Properties of Ultraprocessed Foods That Can Drive Excess Intake

Precision Food Composition Data as a Tool to Decipher the Riddle of Ultra-Processed Foods and Nutritional Quality

BACKGROUND

Epidemiology supports a link between ultra-processed foods (UPFs) and health, mediated mainly through the clustering of foods with suboptimal nutrient profiles within UPFs. However, successful NOVA categorization requires access to a food's ingredient list, which we hypothesized can impact both UPF identification and the link between processing and composition.

METHODS

Foods (n = 4851) in the HelTH branded food composition database were classified as NOVA1-4, with or without using the ingredient lists (generic and branded approach, respectively), to identify differences in NOVA classification (chi-square test) and the estimated average nutritional composition of each NOVA group (Kruskal-Willis U test).

RESULTS

Using the ingredients list increased UPF identification by 30%. More than 30% of foods commonly assumed to be minimally processed (NOVA1-plain dairy, frozen vegetables, etc.) were reclassified as UPFs when using ingredient lists. These reclassified foods, however, had nutritional compositions comparable to NOVA1 foods and better than UPFs for energy, fat, sugars, and sodium (p < 0.001). In fact, UPFs did not show a uniform nutritional composition covering foods from Nutri-Score A (~10%) to Nutri-Score E (~20%).

CONCLUSIONS

The assumption that all UPFs have the same unfavorable nutritional composition is challenged when NOVA is applied using the appropriate branded food composition database.

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

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

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

OBJECTIVE

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

DESIGN

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

SETTING

New Hampshire community.

PARTICIPANTS

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

MAIN OUTCOME MEASURE(S)

Primary outcome: identify correlates of UPF intake.

SECONDARY OUTCOME

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

ANALYSIS

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

RESULTS

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

CONCLUSIONS AND IMPLICATIONS

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

Consumption of ultra-processed foods and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study

Background

It is currently unknown whether ultra-processed foods (UPFs) consumption is associated with a higher incidence of multimorbidity. We examined the relationship of total and subgroup consumption of UPFs with the risk of multimorbidity defined as the co-occurrence of at least two chronic diseases in an individual among first cancer at any site, cardiovascular disease, and type 2 diabetes.

Methods

This was a prospective cohort study including 266,666 participants (60% women) free of cancer, cardiovascular disease, and type 2 diabetes at recruitment from seven European countries in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Foods and drinks consumed over the previous 12 months were assessed at baseline by food-frequency questionnaires and classified according to their degree of processing using Nova classification. We used multistate modelling based on Cox regression to estimate cause-specific hazard ratios (HR) and their 95% confidence intervals (CI) for associations of total and subgroups of UPFs with the risk of multimorbidity of cancer and cardiometabolic diseases.

Findings

After a median of 11.2 years of follow-up, 4461 participants (39% women) developed multimorbidity of cancer and cardiometabolic diseases. Higher UPF consumption (per 1 standard deviation increment, ∼260 g/day without alcoholic drinks) was associated with an increased risk of multimorbidity of cancer and cardiometabolic diseases (HR: 1.09, 95% CI: 1.05, 1.12). Among UPF subgroups, associations were most notable for animal-based products (HR: 1.09, 95% CI: 1.05, 1.12), and artificially and sugar-sweetened beverages (HR: 1.09, 95% CI: 1.06, 1.12). Other subgroups such as ultra-processed breads and cereals (HR: 0.97, 95% CI: 0.94, 1.00) or plant-based alternatives (HR: 0.97, 95% CI: 0.91, 1.02) were not associated with risk.

Interpretation

Our findings suggest that higher consumption of UPFs increases the risk of cancer and cardiometabolic multimorbidity.

Funding

Austrian Academy of Sciences, Fondation de France, Cancer Research UK, World Cancer Research Fund International, and the Institut National du Cancer.

Diet composition and energy intake in humans

Absolute energy from fats and carbohydrates and the proportion of carbohydrates in the food supply have increased over 50 years. Dietary energy density (ED) is primarily decreased by the water and increased by the fat content of foods. Protein, carbohydrates and fat exert different effects on satiety or energy intake (EI) in the order protein > carbohydrates > fat. When the ED of different foods is equalized the differences between fat and carbohydrates are modest. Covertly increasing dietary ED with fat, carbohydrate or mixed macronutrients elevates EI, producing weight gain and vice versa. In more naturalistic situations where learning cues are intact, there appears to be greater compensation for the different ED of foods. There is considerable individual variability in response. Macronutrient-specific negative feedback models of EI regulation have limited capacity to explain how availability of cheap, highly palatable, readily assimilated, energy-dense foods lead to obesity in modern environments. Neuropsychological constructs including food reward (liking, wanting and learning), reactive and reflective decision making, in the context of asymmetric energy balance regulation, give more comprehensive explanations of how environmental superabundance of foods containing mixtures of readily assimilated fats and carbohydrates and caloric beverages elevate EI through combined hedonic, affective, cognitive and physiological mechanisms. This article is part of a discussion meeting issue 'Causes of obesity: theories, conjectures and evidence (Part II)'.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

CLINICAL TRIAL REGISTRY

NCT04280146, https://www.

