Global trends in ultraprocessed food and drink product sales and their association with adult body mass index trajectories

Factors influencing perceptions of processed baby foods and feeding practices among Indian mothers: a qualitative investigation

OBJECTIVE

To explore how professionally qualified, working Indian mothers conceptualize healthy foods in general, perceive processed infant and baby foods available commercially and what feeding practices they actually follow with their children at home.

DESIGN

Five focus groups with 8-12 participants were conducted around the participants' conceptualization of healthy food, their perceptions about commercially available processed baby and infant foods and their actual feeding practices that they routinely follow with their children. Discussion transcripts were analyzed using an inductive coding approach.

SETTING

India.

PARTICIPANTS

Fifty-one professionally qualified, working women with at least one child under 5 years of age.

RESULTS

Participants agreed that fresh food is healthiest. They also had favorable opinions about processed infant and baby foods with regards to healthfulness, hygiene and safety. Healthy foods were largely conceptualized in relation to nutrient claims, ingredients and discernible health outcomes. They use cues, such as health claims, brand, price, package design and others to determine healthfulness of the product. Perception was heavily influenced by these extrinsic cues rather than by participants' own nutrition knowledge. Despite having the knowledge, most participants admitted to using these foods on account of factors such as their own inability to lactate, social pressure, lack of time and convenience.

CONCLUSIONS

Most educated and well off people continue to use these products. While they rue the lack of stringent regulatory measures in India, they feel there is an urgent need to address this huge policy gap by way of legislation and regulation.

Association of ultra-processed food intake with severe non-alcoholic fatty liver disease: a prospective study of 143073 UK Biobank participants

BACKGROUND

Previous studies indicate a link between non-alcoholic fatty liver disease (NAFLD) and unhealthy dietary patterns or nutrient intake. However, it remains unclear whether ultra-processed foods (UPF) contribute to an increased risk of NAFLD. This study aimed to explore how ultra-processed food consumption correlates with severe NAFLD using the UK Biobank data.

METHODS

This prospective cohort study included 143,073 participants from the UK Biobank. UPF consumption levels were determined using the NOVA classification and quantified from 24-h dietary recall data. The association between UPF consumption and severe NAFLD (hospitalization or death) was initially examined using Cox proportional hazards models with intake quartiles. Nonlinear associations were investigated using penalized cubic splines fitted in the Cox proportional hazards models. Adjustments were made for general characteristics, sociodemographic factors, body mass index (BMI), and lifestyle.

RESULTS

Throughout the median follow-up period of 10.5 years, 1,445 participants developed severe NAFLD. The adjusted models indicated a significant increase in severe NAFLD risk in higher UPF intake groups compared to the lowest quartile (HR: 1.26 [95% CI: 1.11-1.43]). Subgroup analysis revealed that individuals with a BMI of 25 or higher were at greater risk in the highest quartile of UPF consumption. Sensitivity analyses yielded results consistent with these findings.

CONCLUSION

Higher consumption of UPF is associated with an increased risk of severe NAFLD. Reducing the intake of UPF can be a potential approach to lower the risk of NAFLD.

Dutch consumers' attitude towards industrial food processing

Industrial food processing and its possible adverse effects on health are widely debated in scientific literature and media. There is not much known about consumers' attitudes towards the processing of foods. Therefore, a questionnaire (n = 463) was distributed and interviews (n = 11) were conducted with Dutch consumers to evaluate the attitudes and associations towards industrial food processing and to assess opinions about communications on food processing and health. The results showed that 51% of the respondents had a neutral, 23% had a positive, and 26% had a negative attitude towards food processing. Respondents with a background in food by profession or education (n = 159) had more frequently a positive attitude towards food processing (P = 0.008). Respondents and interviewees pointed out both positive and negative associations with industrial processing: additives, artificial, not fresh, low nutritional value, unnatural, but also palatability, food safety, shelf life, and convenience. The questionnaire showed that 70% of the respondents thought food processing had a (slightly) negative health effect. Most interviewees indicated that when doing groceries, food processing per se is not relevant in food choices, although some critically inspected the ingredients. Furthermore, interviewees indicated that communication about food and health is scattered and complex. They would like to gain easy and straightforward information from a central source. From the questionnaire respondents, 60% indicated that they would like to have more information about food processing. In conclusion, most Dutch consumers in this study have a neutral and nuanced attitude towards industrial food processing. A connection with food via profession or education showed a more positive attitude, which may indicate the importance of knowledge and the need for clear communication about nutrition, ingredients, and food processing.

Ultra-processed foods intake and sex hormone levels among children and adolescents aged 6-19 years: a cross-sectional study

Background

Sex hormones are crucial for the development of children and adolescents. The increasing consumption of ultra-processed foods (UPFs) among children and adolescents in the United States (US) has raised concerns about their potential impact on health, including hormonal balance.

Methods

Data from 3,354 participants aged 6-19 years from the NHANES 2013-2016 were analyzed. UPF intake was categorized using the NOVA food classification system, and the percentage of total daily energy intake from UPFs was calculated. The serum levels of total testosterone (TT), sex hormone-binding globulin (SHBG), and estradiol (E2) were measured. The free androgen index (FAI) and TT/E2 ratio were calculated to estimate bioavailable testosterone levels and the balance between androgens and estrogens, respectively. Multiple linear regression models, adjusted for potential confounders, estimated the associations.

Results

Our results showed that higher intake of UPFs was marginally associated with decreased serum SHBG levels (quartile (Q) 2 vs. Q1: β = -5.3, 95% confidence interval (CI): -17.0, 8.1%; Q3 vs. Q1: β = -14.6, 95%CI: -25.1, -2.5%; Q4 vs. Q1: β = -9.0, 95%CI: -20.3, 3.8%; P trend = 0.081), and significantly associated with increased serum FAI in female adolescents (Q2 vs. Q1: β = 3.2, 95%CI: -3.3, 9.7; Q3 vs. Q1: β = 7.6, 95%CI: -0.7, 16.0; Q4 vs. Q1: β = 9.5, 95%CI: 1.5, 17.6; P trend = 0.019). Additionally, UPF intake showed a marginally positive association with increased serum SHBG levels (P trend = 0.057) in male children and FAI (P trend = 0.150) in male adolescents, respectively. Similar results were observed when participants were stratified by puberty status, except for the association between UPF intake and SHBG in male children. However, there were no associations between UPF consumption and TT, E2, or the TT/E2 ratio, both in males and females.

Conclusion

Higher UPF consumption is associated with increased FAI in adolescents, particularly in girls, indicating higher bioavailable testosterone levels. Future studies should validate these findings with direct free testosterone measurements and more precise dietary intake assessments.

Catalytic action of alternansucrase on sucrose under in vitro simulated gastric conditions

Alternansucrase, a glucosyltransferase, is currently used to produce slowly digestible alternan oligosaccharides or maltooligosaccharides from sucrose. These oligosaccharides are popular for food fortification to lower postprandial glucose levels. This study aimed to explore the enzymatic reaction of alternansucrase in simulated in vitro gastric reaction conditions. Under the studied conditions, SucroSEB (a model enzyme for alternansucrase) hydrolyzed the sucrose and transglycosylated the glucose to produce glucans, both in the absence and presence of acceptors. The preference of the acceptor was maltose˃ raffinose˃ lactose. The rate of sucrose hydrolysis was significantly higher in the presence of maltose (p = 0.024). The glucans formed during the reaction included oligomers (DP 3-10) and polymers (DP ≥ 11), both of which increased over time. These glucans contained α-1,3 and α-1,6 glycosidic linkages, confirmed by 1H and 13C NMR. They were slowly and partially digestible in the presence of rat intestinal extract in contrast to the complete and rapid digestion of starch. The glucans formed after a longer gastric reaction time exhibited higher dietary fiber potential (19.145 ± 4.77 %; 60 min) compared to those formed during the initial phase (2.765 ± 0.19 %; 15 min). Overall, this study demonstrated the efficacy of SucroSEB in converting sucrose to slowly and partially digestible glucans under simulated in vitro gastric conditions.

Ultraprocessing and presence of additives in commercially produced complementary foods in seven Southeast Asian countries: a cross-sectional study

BACKGROUND

There has been a dramatic shift in food systems, and the consumption of commercially processed and packaged foods has grown globally, including among older infants and young children. Many of these products are ultraprocessed and contain additives, with concerning implications for the health and nutrition of children.

