosed with COVID-19 and 730/1,816 (40.2%) of them died. The death rate among individuals with SARS-CoV-2 was three-fold increased when compared to the group of individuals with OEA. Several symptoms (myalgia, loss of smell, and sore throat) and comorbidities (cardiopathy, systemic arterial hypertension, and diabetes mellitus) were more prevalent in the COVID-19 group when compared to Indigenous individuals with OEA. Similar profile was observed considering the risk of death among the Indigenous individuals with COVID-19 who presented several symptoms (oxygen saturation <95%, dyspnea, and respiratory distress) and comorbidities (renal disorders, cardiopathy, and diabetes mellitus). The multivariate analysis was significant in differentiating between the COVID-19-positive and non-COVID-19 patients [X2(7)=65.187; P-value<0.001]. Among the patients’ features, the following contributed in relation to the diagnosis of COVID-19: age [≥43 years-old [y.o.]; OR=1.984 (95%CI=1.480-2.658)]; loss of smell [OR=2.373 (95%CI=1.461-3.854)]; presence of previous respiratory disorders [OR=0.487; 95%CI=0.287-0.824)]; and fever [OR=1.445 (95%CI=1.082-1.929)]. Also, the multivariate analysis was able to predict the risk of death [X2(9)=293.694; P-value<0.001]. Among the patients’ features, the following contributed in relation to the risk of death: male gender [OR=1.507 (95%CI=1.010-2.250)]; age [≥60 y.o.; OR=3.377 (95%CI=2.292-4.974)]; the need for ventilatory support [invasive mechanical ventilation; OR=24.050 (95%CI=12.584-45.962) and non-invasive mechanical ventilation; OR=2.249 (95%CI=1.378-3.671)]; dyspnea [OR=2.053 (95%CI=1.196-3.522)]; oxygen saturation <95% [OR=1.691 (95%CI=1.050-2.723)]; myalgia [OR=0.423 (95%CI=0.191-0.937)]; and the presence of kidney disorders [OR=3.135 (95%CI=1.144-8.539)]. Interpretation The Brazilian Indigenous peoples are in a vulnerable situation during the COVID-19 pandemic and presented an increased risk of death due to COVID-19. Several factors were associated with enhanced risk of death, as male sex, older age (≥60 y.o.), and need for ventilatory support; also, other factors might help to differentiate SARS by COVID-19 or by OEA, as older age (≥43 y.o.), loss of smell, and fever. Funding Fundação de Amparo à Pesquisa do Estado de São Paulo (Foundation for Research Support of the State of São Paulo; #2021/05810-7).
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Key Words
- %, Percentage
- 95%CI, 95% Confidence Interval
- COVID-19
- COVID-19, Coronavirus Disease (2019)
- Ethnicity
- H1N1, H1N1 Strain of the Flu (Influenzae) virus
- HRCT, High-Resolution Computed Tomography
- ICU, Intensive Care Unit
- Indigenous
- Intensive Care Unit
- MV, Mechanical Ventilation
- NA, Not Applicable
- OEA, Other Etiologic Agents
- OR, Odds Ratio
- Pandemic
- RT-PCR, Real Time-Polymerase Chain Reaction
- Race
- Respiratory Disease
- SAH, Systemic Arterial Hypertension
- SARS, Severe Acute Respiratory Syndrome
- SARS-CoV, Severe Acute Respiratory Syndrome Coronavirus
- SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2
- SIVEP-Gripe, Information System for Epidemiological Surveillance of Influenza (Sistema de Informação de Vigilância Epidemiológica da Gripe)
- SUS, Sistema Único de Saúde (Brazilian Public Health System)
- Severe Acute Respiratory Syndrome
- Virus
- y.o., Years Old
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Affiliation(s)
- Nathália M S Sansone
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, SP, Brazil.,Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, SP, Brazil
| | - Matheus N Boschiero
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, SP, Brazil
| | - Manoela M Ortega
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, SP, Brazil.,Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, SP, Brazil
| | - Isadora A Ribeiro
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, SP, Brazil.,Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, SP, Brazil
| | - Andressa O Peixoto
- Laboratory of Translational Medicine, Center for Investigation in Pediatrics, School of Medical Sciences, University of Campinas. Campinas, SP, Brazil
| | - Roberto T Mendes
- Laboratory of Translational Medicine, Center for Investigation in Pediatrics, School of Medical Sciences, University of Campinas. Campinas, SP, Brazil
| | - Fernando A L Marson
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, SP, Brazil.,Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, SP, Brazil
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Wang K, Xu Z. Comparison of freshly squeezed, Non-thermally and thermally processed orange juice based on traditional quality characters, untargeted metabolomics, and volatile overview. Food Chem 2022; 373:131430. [PMID: 34731802 DOI: 10.1016/j.foodchem.2021.131430] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/14/2021] [Accepted: 10/16/2021] [Indexed: 01/11/2023]
