Consumption of ultra-processed foods and obesity in Canada

Ultra-processed food consumption and the risk of incident chronic kidney disease: a systematic review and meta-analysis of cohort studies

BACKGROUND

Recent individual studies have indicated that ultra-processed food (UPF) consumption may be associated with the incidence of chronic kidney disease (CKD). We conducted a systematic review and meta-analysis based on those longitudinal studies evaluating the relationship between UPF consumption and the risk of incident CKD, and synthesizing the results.

METHOD

PubMed, Embase, The Cochrane Library, Web of Science, and Scopus were searched from inception through 22 March 2023. Any longitudinal studies evaluating the relationship between UPF consumption and the risk of incident CKD were included. Two researchers independently conducted the literature screening and data extraction. RR and its 95% CI were regarded as the effect size. The Newcastle-Ottawa Scale (NOS) was applied to assess the quality of the studies included, and the effect of UPF consumption on the risk of incident CKD was analyzed with STATA version 15.1. This study's protocol was registered in PROSPERO (CRD42023411951).

RESULTS

Four cohort studies with a total of 219,132 participants were included after screening. The results of the meta-analysis suggested that the highest UPF intake was associated with an increased risk of incident CKD (RR = 1.25; 95% CI: 1.18-1.33).

CONCLUSIONS

High-dose UPF intake was associated with an increased risk of incident CKD. However, the underlying mechanisms remain unknown. Thus, more standardized clinical studies and further exploration of the mechanisms are needed in the future.

Socioeconomic inequalities in intakes of ultra-processed and minimally processed foods in nationally representative samples of adults in Canada: An analysis of trends between 2004 and 2015

BACKGROUND

Individuals with a lower socioeconomic position (SEP) often have higher intakes of ultra-processed (UPF) and lower intakes of minimally processed foods (MPF); however, studies have not examined trends in absolute and relative gaps and gradients in UPF and MPF intake using multiple indicators of SEP.

OBJECTIVE

We examined within-year absolute and relative gaps and gradients in UPF and MPF intake and trends between 2004 and 2015 according to six indicators of SEP among nationally representative samples of adults in Canada.

METHODS

Adults (≥18 years) in the Canadian Community Health Survey-Nutrition 2004 (n=20,880) or 2015 (n=13,970) reported SEP (individual and household education, household income adequacy, household food insecurity, neighborhood material and social deprivation) and completed a 24-hour dietary recall. Multivariable linear regression assessed within-year absolute and relative gaps and gradients in the proportion of energy from UPF and MPF and trends between 2004 and 2015.

RESULTS

The largest and most consistent within-year inequities in UPF and MPF intake were for individual and household educational attainment. Overall and among males, higher SEP groups had more favorable intakes over time based on trends in absolute and relative gaps and gradients in UPF and MPF intake by household food insecurity (e.g., the absolute gap in UPF intake declined from -1.2% [95%CI: -5.3%, 2.9%] to -7.9% of energy [95%CI: -11.2%, -4.5%] in the overall population). Overall and among males, lower SEP groups had more favorable intakes over time based on trends in absolute and relative gaps in UPF and MPF intake by neighborhood material deprivation.

CONCLUSIONS

Socioeconomic inequalities in UPF and MPF intake were most pronounced for individual and household education. Between 2004 and 2015, several inequalities in UPF and MPF intake emerged according to household food insecurity (favoring higher SEP groups) and neighborhood material deprivation (favoring lower SEP groups).

The association between ultra-processed food consumption and health-related quality of life differs across lifestyle and socioeconomic strata

BACKGROUND

In this prospective study, we aimed to examine the association between ultra-processed foods and health-related quality of life (HRQoL) and to evaluate the effect of lifestyle and socioeconomic factors on this association.

METHODS

This study included 1766 adults (aged 18 to 78, 54.3% women), who took part in the Tehran Lipid and Glucose study. The Short-Form 12-Item Health Survey version 2 was used to determine HRQoL, which includes the physical component summary (PCS) and mental component summary (MCS) scores. Ultra-processed food consumption was assessed using a validated semi-quantitative food frequency questionnaire. Lifestyle (physical activity and smoking status) and socioeconomic factors (education level and employment status) were also determined. General linear models (GLM) were applied to estimate the mean (95% confidence interval) for MCS and PCS scores across the ultra-processed foods tertiles. Additionally, the effect of lifestyle and socioeconomic factors on the relationship between ultra-processed foods and HRQoL was examined using GLM.

RESULTS

The median consumption of ultra-processed foods was 11.9% (IQR: 8.2 to 16.8) of total energy intake. There was a significant inverse association between ultra-processed foods consumption and PCS, but not MCS, after adjustment for confounding factors. Significant interactions were observed between ultra-processed food consumption, sex, and occupation on PCS score (all P values < 0.001). The interaction test tended to be significant for smoking status, education levels, and physical activity levels. As ultra-processed food consumption increased, the PCS score significantly decreased in women (P = 0.043), low physical active subjects (P = 0.014), smokers (P = 0.015), and lower-educated individuals (P = 0.022). Non-employed individuals with higher ultra-processed food intake showed a decline in their PCS and MCS scores. While there was no significant difference in MCS score among different strata of lifestyle and socioeconomic status across tertiles of ultra-processed foods.

CONCLUSIONS

Higher intake of ultra-processed foods was associated with poorer physical health, particularly among women, those with unhealthy lifestyles, and low socioeconomic conditions.