OBJECTIVES

The study objectives were as follows: 1) to assess the levels of processing among different commercially produced complementary food product (CPCF) categories marketed in the Southeast Asia region, 2) to compare the nutrient content of CPCF products across levels of processing, and 3) to assess the types of additives present in different CPCF categories.

METHODS

This cross-sectional study involved secondary analysis of a cross-sectional dataset of product label information from CPCF purchased in 2021 in Cambodia, Indonesia, Lao People's Democratic Republic, Malaysia, Philippines, Thailand, and Viet Nam. Ingredient lists were reviewed to determine the level of processing-based on the Nova classification-and the presence of additives. Nutrient declaration panels were reviewed to determine total sugar, sodium, and total fat.

RESULTS

Nearly half of all CPCF were ultraprocessed, with total sugar and sodium content significantly higher among ultraprocessed CPCF than unprocessed/minimally processed products. Almost half of CPCF contained additives, with a median of 6 per product. More than 30% of all CPCF made use of cosmetic additives to enhance the products' appearance, flavor, or texture, with emulsifiers, colors, and thickeners the most prevalent. Almost one-third of products contained additives not permitted in Codex Alimentarius standards and guidelines for CPCF.

CONCLUSIONS

Findings from this study should alert national governments to both adopt and ensure enforcement of Codex guidance on additives and regulations enacted to encourage lower levels of processing for CPCF.

The Potential Effectiveness of Front-of-Pack Nutrition Labeling for Improving Population Diets

Nutrition labeling on the front of food packages can support more healthful purchase decisions and encourage favorable reformulation. This systematic literature review applied Cochrane methods to synthesize and appraise the evidence on the effectiveness of front-of-pack labeling (FOPL) on diet-related outcomes and food reformulation to inform policy recommendations. The search was conducted on 11 academic and gray literature databases, from inception to July 2022. Evidence was synthesized using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation), vote counting, and meta-analyses, where appropriate. Overall, 221 articles were included in the review. The randomized controlled trial evidence suggested that, compared with when no FOPL was present, FOPL likely improved consumer understanding of the nutritional quality/content of foods (moderate certainty of evidence), and the healthfulness of food choices (moderate certainty) and purchases (moderate certainty). Interpretive FOPL had a greater effect on these outcomes compared with noninterpretive systems (moderate certainty). There was inconsistency in the best-performing interpretive FOPL system.

Sugar-Sweetened Beverages and Adverse Human Health Outcomes: An Umbrella Review of Meta-Analyses of Observational Studies

Our aim was to conduct an umbrella review of evidence from meta-analyses of observational studies investigating the link between sugar-sweetened beverage consumption and human health outcomes. Using predefined evidence classification criteria, we evaluated evidence from 47 meta-analyses encompassing 22,055,269 individuals. Overall, 79% of these analyses indicated direct associations between greater sugar-sweetened beverage consumption and higher risks of adverse health outcomes. Convincing evidence (class I) supported direct associations between sugar-sweetened beverage consumption and risks of depression, cardiovascular disease, nephrolithiasis, type 2 diabetes mellitus, and higher uric acid concentrations. Highly suggestive evidence (class II) supported associations with risks of nonalcoholic fatty liver disease and dental caries. Out of the remaining 40 meta-analyses, 29 were graded as suggestive or weak in the strength of evidence (classes III and IV), and 11 showed no evidence (class V). These findings inform and provide support for population-based and public health strategies aimed at reducing sugary drink consumption for improved health.

Exploring Maternal Socio-Demographic Factors Shaping Children's Dietary Patterns in Brazil: Results from the 2019 National Health Survey

This study aimed to identify the dietary patterns of Brazilian children aged 6-23 months and to investigate their association with maternal socio-demographic factors. Data from the 2019 Brazilian National Health Survey were used in this cross-sectional study. Mothers of 1616 children aged 6-23 months reported on their children's dietary intake. Dietary patterns were identified using principal component analysis, and their associations with maternal socio-demographic characteristics were assessed using linear regression models. The first consisted of healthy patterns and the second, unhealthy ones. Linear regression showed that adherence to a healthy dietary pattern was higher among children of mothers who were older (β = 0.02, p = 0.01), had more years of education (β = 0.49, p = 0.04), reported living with a partner (β = 0.29, p = 0.01), and resided in an urban area (β = 0.35, p = 0.01). Conversely, adherence to the unhealthy pattern was positively associated with mothers who declared themselves as black or brown (β = 0.25, p = 0.03). Our results show that older mothers with higher levels of education and paid work and who live with a partner are more likely to contribute to their children's healthy eating patterns. We conclude that socio-demographic factors may influence the quality of the food offered to children. Nevertheless, advocating for public policies promoting nutritious complementary diets emphasising fresh and minimally processed foods remains crucial for children whose mothers do not possess these favourable socio-demographic characteristics.

Environmental Sustainability of Food Environments: Development and Application of a Framework in 4 cities in South Asia

Background

Food environments, where people directly engage with broader food systems, may be an important contributor to the environmental sustainability of food systems.

Objectives

The primary objectives of this study were to establish a new food environment framework that considers environmental indicators and to assess data availability and gaps using data previously collected as part of a food systems survey in 4 South Asian cities.

Methods

The framework was developed by conducting a structured literature review of previous food environment frameworks and in-depth interviews with content experts (n = 6). The framework and indicators were then mapped to data collected by consumer and vendor surveys using the Urban Food Systems Assessment Tool (UFSAT) in Ahmedabad (India), Pune (India), Kathmandu (Nepal), and Pokhara (Nepal).

Results

We have expanded the sustainability domain within food environments to include consumer travel to food vendors, the presence of food delivery services, policies related to sustainability, vendor food waste, vendor plastic use, vendor utility usage, vendor recycling and waste management practices, and food packaging. Mapping the framework to existing data from 4 cities in South Asia, we found variations in food environment sustainability indicators, particularly regarding consumer transportation to food vendors, the presence of delivery services, and food waste.

Conclusions

Although the majority of food environment research focuses on the availability and affordability of healthy foods, there is an urgent need to understand better how aspects of food environments contribute to environmental goals. When mapping the framework to existing food systems data, we found gaps in data on environmental sustainability in food environments and variation in indicators across settings.

Ultra-Processed Food Consumption as a Risk Factor for Gastrointestinal Cancer and Other Causes of Mortality in Southern Italy: A Competing Risk Approach

BACKGROUND

Ultra-Processed Foods (UPFs) are increasingly consumed worldwide, even in regions with strong dietary traditions like the Mediterranean and can play a crucial role in the development of chronic diseases, including cancer. This population-based prospective cohort study investigates the association between UPF consumption and gastrointestinal cancers and other causes of mortality in Southern Italy.

METHODS

Data were collected from 4870 participants in the MICOL and NUTRIHEP cohorts. The EPIC questionnaire was used to elicit information on food and drink consumption and UPFs were categorized by degree of processing according to the NOVA classification. Cox proportional hazards regression and competing risk models were employed for statistical analysis.

RESULTS

UPF consumption was positively associated with all-cause mortality: participants in the 3rd UFP quartile, as compared to the lowest, had a 27% higher risk of death (SHR 1.27 95% CI, 1.03; 1.57), while in the highest quartile as compared to the lowest, the risk was 34% higher (SHR 1.34 95% CI, 1.00; 1.79). Higher UPFs intake was also correlated with an increased gastrointestinal cancers mortality risk, especially the 2nd (SHR 1.65, 95% CI: 1.01; 2.71) and 4th quartile (SHR 3.14 95% CI: 1.56; 6.32), with a dose-dependent effect. For the other cancers, a SHR 1.61 (95% CI 1.03; 2.54) was observed for the 3rd quartile.

CONCLUSIONS

Our results reinforce the link between UPF consumption and cancer risk, emphasizing the urgent need for interventions targeting dietary patterns.