CLINICALTRIALS

gov , February 21st 2020.

Beyond ultra-processed: considering the future role of food processing in human health

Food-based dietary guidelines have been the basis of public health recommendations for over half a century, but more recently, there has been a trend to classify the health properties of food not by its nutrient composition, but by the degree to which it has been processed. This concept has been supported by many association studies, narrative reviews and the findings from one randomised controlled feeding trial, which demonstrated the sustained effect of ultra-processed diets on increasing both energy intake and body weight. This has led to widespread speculation as to specific features of ultra-processed foods that promote increased energy intakes. Rising interest in the ultra-processed topic has led to proposals to include guidance and restrictions on the consumption of processed foods in national dietary guidelines, with some countries encouraging consumers to avoid highly processed foods completely, and only choose minimally processed foods. However, there remains a lack of consensus on the role of processed foods in human health when faced with the challenges of securing the food supply for a growing global population, that is, healthy, affordable and sustainable. There has also been criticism of the subjective nature of definitions used to differentiate foods by their degree of processing, and there is currently a lack of empirical data to support a clear mechanism by which highly processed foods promote greater energy intakes. Recommendations to avoid all highly processed foods are potentially harmful if they remove affordable sources of nutrients and will be impractical for most when an estimated two-thirds of current energy purchased are from processed or ultra-processed foods. The current review highlights some considerations when interpreting the dietary association studies that link processed food intake to health and offers a critique on some of the mechanisms proposed to explain the link between ultra-processed food and poor health. Recent research suggests a combination of higher energy density and faster meal eating rates are likely to influence meal size and energy intakes from processed foods and offers new perspectives on how to manage this in the future. In going beyond the ultra-processed debate, the aim is to summarise some important considerations when interpreting existing data and identify the important gaps for future research on the role of processed food in health.

The Importance of Food Processing and Eating Behavior in Promoting Healthy and Sustainable Diets

Numerous association studies and findings from a controlled feeding trial have led to the suggestion that "processed" foods are bad for health. Processing technologies and food formulation are essential for food preservation and provide access to safe, nutritious, affordable, appealing and sustainable foods for millions globally. However, food processing at any level can also cause negative health consequences that result from thermal destruction of vitamins; formation of toxins such as acrylamide; or excessive intakes of salt, sugar, and fat. Research on ultraprocessed foods centers on food composition and formulation. In addition, many modern food formulations can have poor nutritional quality and higher energy density. We outline the role of processing in the provision of a safe and secure food supply and explore the characteristics of processed foods that promote greater energy intake. Despite the potential for negative health effects, food processing and formulation represent an opportunity to apply the latest developments in technology and ingredient innovation to improve the food supply by creating foods that decrease the risk of overeating. Expected final online publication date for the Annual Review of Nutrition, Volume 42 is August 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Nutrition and Health Claims: Consumer Use and Evolving Regulation

Purpose of Review

The value of nutrition and health claims (N&HC) depends on how consumers use them and the regulatory framework that enables them. This paper aims to explore the impact of claims on consumer behaviour and identify evolving regulatory challenges, using the Australian experience as a reference point.

Recent Findings

N&HC can influence consumer food purchasing and consumption, but how consumers interpret and act on specific claims is less well understood, and regulatory frameworks are evolving. In the last 10 years, changes to the Australian regulatory framework have exposed greater opportunities for promoting foods, albeit with challenges regarding self-substantiation of claims.

Summary

N&HC can play a significant role in driving consumer choices towards a healthier food supply. The Australian experience demonstrates how N&HC can continue to evolve, reflecting developments in methodologies and a fundamental appreciation of the relationship between food and health.

Texture-based differences in eating rate influence energy intake for minimally processed and ultra-processed meals

BACKGROUND

Consumption of ultra-processed foods has been linked with higher energy intakes. Food texture is known to influence eating rate (ER) and energy intake to satiation, yet it remains unclear whether food texture influences energy intakes from minimally processed and ultra-processed meals.