Abstract
The NOVA food classification system, divides foods into four categories, namely unprocessed and minimally processed foods, processed culinary ingredients, processed foods, and ultra-processed foods. With the recently increasing pursuit of healthy diets, special attention to minimally processed foods has become crucial. According to NOVA, freshly squeezed, high pressure processing (HPP) and pasteurized orange juice are minimally processed foods. In this study, the differences in the quality and composition of these minimally processed juice are explored, as it was found that their traditional quality characteristics were too weak to illustrate their difference. However, based on untargeted metabolomics, two differential compounds were identified between freshly squeezed and HPP orange juice, in addition to 15 differential compounds between freshly squeezed and pasteurized orange juice. Moreover, all the pasteurized orange juice in this study was deemed to be out of the acceptance area of freshly squeezed and HPP orange juice in a data-driven soft independent modeling of class analogy (dd-SIMCA) model based on volatile overview. The results of this study provide data for clarifying the compositional differences between minimally processed juice for their further subclassification.
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Affiliation(s)
- Kewen Wang
- Institute of Quality Standard & Testing Technology for Agro-Products, Key Laboratory of Agro-food Safety and Quality, Ministry of Agriculture and Rural Affairs, Chinese Academy of Agricultural Sciences, Beijing 100081, China; College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China
| | - Zhenzhen Xu
- Institute of Quality Standard & Testing Technology for Agro-Products, Key Laboratory of Agro-food Safety and Quality, Ministry of Agriculture and Rural Affairs, Chinese Academy of Agricultural Sciences, Beijing 100081, China.
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50
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Cai Q, Duan MJ, Dekker LH, Carrero JJ, Avesani CM, Bakker SJL, de Borst MH, Navis GJ. Ultraprocessed food consumption and kidney function decline in a population-based cohort in the Netherlands. Am J Clin Nutr 2022; 116:263-273. [PMID: 35348601 PMCID: PMC9257475 DOI: 10.1093/ajcn/nqac073] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 03/25/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Ultraprocessing makes food products more convenient, appealing, and profitable. Recent studies show that high ultraprocessed food (UPF) intake is associated with cardiometabolic diseases. OBJECTIVES The aim of this study is to investigate the association between UPF consumption and risks of kidney function decline in the general population. METHODS In a prospective, general population-based Lifelines cohort from Northern Netherlands, 78,346 participants free of chronic kidney disease (CKD) at baseline responded to a 110-item FFQ. We used a multivariable regression analysis to study the associations of the proportion (in grams/day) of UPFs in the total diet with a composite kidney outcome [incident CKD or a ≥30% estimated glomerular filtration rate (eGFR) decline relative to baseline] and annual change in eGFR. RESULTS On average, 37.7% of total food intake came from UPFs. After 3.6 ± 0.9 years of follow-up, 2470 participants (3.2%) reached the composite kidney outcome. Participants in the highest quartile of UPF consumption were associated with a higher risk of the composite kidney outcome (OR, 1.27; 95% CI, 1.09-1.47; P = 0.003) compared with those in the lowest quartile, regardless of their macro- or micronutrient intake or diet quality. Participants in the highest quartile had a more rapid eGFR decline (β, -0.17; 95% CI, -0.23 to -0.11; P < 0.001) compared with those in the lowest quartile. Associations were generally consistent across different subgroups. CONCLUSIONS Higher UPF consumption was associated with a higher risk of a composite kidney outcome (incident CKD or ≥30% eGFR decline) and a more rapid eGFR decline in the general population, independent of confounders and other dietary indices.
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Affiliation(s)
| | - Ming-Jie Duan
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Louise H Dekker
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Juan Jesús Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Carla Maria Avesani
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Martin H de Borst
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerjan J Navis
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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