GroceryDB: Prevalence of Processed Food in Grocery Stores

The offering of grocery stores is a strong driver of consumer decisions, shaping their diet and long-term health. While highly processed food like packaged products, processed meat, and sweetened soft drinks have been increasingly associated with unhealthy diet, information on the degree of processing characterizing an item in a store is not straightforward to obtain, limiting the ability of individuals to make informed choices. Here we introduce GroceryDB, a database with over 50,000 food items sold by Walmart, Target, and Wholefoods, unveiling how big data can be harnessed to empower consumers and policymakers with systematic access to the degree of processing of the foods they select, and the potential alternatives in the surrounding food environment. The wealth of data collected on ingredient lists and nutrition facts allows a large scale analysis of ingredient patterns and degree of processing stratified by store, food category, and price range. We find that the nutritional choices of the consumers, translated as the degree of food processing, strongly depend on the food categories and grocery stores. Moreover, the data allows us to quantify the individual contribution of over 1,000 ingredients to ultra-processing. GroceryDB and the associated http://TrueFood.Tech/ website make this information accessible, guiding consumers toward less processed food choices while assisting policymakers in reforming the food supply.

Dietary intake, obesity, and physical activity in association with biliary tract cancer risk: Results from meta-analyses of individual-level data from prospective cohort studies of 723,326 adults

Biliary tract cancer (BTC) is a rare and aggressive malignancy with increasing incidence. Most BTC cases are diagnosed with metastatic disease which carries a 5-year survival rate of <5%. Physical activity, diet, and obesity might be associated with BTC risk, but studies have been limited particularly in African descendants. We addressed this knowledge gap by evaluating associations of BTC risk with obesity, physical activity, and dietary intakes in 723,326 adult participants in four cohort studies conducted in China, the United Kingdom, and the United States. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) in each cohort; results were combined using meta-analysis. All cohorts had ≥11 median follow-up years with 839 incident BTC cases combined. BTC risk was positively associated with body mass index (BMI) and waist-to-hip ratio (WHR) whereas physical activity, fruit intake, and fish intake were inversely associated. HR and (95% CI) comparing BMI >35.0 to 18.5-24.9: 1.71 (1.26, 2.31), p-trend <.0001; comparing BMI-adjusted WHR top to bottom quartile: 1.20 (0.94, 1.53), p-trend = .05; comparing ≥15-0 metabolic equivalent task-hours/week 0.76 (0.61, 0.94), p-trend = .009; comparing highest to lowest intake tertile for fruit and fish 0.79 (0.66, 0.95), p-trend = .01; 0.82 (0.68, 0.98), p-trend = .04, respectively. Associations were, in general, similar across ancestry groups. Our study provides strong evidence for important roles of obesity, diet, and physical activity in BTC etiology and stresses the need for lifestyle modification to combat the rising incidence of this fatal malignancy.

Market-driven fortification of vitamins and minerals in packaged foods targeted at children in Brazil

This study aimed to characterise the market-driven fortification of vitamins and minerals in packaged foods targeted at children in Brazil. We analysed 535 food labels using data collected in a census-type method (n = 5620) of food labels in a Brazilian supermarket in 2013. Micronutrients declared in nutrition claims and the ingredients list (synthetic compounds) were considered to be added for commercial purposes. Analysis of the ingredients list and nutrition claims showed that market-driven fortification of vitamins and minerals was present in 27.1% of foods. The main vitamins and minerals were vitamins A, B complex, C, D, calcium, iron and zinc. The food groups 'Milk and dairy products' and 'Sugars, sugary foods and snacks' had the highest frequencies of micronutrients declared in the ingredients list. Calcium, iron, phosphorus, zinc and all vitamins, except B7, were found to be added for commercial purposes. Micronutrients were found to be commonly added to packaged foods as a marketing strategy directed at parents and their children. Future studies should assess the amount of vitamins and minerals added to packaged foods targeted at children and whether intakes of vitamins and minerals in children are potentially excessive.

Type and timing of ultra-processed foods consumption and its association with dietary intake and physical activity in women with obesity living in poverty

BACKGROUND

The present study aimed to investigate the type and timing of ultra-processed foods (UPF) consumption and its association with dietary intake (DI) and physical activity (PA) in women with obesity living in poverty.

METHODS

A cross-sectional study was employed. Obesity was defined by at least two criteria (body mass index, waist circumference or % fat mass). Poverty was defined as the three lowest classes of the Brazilian Economic Classification Criterion. PA was measured with triaxial accelerometers and DI was assessed with three 24-h dietary recalls. Foods were categorised according to the NOVA classification, with UPF classified into five subgroups, as well as the timing of consumption into six meals.

RESULTS

In total, 56 adult women were included. Overall energy intake was 1653.21 (503.22) kcal/day. UPF intake was 21.62% (11.94%) kcal/day, being higher at breakfast (4.91% kcal/day), afternoon snack (5.39% kcal/day) and dinner (5.01% kcal/day). Only UPF subgroup 4 (sandwich biscuits, sweets, or treats) showed a positive association with energy intake (β = 54.40 [27.6, 81.10] kcal/day) and a negative association with protein intake (β = -0.31% [-0.48%, -0.14%] kcal/day). UPF consumption in morning (β = -0.41% [-0.79%, -0.02%] kcal/day) and afternoon (β = -0.18% [-0.33%, -0.04%] kcal/day) snacks was associated with lower protein intake. Furthermore, lunchtime UPF consumption was positively associated with walking time (β = 0.16% [0.02%; 0.30%]) and steps/hour (β = 8.72 [1.50; 15.94] steps/h).

CONCLUSIONS

Women with obesity living in poverty consume more UPF during breakfast, afternoon snack and dinner. Physical activity is positively associated with UPF consumption at lunch. UPF, such as sandwich biscuits, sweets or treats, contribute to increasing energy intake and reducing protein intake.

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

BACKGROUND & AIMS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Psychosocial risk and protective factors for youth problem behavior are associated with food addiction in the Generation Z

Objective

Food Addiction (FA) and other well-known risk behavior as substance misuse tend to co-occur and may share similar risk and protective factors. The aim of this study was to assess the association between the diagnosis/severity of FA and psychosocial domains typically related to risk behavior syndrome in a large, nationally representative community sample of Generation Z underage Italian students.

Method

The sample consisted of 8,755 students (3,623 from middle schools, 5,132 from high schools). A short version of the Yale Food Addiction Scale 2.0 was administered to evaluate FA. Risk and protective factors related to demographic, personality, behavior, and family variables were examined. Stepwise multivariate logistic and linear regressions were conducted.

Results

The prevalence of FA was 30.8%. Female gender, social anxiety and depression symptoms, social withdrawal risk, Internet gaming disorder, social media addiction, current substance use, social challenge engagement and experienced doxing boosted the chance of FA diagnosis, whereas eating fruit and vegetables, playing competitive sports and an average sleep duration of 7-8 h per night reduced these odds. FA severity was significantly and positively associated with trait impulsiveness, social anxiety and depressive symptoms, risk of social withdrawal, recent substance use, social media, and gaming addiction, doxing suffered and risky social challenges participation. Negative associations between the severity of FA and fruit and vegetable diet habits were found.

Conclusion

Our findings confirm that FA is widespread among Italian adolescents. The associations between the diagnosis and severity of FA and psychosocial risk factors for health, including, addictive and deviant behaviors related to digital misuse, suggest its belonging to the risk behavior constellation. Health promotion schemes based on a multicomponent strategy of intervention should consider the inclusion of FA and its psychosocial correlates.

Trends in ultra-processed food availability and its association with diet-related non-communicable disease health indicators in the Portuguese population

Broad variations in dietary and physical activity patterns are part of nutritional transition concept. An additional nutritional transition has as main characteristic the change of consumption of processed foods for ultra-processed foods (UPF). This study aims to evaluate trends of UPF availability in Portuguese population and its association with diet-related non-communicable diseases (NCD) health indicators. This ecological study used data from the Household Budget Surveys conducted by the National Statistics Institute each 5 years within a national representative sample of households. The percentage of UPF was calculated based on the total daily amount of food and beverages available per capita (in grams). Data from the years 1990, 1995, 2000 and 2005 were used, which were retrieved from DAFNE-Anemos Software. NCD age-standardised mortality, prevalence and incidence were obtained from the Global Burden of Disease database, for the years 2000, 2005, 2010 and 2015. Between 1990 and 2005, the UPF availability increased from 3·9 % to 13·8 %. Over the years, almost all food and beverages categories increased the UPF availability contribution, mainly noticeable for milk, sugar, cereal and meat products. Positive correlations were observed between UPF availability and digestive diseases both in prevalence (r = 0·062; P = 0·037) and incidence (r = 0·005; P = 0·010) measures. Neoplasms incidence also showed positive correlation with UPF availability (r = 0·002; P = 0·012). Trends in UPF availability in Portugal increased exponentially. At the same time, there is a trend towards a decrease in unprocessed and processed food availability. The Portuguese population should be made aware of the health risks resulting from excessive consumption of UPF.