OBJECTIVES

We examined the independent and combined effects of food texture and degree of processing on ad libitum food intake. We also investigated whether differences in energy intake during lunch influenced postmeal feelings of satiety and later food intake.

METHODS

In this crossover study, 50 healthy-weight participants [n = 50 (24 men); mean ± SD age: 24.4 ± 3.1 y; BMI: 21.3 ± 1.9 kg/m2] consumed 4 ad libitum lunch meals consisting of "soft minimally processed," "hard minimally processed," "soft ultra-processed," and "hard ultra-processed" components. Meals were matched for total energy served, with some variation in meal energy density (±0.20 kcal/g). Ad libitum food intake (kcal and g) was measured and ER derived using behavioral coding of videos. Subsequent food intake was self-reported by food diary.

RESULTS

There was a main effect of food texture on intake, whereby "hard minimally processed" and "hard ultra-processed" meals were consumed slower overall, produced a 21% and 26% reduction in food weight (g) and energy (kcal) consumed, respectively. Intakes were higher for "soft ultra-processed" and "soft minimally processed" meals (P < 0.001), after correcting for meal pleasantness. The effect of texture on food weight consumed was not influenced by processing levels (weight of food: texture*processing-effect, P = 0.376), but the effect of food texture on energy intake was (energy consumed: texture*processing-effect, P = 0.015). The least energy was consumed from the "hard minimally processed" meal (482.9 kcal; 95% CI: 431.9, 531.0 kcal) and the most from the "soft ultra-processed" meal (789.4 kcal; 95% CI: 725.9, 852.8 kcal; Δ=↓∼300 kcal). Energy intake was lowest when harder texture was combined with the "minimally processed" meals. Total energy intake across the day varied directly with energy intakes of the test meals (Δ15%, P < 0.001).

CONCLUSIONS

Findings suggest that food texture-based differences in ER and meal energy density contribute to observed differences in energy intake between minimally processed and ultra-processed meals.This trial was registered at clinicaltrials.gov as NCT04589221.

Sensory-Related Industrial Additives in the US Packaged Food Supply

Background: Increasing evidence suggests that ultra-processed foods (UPFs) lead to elevated risk of obesity-related conditions, but UPF measurement has been criticized for its subjectivity and lack of clarity on biological mechanism. Sensory-related industrial additives (SRIAs) are a defining feature of UPFs and may encourage overconsumption by enhancing the sensory quality of foods. However, practical challenges have prevented systematic incorporation of SRIAs into UPF measurement.

Objective: The objectives of this work were to describe a new, open-source ingredient list search method and to apply this method to describe the presence of SRIAs in US packaged foods.

Methods: We developed computer coding to search for 64 common SRIAs related to sweetness, flavor, appearance, and texture in 241,688 foods in the US Branded Food Products Database (BFPD). The BFPD includes manufacturer-provided ingredient lists for ~300,000 branded and private label food items. We determined the total number of SRIAs (0–64) and the number of different types of SRIAs (sweetness, flavor, appearance, texture, 0–4) in each food, then calculated the percent of all foods with SRIAs. This was done for all foods, and by food group for 224,098 items with food group data.

Results: Most (64.9%) foods in the BFPD contained at least one SRIA, and more than a third had at least three. Sweets (89.5%), beverages (84.9%), and ready-to-eat (RTE) foods (82.0%) were the most likely to contain SRIAs. With respect to SRIA types, 25.7% of all food items had at least three of the four types of SRIAs examined, with texture-related additives being the most common. Among sweets, 20% had all four types of SRIAs.

Discussion: This work confirms the high prevalence of SRIAs in US packaged foods. They are ubiquitous in sweets, beverages, and RTE foods, but also present in substantial proportions of other food groups. Quantifying the presence of SRIAs in ingredient lists offers a novel way to identify UPFs for research; to distinguish more vs. less ultra-processed foods; and to test whether UPFs increase risk for obesity-related conditions through additives that enhance the product's sensory qualities.

Meal-to-meal and day-to-day macronutrient variation in an ad libitum vending food paradigm

BACKGROUND

Theory posits that macronutrient intake is regulated by protein consumption and adequate intake of protein results in consumption of less carbohydrates and fat. The current study investigates the effect of protein intake on calorie and macronutrient content using an ad libitum vending machine paradigm.

METHODS

Healthy volunteers (n = 287; 177 m; Age = 36 ± 11; BMI = 32 ± 8) were admitted to our clinical research unit. Macronutrient meal content (grams) and energy intake (Kcal) were quantified by specialized food processing software and collected on an hourly basis over a three-day period using a validated ad libitum vending machine paradigm. Body composition was assessed by DXA. Lagged multi-level models accounting for age, sex, race/ethnicity, fat and fat free mass indices were fitted to examine the impact of prior macronutrient content on subsequent meals.