A policy approach to identifying food and beverage products that are ultra-processed and high in added salt, sugar and saturated fat in the United States: a cross-sectional analysis of packaged foods

Background

Governments globally aim to reduce the intake of unhealthy foods. Many policies exist that aim to address foods high in saturated fat, salt and sugar (HFSS) but the identification of ultra-processed foods (UPF) have presented a greater challenge due to the lack of an appropriate policy definition. To support policymakers, we provide approaches that can support governments to identify both HFSS foods and UPFs.

Methods

Four approaches combining elements of UPF definitions (i.e., presence of additives) and HFSS definitions were compared attempting to simplify and standardize the identification of less healthy products. Nationally representative food purchase data from NielsenIQ linked with nutrition facts label data were used to examine the mean proportion of product volume purchased by US households to be targeted. Differences between approaches were examined using Student t test; Bonferroni adjusted P value < 0.0001 was considered significant.

Findings

In 2020, 50% of 33,054,687 products purchased by US households were considered UPFs (65% of foods and 38% of beverages) and 43% HFSS (65% of foods and 26% of beverages), however there was not 100% agreement between the two definitions (P < 0.0001). By starting with HFSS criteria and adding elements of UPF (colors and flavors), we were able to provide a method with 100% agreement between the identification of UPFs and HFSS products.

Interpretation

Results demonstrated how combining HFSS criteria with UPF criteria can be used to identify less healthy foods and ensure policymakers have both a simple and accurate method to target products for policy intervention.

Funding

Bloomberg Philanthropies and the Global Food Research Program of UNC-Chapel Hill provided funds.

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

BACKGROUND

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

OBJECTIVE

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

DESIGN

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

PARTICIPANTS/SETTING

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

MAIN OUTCOME MEASURES

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

STATISTICAL ANALYSES PERFORMED

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

RESULTS

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

CONCLUSIONS

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

Nutrient profile of packaged foods according to the degree of processing

An increased consumption of ultra-processed foods (UPF) leads to a rising prevalence of chronic noncommunicable diseases. This study aims to characterise the nutrient profile of white-label pre-packaged foods and bakery products available in a market leader Portuguese food retail chain, according to the extent of processing proposed by NOVA classification system. The nutrient profile (energy, sugar, total fat, saturated fat and sodium) according to processing degree was analysed using non-parametric tests. UPF were the most energy dense (278 kcal/100 g, p < .001) and the highest in sugar (15.9 g/100 g, p < .001). Processed foods were the highest in sodium (538 mg/100 g, p < .001). Processed and UPF showed significantly higher total (12.4 and 10.8 g/100 g, respectively) and saturated fat content (6.10 and 4.61 g/100 g, respectively) than unprocessed/minimally processed foods (p < .001). Regarding the variation of the nutritional value across the extent of processing, different results were observed for some categories suggesting the importance of a stratified analysis. The consumption of less processed foods and the manufacture of processed/UPF with better nutrient profile should be promoted.

Higher ultra processed foods intake is associated with low muscle mass in young to middle-aged adults: a cross-sectional NHANES study

Design

Ultra-processed foods (UPFs) have become a pressing global health concern, prompting investigations into their potential association with low muscle mass in adults.

Methods

This cross-sectional study analyzed data from 10,255 adults aged 20-59 years who participated in the National Health and Nutritional Examination Survey (NHANES) during cycles spanning from 2011 to 2018. The primary outcome, low muscle mass, was assessed using the Foundation for the National Institutes of Health (FNIH) definition, employing restricted cubic splines and weighted multivariate regression for analysis. Sensitivity analysis incorporated three other prevalent definitions to explore optimal cut points for muscle quality in the context of sarcopenia.

Results

The weighted prevalence of low muscle mass was 7.65%. Comparing the percentage of UPFs calories intake between individuals with normal and low muscle mass, the values were found to be similar (55.70 vs. 54.62%). Significantly linear associations were observed between UPFs consumption and low muscle mass (P for non-linear = 0.7915, P for total = 0.0117). Upon full adjustment for potential confounding factors, participants with the highest UPFs intake exhibited a 60% increased risk of low muscle mass (OR = 1.60, 95% CI: 1.13 to 2.26, P for trend = 0.003) and a decrease in ALM/BMI (β = -0.0176, 95% CI: -0.0274 to -0.0077, P for trend = 0.003). Sensitivity analysis confirmed the consistency of these associations, except for the International Working Group on Sarcopenia (IWGS) definition, where the observed association between the highest quartiles of UPFs (%Kcal) and low muscle mass did not attain statistical significance (OR = 1.35, 95% CI: 0.97 to 1.87, P for trend = 0.082).

Conclusion

Our study underscores a significant linear association between higher UPFs consumption and an elevated risk of low muscle mass in adults. These findings emphasize the potential adverse impact of UPFs on muscle health and emphasize the need to address UPFs consumption as a modifiable risk factor in the context of sarcopenia.

Monitoring health and nutrition claims on food labels in Brazil

Introduction

The monitoring of nutrition and health claims on food and beverage labels has been proposed by international and national organizations because it can collaborate with the development of public policies to regulate food labeling and marketing strategies. One way of carrying out this monitoring is by using data collected by private companies.

Objective

To compare information on nutrition and health claims available in a commercial database of a private company that monitors the launch of new foods and beverages in Brazilian food retailers with information on those same claims manually coded by trained research assistants.

Methods

This is a cross-sectional observational study using a data sample of newly launched food and beverages available at a commercial database from 2018 to 2021. We compared the information on health and nutrition claims available on the commercial dataset with reliable information on the same nutrition and health claims manually coded by trained research assistants using a tested taxonomy to classify such claims. We used Gwet's Kappa AC1 with 95% CI and percentage agreement to compare both data sources and calculated sensitivity and specificity of the compared data.

Results

A total of 6,722 foods and beverages were analyzed. Mintel-GNPD presented 36.28% (n = 2,439) of nutrition claims, while in the trained researchers' coding, it was 33.73% (n = 2,267). We found a prevalence of 5.4% (n = 362) for health claims in Mintel-GNPD and 10.8% (n = 723) in the researchers' coding. All subcategories of nutrition and health claims showed high agreement (Kappa >0.81). Health claims presented kappa = 0.89 with 33.7% sensitivity and 98.0% specificity while nutrition claims showed kappa = 0.86 with 92.9% sensitivity and 92.5% specificity.

Conclusion

Nutrition and health claims showed high agreement, with great results in nutrition claims, indicating that Mintel-GPND is suitable for monitoring such claims on food and beverage packaging in Brazil. Additionally, our findings show a high prevalence of nutrition and health claims on food packages launched in the Brazilian food retail, highlighting the need to monitor these to develop public policies to regulate food marketing on packaging in Brazil.

Examining gender differences in adolescent exposure to food and beverage marketing through go-along interviews

This study explores how adolescents engage with unhealthy food and beverage marketing in online settings, from a gender perspective. Employing an online ethnography approach and using go-along interviews, we explored the experiences of adolescent boys and girls aged 13-17 as they navigated their online experiences with digital food and beverage marketing. Notable themes emerged, including the identification of predatory actions by food companies, the role of protective factors such as family, and the influence of social media influencers in shaping adolescent dietary preferences. Importantly, this research unearthed gender disparities in the participants' responses. Girls, in particular, exhibited a heightened awareness of the protective role played by their families, emphasized the influence of color in marketing strategies, recognized the significance of gender in marketing, and reported exposure to alcohol advertisements-findings that boys less frequently echoed. The study underscores the importance of adolescence as a critical phase in development, during which food companies target these impressionable individuals, driven by their independence and potential for brand loyalty. Moreover, it highlights the potential avenue of gender-specific marketing, offering valuable insights into the gendered dimensions of adolescents' food marketing experiences. By examining the interplay between digital food marketing and gender, this research addresses a critical gap in the literature, shedding light on how gender influences adolescents' perceptions, responses, and behaviors in the context of food marketing strategies. These findings have the potential to inform adolescents of the marketing techniques that target them and guide policymakers in developing and implementing evidence-based regulations aimed at safeguarding adolescents from exposure to unhealthy food marketing.

How and why ultra-processed foods harm human health

The analysis of food using a perspective centred on nutrients seems inadequate for understanding the dietary transition and its impact on the growth of obesity and chronic diseases. Industrial food processing is now proposed as the key to explain the relationship between food and health. The NOVA food classification considers the degree and the purpose of food processing, which includes physical, biological and chemical processes used after foods are separated from nature, and before being consumed or prepared as dishes and meals. NOVA has four food groups: (1) unprocessed and minimally processed foods; (2) processed culinary ingredients; (3) processed foods and (4) ultra-processed foods, which are formulations made mostly or entirely from substances derived from group 1 foods and additives, with little if any intact group 1 food. Many investigations linking high ultra-processed food consumption with deterioration of diets and adverse health outcomes are reinforced by prospective studies, systematic reviews and meta-analyses. There are various plausible explanations of why diets high in ultra-processed foods are harmful. Their production and consumption continue to rise worldwide. Efficient and effective public policies and actions that reduce production and consumption of ultra-processed products are needed, to protect human health now and in future.

Assessment of ultra processed foods consumption in Senegal: validation of the Nova-UPF screener

BACKGROUND

Ultra-processed foods (UPF), as proposed by the Nova food classification system, are linked to the development of obesity and several non-communicable chronic diseases and deaths from all causes. The Nova-UPF screener developed in Brazil is a simple and quick tool to assess and monitor the consumption of these food products. The aim of this study was to adapt and validate, against the 24-hour dietary recall, this short food-based screener to assess UPF consumption in the Senegalese context.

METHODS

The tool adaptation was undertaken using DELPHI methodology with national experts and data from a food market survey. Following the adaptation, sub-categories were renamed, restructured and new ones introduced. The validation study was conducted in the urban area of Dakar in a convenience sample of 301 adults, using as a reference the dietary share of UPF on the day prior to the survey, expressed as a percentage of total energy intake obtained via 24-hour recall. Association between the Nova-UPF score and the dietary share of UPF was evaluated using linear regression models. The Pabak index was used to assess the agreement in participants' classification according to quintiles of Nova-UPF score and quintiles of the dietary share of UPF.

RESULTS

The results show a linear and positive association (p-value < 0.001) between intervals of the Nova-UPF score and the average dietary share of UPF. There was a near perfect agreement in the distribution of individuals according to score's quintiles and UPF dietary share quintiles (Pabak index = 0.84).

CONCLUSION

The study concluded that the score provided by the Nova-UPF screener adapted to the Senegalese context is a valid estimate of UPF consumption.

One Health Perspectives on Food Safety in Minimally Processed Vegetables and Fruits: From Farm to Fork

While food markets and food production chains are experiencing exponential growth, global attention to food safety is steadily increasing. This is particularly crucial for ready-to-eat products such as fresh-cut salads and fruits, as these items are consumed raw without prior heat treatment, making the presence of pathogenic microorganisms quite frequent. Moreover, many studies on foodborne illnesses associated with these foods often overlook the transmission links from the initial contamination source. The prevention and control of the dissemination of foodborne pathogens should be approached holistically, involving agricultural production, processing, transport, food production, and extending to final consumption, all while adopting a One Health perspective. In this context, our objective is to compile available information on the challenges related to microbiological contamination in minimally handled fruits and vegetables. This includes major reported outbreaks, specific bacterial strains, and associated statistics throughout the production chain. We address the sources of contamination at each stage, along with issues related to food manipulation and disinfection. Additionally, we provide potential solutions to promote a healthier approach to fresh-cut fruits and vegetables. This information will be valuable for both researchers and food producers, particularly those focused on ensuring food safety and quality.

Synthesis of Effect Sizes on Dose Response from Ultra-Processed Food Consumption against Various Noncommunicable Diseases

Ultra-processed foods (UPFs), according to the NOVA classification food system, are food products that are processed using advanced processing technology, which improves palatability and sensory quality. However, UPFs increase the daily intake of energy, sodium, sugar, and total fat (including saturated fat), and decrease the intake of fiber. This might trigger overweight and obesity, the initial stages of noncommunicable diseases (NCDs). However, the effect of UPF consumption on NCDs remains under debate. This study aimed to synthesize the effect size of UPF dose response on various NCDs by using a meta-analysis method. The main output was a hazard ratio (HR) and a 95% confidence interval (CI). Using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) selection guidelines, 18 research articles were chosen for further effect size synthesis. The results showed that UPF consumption significantly increased the daily intake of carbohydrates, added sugar, saturated fat, sodium, energy, cholesterol, and total fat; increases of 49.64, 40.78, 30.00, 27.76, 26.67, 25.69, and 15.77%, respectively, were observed. Moreover, with UPF consumption, the fiber intake was way below the daily dietary recommendation (DR), at -38.55%. Further, a 10% increment in UPF consumption significantly affects diabetes, cardiovascular diseases, obesity, and cancer (HR ± 95% CI: 1.115 ± 0.044, 1.096 ± 0.053, 1.068 ± 0.050, and 1.020 ± 0.020, respectively). Thus, limiting daily UPF consumption could help prevent obesity and various NCDs.

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

OBJECTIVE

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

DESIGN

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

SETTING

Brazil.

PARTICIPANTS

3698 Brazilian municipalities.

RESULTS

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

CONCLUSIONS

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

Upstream Determinants of Overweight and Obesity in Europe

PURPOSE OF REVIEW

To review the upstream determinants of overweight and obesity in Europe, including food and built environments, and political, commercial, and socioeconomic determinants.

RECENT FINDINGS

Overweight and obesity affect 60% of European adults, and one in three children, and are more common in individuals with low compared to high socioeconomic position (SEP). Individuals in low SEP groups are more exposed to unhealthy built and food environments, including higher exposure to unhealthy food marketing. Industries influencing the food system have much economic power, resulting in ignoring or silencing the role of ultra-processed foods and commercial practices in weight gain. Overall, effective policies to address overweight and obesity have been insufficiently implemented by governments. To accelerate implementation, strengthened political commitment is essential. Policies must also focus on the upstream, structural, and systemic drivers of overweight and obesity; be comprehensive; and target socioeconomic inequalities in diets and physical activity.

New insights in the mechanisms of weight-loss maintenance: Summary from a Pennington symposium

Obesity is a chronic disease that affects more than 650 million adults worldwide. Obesity not only is a significant health concern on its own, but predisposes to cardiometabolic comorbidities, including coronary heart disease, dyslipidemia, hypertension, type 2 diabetes, and some cancers. Lifestyle interventions effectively promote weight loss of 5% to 10%, and pharmacological and surgical interventions even more, with some novel approved drugs inducing up to an average of 25% weight loss. Yet, maintaining weight loss over the long-term remains extremely challenging, and subsequent weight gain is typical. The mechanisms underlying weight regain remain to be fully elucidated. The purpose of this Pennington Biomedical Scientific Symposium was to review and highlight the complex interplay between the physiological, behavioral, and environmental systems controlling energy intake and expenditure. Each of these contributions were further discussed in the context of weight-loss maintenance, and systems-level viewpoints were highlighted to interpret gaps in current approaches. The invited speakers built upon the science of obesity and weight loss to collectively propose future research directions that will aid in revealing the complicated mechanisms involved in the weight-reduced state.

Ultraprocessed Foods and Cancer in Low-Middle-Income Countries

Low middle income countries (LMICs) are the predominant contributors to global cancer-related mortality and are projected to bear the greater share of the global cancer burden in the next few decades. Among other factors, lifestyle changes have been linked to the rising incidence of cancer in these countries. As one of the keys to a healthy lifestyle, a balanced diet plays a major role in the preservation of health. Globalization and rapid urbanization have prompted a paradigm shift in various aspects of daily life in LMICs; the influence on dietary choices has been particularly noticeable. Studies show a concerning rise in the sale and consumption of ultraprocessed foods in these countries. In addition to hyperpalatability, this trend has been attributed to various other factors including convenience, availability, economic considerations, and marketing strategies. Although several studies from LMICs recognize and recommend the need for effective public health measures to reduce the consumption of these foods, findings from certain studies suggest that established public health strategies occasionally fail in the real-world scenario. Barriers to effective policymaking also contribute to the prevailing dietary trends. This review of studies from the LMIC setting demonstrates the current problem, limitations of established public health measures, and the complexities associated with effective policymaking. In view of the threat posed to cancer risk, there is an urgent need to curb the consumption of ultraprocessed foods in LMICs. National policymakers therefore need to circumnavigate the challenges effectively to ensure timely achievement of the United Nations sustainable development goals.