RESULTS

Protein intake was associated with decreased energy intake (Kcal; B = -1.67 kcal, p = 0.0048), lower protein and carbohydrate intake (B = -0.08 g, p = 0.0006; B = -0.21 g, p = 0.0003, respectively) at subsequent meals. Daily Macronutrient intake and subsequent intake were positively associated.

CONCLUSIONS

Dietary protein exhibits a negative regulatory effect on a short-term meal-to-meal rather than day-to-day basis. In the setting of readily available food, protein intake impacts energy intake only over very short time courses.

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

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

A dental revolution: The association between occlusion and chewing behaviour

Dentistry is confronted with the functional and aesthetic consequences that result from an increased prevalence of misaligned and discrepant dental occlusal relations in modern industrialised societies. Previous studies have indicated that a reduction in jaw size in response to softer and more heavily processed foods during and following the Industrial Revolution (1,700 CE to present) was an important factor in increased levels of poor dental occlusion. The functional demands placed on the masticatory system play a crucial role in jaw ontogenetic development; however, the way in which chewing behaviours changed in response to the consumption of softer foods during this period remains poorly understood. Here we show that eating more heavily processed food has radically transformed occlusal power stroke kinematics. Results of virtual 3D analysis of the dental macrowear patterns of molars in 104 individuals dating to the Industrial Revolution (1,700-1,900 CE), and 130 of their medieval and early post-medieval antecedents (1,100-1,700 CE) revealed changes in masticatory behaviour that occurred during the early stages of the transition towards eating more heavily processed foods. The industrial-era groups examined chewed with a reduced transverse component of jaw movement. These results show a diminished sequence of occlusal contacts indicating that a dental revolution has taken place in modern times, involving a dramatic shift in the way in which teeth occlude and wear during mastication. Molar macrowear suggests a close connection between progressive changes in chewing since the industrialization of food production and an increase in the prevalence of poor dental occlusion in modern societies.

Sustainable food systems and nutrition in the 21st century: a report from the 22nd annual Harvard Nutrition Obesity Symposium

Food systems are at the center of a brewing storm consisting of a rapidly changing climate, rising hunger and malnutrition, and significant social inequities. At the same time, there are vast opportunities to ensure that food systems produce healthy and safe food in equitable ways that promote environmental sustainability, especially if the world can come together at the UN Food Systems Summit in late 2021 and make strong and binding commitments toward food system transformation. The NIH-funded Nutrition Obesity Research Center at Harvard and the Harvard Medical School Division of Nutrition held their 22nd annual Harvard Nutrition Obesity Symposium entitled "Global Food Systems and Sustainable Nutrition in the 21st Century" in June 2021. This article presents a synthesis of this symposium and highlights the importance of food systems to addressing the burden of malnutrition and noncommunicable diseases, climate change, and the related economic and social inequities. Transformation of food systems is possible, and the nutrition and health communities have a significant role to play in this transformative process.

Multi-component food-items and eating behaviour: What do we know and what do we need to know?

Multi-component food-items are single food products that comprise more than one food class, brought together usually via some form of processing. Importantly, individual components of the food-item remain discernible and sensorially distinguishable from each other (e.g., chocolate chip cookies or 'choc ice'). Despite a sizable research literature on the formulation of such products, there lacks a concomitant research literature on the effect(s) of multi-component food-items (compared to single component food-items) on eating behaviour. Considerable previous research has investigated the effect of multiple separate food items on food intake, portion size selection and palatability. However, studies rarely use test foods that capture the physical or chemical interactions between components that are characteristic of multi-component foods. Nevertheless, previous research and relevant theory allow us to generate hypotheses about how multi-component foods may affect eating behaviour; consideration of food variety and perceived sensory complexity suggest that consumption of multi-component foods are likely to increase perceived palatability of such foods, self-selected portion size and food intake. Moreover, many (but not all) multi-component foods would be considered ultra-processed, which is a driver of food intake in and of itself. One possibility is that food components brought together as part of a multi-component food-item interact to strongly drive eating behaviour. To explore this idea, researchers will need to work across disciplines to address various practical and methodological barriers including the technical preparation of test foods.

Consumption of ultra-processed foods associated with weight gain and obesity in adults: A multi-national cohort study

BACKGROUND

There is a worldwide shift towards increased consumption of ultra-processed foods (UPF) with concurrent rising prevalence of obesity. We examined the relationship between the consumption of UPF and weight gain and risk of obesity.