Health-Washing of Ultraprocessed Products on Instagram: Prevalence and Strategies in an Emerging Market

OBJECTIVE

To evaluate the prevalence of health-related cues as part of the digital marketing of ultraprocessed foods on Instagram among food companies in Uruguay.

METHODS

Cross-sectional exploratory study. All content posted by 118 Instagram accounts of companies promoting ultraprocessed foods in Uruguay over 6 months (from August 2020 to February 2021) was retrieved. The content of 1,893 Instagram posts was coded considering visual and textual cues conveying health-related associations. The number and percentage of posts, including cues within each category and theme, were calculated.

RESULTS

More than half of all posts contained at least 1 visual or textual cue conveying health-related associations. Three main themes emerged: i) product composition, ii) healthy lifestyle, and iii) health and health benefits. The prevalence of health-related cues differed dramatically across product categories, ranging from 100% to 1.5%.

CONCLUSIONS AND IMPLICATIONS

Health-washing constitutes an integral part of the digital marketing of ultraprocessed foods on Instagram in Uruguay. The inclusion of health-related cues can potentially undermine public health efforts targeted at reducing consumption of these foods. These findings suggest that strict and comprehensive regulations on the digital marketing of such products are needed in policies promoting healthy eating habits globally.

Ultraprocessed foods and chronic kidney disease-double trouble

High energy intake combined with low physical activity generates positive energy balance, which, when maintained, favours obesity, a highly prevalent morbidity linked to development of non-communicable chronic diseases, including chronic kidney disease (CKD). Among many factors contributing to disproportionately high energy intakes, and thereby to the obesity epidemic, the type and degree of food processing play an important role. Ultraprocessed foods (UPFs) are industrialized and quite often high-energy-dense products with added sugar, salt, unhealthy fats and food additives formulated to be palatable or hyperpalatable. UPFs can trigger an addictive eating behaviour and is typically characterized by an increase in energy intake. Furthermore, high consumption of UPFs, a hallmark of a Western diet, results in diets with poor quality. A high UPF intake is associated with higher risk for CKD. In addition, UPF consumption by patients with CKD is likely to predispose and/or to exacerbate uraemic metabolic derangements, such as insulin resistance, metabolic acidosis, hypertension, dysbiosis, hyperkalaemia and hyperphosphatemia. Global sales of UPFs per capita increased in all continents in recent decades. This is an important factor responsible for the nutrition transition, with home-made meals being replaced by ready-to-eat products. In this review we discuss the potential risk of UPFs in activating hedonic eating and their main implications for health, especially for kidney health and metabolic complications of CKD. We also present various aspects of consequences of UPFs on planetary health and discuss future directions for research to bring awareness of the harms of UPFs within the CKD scenario.

Who consumes ultra-processed food? A systematic review of sociodemographic determinants of ultra-processed food consumption from nationally representative samples

Ultra-processed food (UPF) intake is associated with increased non-communicable disease risks. However, systematic reports on sociodemographic predictors of UPF intake are lacking. This review aimed to understand UPF consumption based on sociodemographic factors, using nationally representative cohorts. The systematic review was pre-registered (PROSPERO:CRD42022360199), following PRISMA guidelines. PubMed/MEDLINE searches (‘ultra-processed/ultraprocessed’ and ‘ultra-processing/ultraprocessing’) until 7 September 2022 retrieved 1131 results. Inclusion criteria included: observational, nationally representative adult samples, in English, in peer-reviewed journals, assessing the association between sociodemographics and individual-level UPF intake defined by the NOVA classification. Exclusion criteria included: not nationally representative, no assessment of sociodemographics and individual-level UPF intake defined by NOVA. Risk of bias was assessed using the Newcastle–Ottawa Scale (NOS). Fifty-five papers were included, spanning thirty-two countries. All thirteen sociodemographic variables identified were significantly associated with UPF intake in one or more studies. Significant differences in UPF intake were seen across age, race/ethnicity, rural/urbanisation, food insecurity, income and region, with up to 10–20% differences in UPF intake (% total energy). Higher UPF intakes were associated with younger age, urbanisation and being unmarried, single, separated or divorced. Education, income and socioeconomic status showed varying associations, depending on country. Multivariate analyses indicated that associations were independent of other sociodemographics. Household status and gender were generally not associated with UPF intake. NOS averaged 5·7/10. Several characteristics are independently associated with high UPF intake, indicating large sociodemographic variation in non-communicable disease risk. These findings highlight significant public health inequalities associated with UPF intake, and the urgent need for policy action to minimise social injustice-related health inequalities.

Use of screens and intake of unhealthy food among children and adolescents: association with physical activity in a cross-sectional study

BACKGROUND

The intake of unhealthy food taken on very regular basis may bring even further negative impact on health if associated with excessive time using of screen-based electronic devices.

OBJECTIVE

To estimate the association between the use of different types of screen-based devices and the intake of unhealthy foods amongst children and adolescents and to determine whether daily physical activity (DPA) has a moderating effect on the association.

METHODS

Cross-sectional study carried out with a probabilistic sample of students from second to fifth grade of public elementary schools in Feira de Santana, Bahia (n = 2,477; girls: 53.2%; age: 9.1 ± 1.38 years; BMI z-score 0.37 ± 4.19 Kg/m²). Food intake, screen use, and physical activity were assessed using an online questionnaire based on previous day recall (Web-CAAFE). Prevalence Ratios (PR) and 95% Confidence Intervals (95%CI) were estimated via multiple zero-inflated negative binomial regression, with adjustments for sex, age, and weekly frequency of school meal intake. The moderating effect of DPA was verified by inserting interaction terms with each screen-based device individually and with the daily sum of screen-based device exposure (∑ Screens).

RESULTS

The majority of students (72.2%) reported using screens. The intake of unhealthy foods was positively associated with the use of cell phones (PR = 1.21; 95%CI = 1.13-1.30), computers (PR = 1.33; 95%CI = 1.22-1.46), and video games (PR = 1.36; 95%CI = 1.22-1.52). TV use was inversely associated with intake of unhealthy foods (PR = 0.92; 95%CI = 0.87-0.99). DPA moderated the effect of video game use on intake of unhealthy foods, that is, among students with DPA ≥ 4 who used video games, the intake of unhealthy foods was 21% lower (PR = 0.79; 95%CI = 0. 65-0.97). Overall, ∑ Screen-based devices were associated with a 20% increase in intake of unhealthy foods.

CONCLUSION

The intake of unhealthy foods was positively associated with the use of cell phones, computers, and video games. In addition, a frequency of four or more DPA attenuated the effect of video game exposure on intake of unhealthy foods. Upcoming investigations on the use of screen-based devices and the intake of unhealthy foods among schoolchildren should consider the exposure to different types of screen-based devices, as well as the influence of DPA.

Basic human values drive food choice decision-making in different food environments of Kenya and Tanzania

Increased access to a variety of foods in low-and-middle-income countries (LMICs) has led to greater autonomy in food choice decision-making. Autonomy allows individuals to make decisions through negotiation of considerations in ways that are consistent with basic values. The aim of this study was to identify and describe how basic human values drive food choice in two diverse populations with transitioning food environments living in the neighboring East African countries of Kenya and Tanzania. Secondary data analysis was carried out on focus group discussions conducted with men and women in Kenya (n = 28) and Tanzania (n = 28) as part of prior studies on food choice. A priori coding based on Schwartz's theory of basic human values was conducted, followed by a narrative comparative analysis, which included review by original principal investigators. Values of conservation (security, conformity, tradition), openness to change (self-directed thought and action, stimulation, indulgence), self-enhancement (achievement, power, face), and self-transcendence (benevolence-dependability and -caring) were prominent drivers of food choice in both settings. Participants described how values were negotiated and highlighted existing tensions. For example, the value of tradition was cited as important in both settings but changing food contexts (e.g., new foods, diverse neighborhoods) increased prioritization of values like stimulation, indulgence, and self-directed thought and action. The application of a basic values framework was useful for understanding food choice in both settings. A focused understanding of how values drive food choice decision-making in the context of changing food availability in LMICs is essential for the promotion of sustainable healthy diets.

Higher ultra-processed food intake was positively associated with odds of NAFLD in both US adolescents and adults: A national survey

BACKGROUND

The effect of ultra-processed foods (UPF) on NAFLD remains unclear. Related evidence for adult NAFLD is limited and no study has yet evaluated UPF's impact on NAFLD in adolescence.

METHODS

We used data from the National Health and Nutrition Examination Survey (2017-2018) with 806 adolescents and 2734 adults. UPF intake was estimated using dietary data from two 24-hour dietary recalls. NAFLD was defined by transient elastography. Logistic regression was used to estimate the multivariable OR and 95% CI for associations between UPF and NAFLD with survey weight adjustments.

RESULTS

The mean UPF intake was 812 g/d in adolescents and 823 g/d in adults. A total of 12.4% of the adolescents and 35.6% of the adults had NAFLD. Higher UPF intake was associated with higher odds of NAFLD in both adolescents (OR Quintile 5 vs. Quartile 1 = 2.34, 95% CI, 1.01, 5.41; ptrend = 0.15) and adults (OR Quintile 5 vs. Quintile 1 = 1.72, 95% CI, 1.01, 2.93; ptrend = 0.002). In adults, ~68% and 71% of the association between UPF intake and NAFLD was mediated by body mass index and waist circumference (all p-values < 0.001), respectively. The results were similar for adolescents but not statistically significant. A higher UPF intake was associated with lower levels of serum albumin and higher levels of C-reactive protein in adults.

CONCLUSIONS

Higher UPF intake was linked to higher NAFLD odds in both adolescents and adults, mainly because of elevated body fatness. If confirmed, reducing UPF intake may help prevent NAFLD in both adolescents and adults.

Purchase of ultra-processed foods in Norway: a repeated cross-sectional analysis of food sales in 2013 and 2019

OBJECTIVE

A dietary pattern dominated by ultra-processed foods has been associated with non-communicable diseases in several studies. A previous study from 2013 found a high share of ultra-processed foods in Norwegian food sales. This study aimed to investigate the current share of ultra-processed foods in Norway and the development in expenditure on ultra-processed foods from 2013.

DESIGN

A repeated cross-sectional analysis of scanner data from the Consumer Price Index from September 2013 and 2019 and an investigation of the processing degree according to the NOVA classification system.

SETTING

Food sales in Norway.

PARTICIPANTS

Norwegian grocery stores (n 180, for both time periods).

RESULTS

The share of expenditure in 2019 was highest for ultra-processed foods (46·5 %) and minimally or unprocessed foods (36·3 %), followed by processed foods (8·5 %) and processed culinary ingredients (1·3 %). An increasing degree of processing was found for several of the food groups between 2013 and 2019; however, most effect sizes were weak. In 2019, soft drinks became the most frequently purchased food item, surpassing milk and cheese, with the highest expenditure in Norwegian grocery stores. Increases in expenditure on ultra-processed foods were mainly due to increased expenditures on soft drinks, sweets and potato products.

CONCLUSIONS

A high share of expenditure on ultra-processed food was found in Norway, which may imply a high consumption of these foods. The change in expenditure of NOVA groups between 2013 and 2019 was small. Carbonated and non-carbonated soft drinks were the most frequently purchased products in Norwegian grocery stores and contributed to most of the expenditures.

Diet quality partially mediates the association between ultraprocessed food consumption and adiposity indicators

OBJECTIVE

This study evaluated the potential role of overall diet quality in the associations between ultraprocessed food (UPF) consumption and adiposity indicators among Korean adults.

METHODS

Baseline data of participants (n = 4331) of the Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) cohort study were obtained. Dietary information was collected by a validated food frequency questionnaire. UPF was defined using the NOVA classification. Overall diet quality was assessed using the Korean Healthy Eating Index. Adiposity indicators included BMI, waist circumference, percentage body fat by bioimpedance, and visceral fat mass by whole-body dual-energy x-ray absorptiometry. Mediation analysis after adjustment for potential confounders was performed.

RESULTS

UPF intake was associated with higher adiposity indicators after adjustment for confounders. The mediating effect of the Korean Healthy Eating Index on the relationship between UPF consumption and each adiposity indicator was 35.6% (95% CI: 4.9% to 255.9%) for BMI, 38.3% (17.9% to 132.1%) for waist circumference, 40.2% (8.3% to 259.4%) for percentage body fat, and 60.7% (-396.4% to 662.7%) for visceral fat mass.

CONCLUSIONS

UPF consumption was positively associated with adiposity indicators, which were partially attributed to the overall diet quality. Further studies are needed to better understand the causal mechanisms of these associations.

Snacking practices from infancy to adolescence: parental perspectives from longitudinal lived experience research in England

Consumption of snacks and ultra-processed foods (UPF) high in fat, salt and sugar (HFSS) is associated with rising rates of obesity and growing socioeconomic disparities in nutrition. While infancy, childhood and adolescence are critical periods for development of dietary preferences, there remains a dearth of research exploring factors that underpin snacking behaviour over this time. This review aims to address this gap by drawing from qualitative lived experience research, with 122 families of different socioeconomic position (SEP), to explore how the (i) home food environment, (ii) food environment and (iii) social value and meanings of food shape parental provision of snacks. This review shows that snacking holds important meanings in everyday family life, with infants integrated into existing snacking practices from an early age. Price promotions, low-cost and long shelf-lives all make UPF and HFSS snacks an appealing option for many low-SEP parents; while children's requests and preferences for HFSS snacks present a challenge across SEP. However, higher-SEP parents can ensure fresh fruits are always available as an alternative snack, while fruit is described as a financially risky expenditure for low-SEP families. The present findings also indicate that retailers and producers are increasingly promoting 'healthier' snacks through product packaging and marketing, such as 'meets one of your five a day', despite these products displaying similar nutritional profiles to traditional UPF and HFSS snacks. We outline a series of policy recommendations, including extending Healthy Start Vouchers and the Fruit and Vegetable Scheme in schools and action to address misleading product marketing and packaging.

Ultra-Processed Food Consumption and Obesity in Korean Adults

BACKGRUOUND

This study aimed to investigate the association between consumption of ultra-processed foods (UPF) and obesity in Korean adults.

METHODS

We included the Cardiovascular and Metabolic Diseases Etiology Research Center cohort study baseline data of adults aged 30 to 64 years who completed a validated food frequency questionnaire. UPF was defined using the NOVA food classification. Multivariable linear and logistic regression analyses were performed to assess the association of dietary energy contribution of UPF with obesity indicators (body mass index [BMI], obesity, waist circumference [WC], and abdominal obesity).

RESULTS

Consumption of UPF accounted for 17.9% of total energy intake and obesity and abdominal obesity prevalence was 35.4% and 30.2%, respectively. Compared with those in the lowest quartile of UPF consumption, adults in the highest quartile had greater BMI (β=0.36; 95% confidence interval [CI], 0.15 to 0.56), WC (β=1.03; 95% CI, 0.46 to 1.60), higher odds of having obesity (odds ratio [OR], 1.24; 95% CI, 1.07 to 1.45), and abdominal obesity (OR, 1.34; 95% CI, 1.14 to 1.57), after adjusting for sociodemographic characteristics, health-related behaviors, and family history of diseases. Dose-response associations between UPF consumption and obesity indicators were consistently found (all P trend <0.01). However, the strength of association was halved for all obesity indicators after further adjustments for total energy intake and overall diet quality score, and the trend toward association for obesity and WC disappeared.

CONCLUSION

Our finding supports the evidence that consumption of UPF is positively associated with obesity among Korean adults.

Food Additives in Ultra-Processed Packaged Foods: An Examination of US Household Grocery Store Purchases

BACKGROUND

Food additives have been used mainly in the past century to perform specific functions in foods. Some types of food additives have been linked to adverse health outcomes, yet there is little research examining food additives in the US food supply.

OBJECTIVE

To examine the proportion of products purchased by US households containing four common technical food additives using time-specific food composition data and examine whether purchases have changed over time.

PARTICIPANTS/SETTING

Nielsen Homescan Consumer Panels, 2001 and 2019.