METHODS

This prospective cohort included 348 748 men and women aged 25-70 years. Participants were recruited between 1992 and 2000 from 9 European countries in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Two body weight measures were available, at baseline and after a median follow-up time of 5 years. Foods and drinks were assessed at baseline by dietary questionnaires and classified according to their degree of processing using NOVA classification. Multilevel mixed linear regression was used to estimate the association between UPF consumption and body weight change (kg/5 years). To estimate the relative risk of becoming overweight or obese after 5 years we used Poisson regression stratified according to baseline body mass index (BMI).

RESULTS

After multivariable adjustment, higher UPF consumption (per 1 SD increment) was positively associated with weight gain (0·12 kg/5 years, 95% CI 0·09 to 0·15). Comparing highest vs. lowest quintile of UPF consumption was associated with a 15% greater risk (95% CI 1·11, 1·19) of becoming overweight or obese in normal weight participants, and with a 16% greater risk (95% CI 1·09, 1·23) of becoming obese in participants who were overweight at baseline.

CONCLUSIONS

These results are supportive of public health campaigns to substitute UPF for less processed alternatives for obesity prevention and weight management.

The impact of feeding experiences during infancy on later child eating behaviours

PURPOSE OF REVIEW

Individual differences in appetite and eating behaviours appear early in infancy. This review synthesizes recent research investigating the impact of feeding experiences during infancy on later appetite and energy intake regulation, and appraises the consistency and longevity of any effects.

RECENT FINDINGS

Three themes of early feeding experiences were identified; breastfeeding, infants' first foods and caregivers' feeding practices. Recent findings suggest that breastfeeding alone is unlikely to promote better regulation of food intake later in childhood. It remains unclear whether the method of first food introduction (e.g., baby-led weaning vs traditional spoon feeding), or types of food introduced (e.g. ultra-processed foods), affect later child eating self-regulation. Randomised controlled trials (RCTs) on receiving guidance for responsive feeding showed some benefits; lower child body mass index z-scores in toddlerhood, parents reported less likelihood to pressure their child to eat or use food as a reward and lower emotional eating in the child.

SUMMARY

There is little consistent new evidence for the lasting impact of any one specific infant feeding experience on later eating self-regulation. More RCTs using observed and measured behaviours, with longer follow-ups of children's eating behaviours, and those conducted across different populations are warranted.

Parental reward-based eating drive predicts parents' feeding behaviors and Children's ultra-processed food intake

Reward-based eating drive is associated with individual consumption, but there has been a paucity of research on the relationships between parental reward-based eating, child feeding behaviors, and child food consumption. Child feeding behaviors likely to be associated with parental reward-based eating drive include the provision of ultra-processed foods, as they are designed to be hyperpalatable and are associated with disordered food intake. The present study uses a virtual reality (VR) buffet restaurant environment to examine parents' food choice behaviors for their children and a food frequency assessment to measure the children's reported consumption over the course of a week. Results found that parental reward-based eating drive significantly predicted ultra-processed calories chosen by parents for their children in the VR Buffet, as well as the amount of ultra-processed food children ate according to the food frequency assessment. Both of these effects were significantly mediated by the healthfulness of the home food environment. This study is among the first to demonstrate associations between parental reward-based eating drive and child-focused food behavior and to elucidate a mediating effect of the home food environment on such relationships. These findings may be useful for the development of family-based interventions to improve child feeding and ultimately child health.

Oral Processing, Satiation and Obesity: Overview and Hypotheses

Increasing the speed of eating or decreasing the amount of chewing of a test meal significantly decreases its satiation, increases concomitant caloric intake, and influences entero-endocrine secretion. Speed of eating is a strong risk factor for obesity and longitudinal studies suggest an etiological relationship. Individuals with obesity have an increase in bite size, less chewing per bite, decreased satiation, and greater food intake. Oral processing in terms of bite size and amount of chewing per gram of food is influenced by food texture and textural complexity. Soft foods increase bite size and decrease chewing per gram of food and meal duration compared to hard foods. An ultra-processed diet can lead to greater weight gain than a non-processed diet and a significant increase in eating rate. Many children with obesity are noted by their parents to have persistent hunger on a questionnaire and this is often extreme. Results of attempts to change eating behavior have been mixed in terms of producing long-term changes in eating behavior and body weight. It is hypothesized that there may be a unidirectional relationship between changes in oral processing, satiation and weight gain. However, the presence of persistent hunger can produce a vicious cycle that may exacerbate obesity and make treatment difficult. The increased energy density of foods as found particularly in ultra-processed foods also influences energy intake and obesity.