MAIN OUTCOME MEASURES

The proportion of packaged food products containing common types of food additives purchased by US households was determined overall and by food category.

STATISTICAL ANALYSIS PERFORMED

Differences were examined using Student t test; P value < 0.001 was considered significant.

RESULTS

Between 2001 and 2019, the proportion of food products purchased by US households that contained additives increased from 49.6% to 59.5% (P < 0.001). The proportion of carbonated soft drinks purchased containing flavors decreased, with a subsequent increase in purchases containing nonnutritive sweeteners. Baby foods showed a 20% increase in the proportion of purchases containing additives and >15% increase in the proportion of purchases containing three or more additives.

CONCLUSIONS

There is convincing evidence that US household purchases of common types of technical food additives are increasing. Despite some positive changes such as a decrease in the use of added flavors in carbonated soft drinks, across most food categories an increase in purchases of all types of products containing additives was observed. In particular the finding that purchases of baby food products containing additives have increased substantially is crucial in informing future research in this area and warrants further investigation.

Food Processing and Risk of Crohn's Disease and Ulcerative Colitis: A European Prospective Cohort Study

BACKGROUND & AIMS

Industrial foods have been associated with increased risks of several chronic conditions. We investigated the relationship between the degree of food processing and risks of Crohn's disease (CD) and ulcerative colitis (UC) in the European Prospective Investigation into Cancer and Nutrition cohort.

METHODS

Analyses included 413,590 participants (68.6% women; mean baseline age, 51.7 y) from 8 European countries. Dietary data were collected at baseline from validated country-specific dietary questionnaires. Associations between proportions of unprocessed/minimally processed and ultraprocessed food intake and CD and UC risks were estimated using Cox models to obtain hazard ratios (HRs) and 95% CIs. Models were stratified by center, age, and sex, and adjusted for smoking status, body mass index, physical activity, energy intake, educational level, and alcohol consumption.

RESULTS

During a mean follow-up period of 13.2 years, 179 incident cases of CD and 431 incident cases of UC were identified. The risk of CD was lower in people consuming high proportions of unprocessed/minimally processed foods (adjusted HR for the highest vs lowest quartile: 0.57; 95% CI, 0.35-0.93; P trend < .01), particularly fruits and vegetables (adjusted HRs, 0.54; 95% CI, 0.34-0.87 and 0.55; 95% CI, 0.34-0.91, respectively). There was no association between unprocessed/minimally processed food intake and the risk of UC. No association was detected between ultraprocessed food consumption and CD or UC risks.

CONCLUSIONS

In the European Prospective Investigation into Cancer and Nutrition cohort, consumption of unprocessed/minimally processed foods was associated with a lower risk of CD. No association between UC risk and food processing was found.

Ultra-processed foods and the development of obesity in adults

Ultra-processed foods (UPF) are ubiquitous in the modern-day food supply and widely consumed. High consumption of these foods has been suggested to contribute to the development of obesity in adults. The purpose of this review is to present and evaluate current literature on the relationship between UPF consumption and adult obesity. Cross-sectional studies (n = 9) among different populations worldwide show a positive association between UPF consumption and obesity. Longitudinal studies (n = 7) further demonstrate a positive association between UPF consumption and development of obesity, suggesting a potential causal influence of UPF consumption on obesity risk. However, only one randomized controlled trial has tested the causality of this association. The study included in this review found greater energy intake and weight gain with consumption of a high UPF diet compared to a high unprocessed food diet. The potential mechanisms by which UPF increase the risk of obesity include increased energy intake due to increased sugar consumption, decreased fiber consumption, and decreased protein density; however, more research is needed. Overall, the evidence identified in the current review consistently support a positive relation between high UPF consumption and obesity. While there is a need for more experimental research to establish causality and elucidate the mechanisms, the sum of the evidence supports a need for research on treatment modalities that include reductions in UPF consumption for the management of adult obesity.

In vitro digestion models for the design of safe and nutritious foods

Responsible development of future foods requires in depth understanding of food digestion in the human body based on robust research models, ranging from in vitro models to randomized controlled human trials. This chapter overviews fundamental aspects of food digestion, namely bioaccessibility and bioavailability, and models mirroring gastric, intestinal, and colonic conditions. Second, the chapter demonstrates the potential of in vitro digestion models to help screen adverse effects of food additives, such as Titanium dioxide or carrageenan, or underpin the determinants of macro- and micronutrient digestion in different strata of the population, for example digestion of emulsions. Such efforts support rationalized design of functional foods, such as infant formulae, cheese, cereals and biscuits which are validated in vivo or in randomized controlled trials.

Association between Consumption of Ultra-Processed Foods and Sociodemographic Characteristics in Brazilian Adolescents

BACKGROUND

The consumption of ultra-processed foods is associated with several negative health outcomes. Studies on adolescents have shown that this population has a high consumption of these foods, especially in high-income countries. However, there are no studies on the types of ultra-processed foods consumed. The present study evaluated secondary data from a representative sample of the National School Health Survey, the consumption of ultra-processed foods by 159,245 Brazilian adolescents.

METHODS

Data were collected via a self-administered questionnaire using a mobile device. A Poisson regression model was used to assess the prevalence of ultra-processed food consumption and its correlation with sociodemographic characteristics.

RESULTS

The consumption of ultra-processed foods was significant among Brazilian adolescents, and almost half of the participants reported consumption the day before. We observed that sociodemographic characteristics such as school type, race/skin color, region, municipality type, age, living with mother, living with father, and maternal education level were associated with greater or lesser consumption of ultra-processed foods. Adolescents who study in private schools, are female, white, and live in non-capital cities consume more ultra-processed foods.

CONCLUSIONS

Access to in natura and minimally processed foods must be on the agenda of governments and encouraged by food and nutrition education to guarantee the right to adequate and healthy food.

Machine learning prediction of the degree of food processing

Despite the accumulating evidence that increased consumption of ultra-processed food has adverse health implications, it remains difficult to decide what constitutes processed food. Indeed, the current processing-based classification of food has limited coverage and does not differentiate between degrees of processing, hindering consumer choices and slowing research on the health implications of processed food. Here we introduce a machine learning algorithm that accurately predicts the degree of processing for any food, indicating that over 73% of the US food supply is ultra-processed. We show that the increased reliance of an individual's diet on ultra-processed food correlates with higher risk of metabolic syndrome, diabetes, angina, elevated blood pressure and biological age, and reduces the bio-availability of vitamins. Finally, we find that replacing foods with less processed alternatives can significantly reduce the health implications of ultra-processed food, suggesting that access to information on the degree of processing, currently unavailable to consumers, could improve population health.

Consumption of ultra-processed foods in Brazil: distribution and temporal evolution 2008-2018

OBJECTIVE

To evaluate sociodemographic factors associated with the consumption of ultra-processed foods and the temporal evolution of their consumption in Brazil between 2008 and 2018.

METHODS

The study used food consumption data of individuals aged ≥ 10 years from 2008-2009 and 2017-2018 Pesquisas de Orçamentos Familiares (POF - Household Budget Surveys), grouping the foods according to the Nova classification. We used crude and adjusted linear regression models to assess the association between sociodemographic characteristics and consumption of ultra-processed foods in 2017-2018 and the temporal variation in their consumption between 2008 and 2018.

RESULTS

Ultra-processed foods accounted for 19.7% of calories in 2017-2018. The adjusted analysis showed that their consumption was higher in women (versus men) and the South and Southeast regions (versus North) and lower in blacks (versus whites) and rural areas (versus urban), in addition to decreasing with the increased age and increasing with higher education and income. Consumption of ultra-processed foods increased by 1.02 percentage points (pp) from 2008-2009 to 2017-2018. This increase was significantly higher among men (+1.59 pp), black people (+2.04 pp), indigenous (+5.96 pp), in the rural area (+2.43 pp), those with up to 4 years of schooling (+1.18 pp), in the lowest income quintile (+3.54 pp), and the North (+2.95 pp) and Northeast (+3.11 pp) regions. On the other hand, individuals in the highest level of schooling (-3.30 pp) and the highest income quintile (-1.65 pp) reduced their consumption.

CONCLUSIONS

The socioeconomic and demographic segments with the lowest relative consumption of ultra-processed foods in 2017-2018 are precisely those that showed the most significant increase in the temporal analysis, pointing to a trend towards national standardization at a higher level of consumption.