Food Consumption Inequalities in Primary Care in a Large Metropolis

The aim of this study was to examine the association between health vulnerability and food consumption according to the NOVA classification within primary care in a major Brazilian city. A cross-sectional study was conducted among adults over 20 years old. These participants were part of a representative sample from the Health Academy Program (PAS) in Belo Horizonte, Brazil. We evaluated socio-demographic variables, self-reported illnesses, perceived health and quality of life, and the length of participation in PAS. Health vulnerability was gauged through the Health Vulnerability Index (HVI), which is calculated for each census sector and classified as low, medium, and high/very high. On the other hand, food consumption was determined by evaluating the average consumption described in a 24 h diet recall (24HR) and categorizing it under the NOVA classification: culinary preparations, processed foods, and ultra-processed foods (UPFs). The average calorie intake was 1429.7 kcal, primarily from culinary preparations (61.6%) and UPFs (27.4%). After adjustments, individuals residing in high/very high-HVI areas consumed more culinary preparations (β = 2.7; 95%CI: 4.7; 0.7) and fewer UPFs (β = -2.7; 95%CI: -4.7; -0.7) compared to those from low-vulnerability areas. PAS participants residing in more vulnerable areas reported healthier dietary habits, consuming more homecooked meals and fewer UPFs. These findings underscore the importance of concentrating efforts on promoting and preserving healthy eating habits and emphasizing the value of home cooking in the most vulnerable regions.

Quantitative Assessment of the Inadequate Intake of Macronutrients, Minerals, and Vitamins Associated with Ultra-Processed Food Consumption

Studies indicate that ultra-processed food (UP) consumption correlates negatively with essential vitamin and mineral intake and positively with sodium and lipid intake. The objective of this study was to explore the relationship between UP consumption and deviations from nutritional guidelines. An observational, cross-sectional analytical study was conducted on a probability sample of manufacturing workers in the state of Rio Grande do Norte, Brazil. Food consumption was assessed with a 24 h recall survey, and nutrient intake inadequacies were calculated as the difference between individuals' intake of energy, macronutrients, minerals and vitamins, and the dietary reference intakes for individuals of the same sex and age group, and then analyzed for trends across the percentage contribution of UP to total energy intake with nonparametric multiple regression adjusted for covariates. The study included 921 workers from 33 industries, 55.9% male, with a mean age of 32 years. Overall, the study population exhibited deficits in energy, all macronutrients, and in some micronutrients. With increasing UP contribution to total energy intake, there is a trend towards a greater intake of energy (p < 0.001), total, saturated, monounsaturated, and trans fats (p < 0.001), n6-polyunsaturated fatty acids (p = 0.03), carbohydrates (p < 0.001), calcium (p = 0.008), and manganese (p < 0.001), thiamin (p < 0.001), and vitamin B6 (p = 0.01); however, this comes with a negative consequence in terms of reducing the protein consumption (p = 0.037), fiber (p = 0.035), copper (p = 0.033), and vitamin E (p = 0.002) intake. The results show that correcting energy and micronutrient deficiencies by increasing UP consumption can also lead to a decrease in diet quality.

Social marketing targeting healthy eating and physical activity in young adult university students: A scoping review

Adult obesity has remained a key health concern globally. Theory-based social marketing interventions are considered effective for improving dietary and physical activity (PA) behaviours. However, their application in universities is not yet established. This review aimed to identify social marketing strategies targeting healthy eating and/or PA behaviours of young adult university students and outline the intervention effectiveness. Literature search, screening, and data extraction followed the Joanna Briggs Institute (JBI) methodology for scoping reviews. PubMed/Medline and Scopus databases were searched for intervention and exploratory studies published between January 1, 2000, and September 20, 2023. Twelve articles were selected based on the eligibility criteria. Although different in study design, all studies reported improved healthy eating-related outcomes, while three showed improved PA-related outcomes. One study incorporated all six of the social marketing benchmarks, but the majority identified two. Most studies focused on behavioural objective, formative research, and marketing mix in their intervention design. Four studies incorporated behaviour change theories in development of the social marketing campaigns. Social marketing using social media could be a significant approach for improving healthy eating and PA in young adult university students when behavioural change theories and all social marketing benchmarks are adopted. More generalizable longer-term investigation into the effectiveness of this approach in university young adults is needed to tackle adult obesity related health issues.

Prevalence of consumption of mechanically separated meat, consumer profile, nutrient intake and food choices among manufacturing workers in Northeastern Brazil

Mechanically separated meat (MSM) is widely used in the food industry, however, there is a lack of studies on its consumption in populations. The objective of this study was to identify the frequency and amount of MSM consumption, factors associated with MSM consumption, nutrient intake and preferential choice of food groups among MSM consumers. This was an observational, cross-sectional prospective study based on a probability sample of manufacturing workers, conducted in Brazil. Logistic and linear multiple regression with robust standard errors were used. 921 workers from 33 manufacturing companies were studied, with an average age of 38.2 ± 10.7 years, 55.9% males. MSM products are consumed by 28.8% and represent in average 10% of total daily caloric intake, and 47.3% of the daily kcal from ultra-processed products. Younger age and greater waist circumference are associated with MSM consumption. Younger age and lesser educational level are associated with increased contribution of MSM to total daily kcal intake. MSM consumers have greater consumption of energy, fats, carbohydrates and sodium. Their dietary patterns are characterized by lower consumption of in natura and minimally processed foods, such as tubers and roots, fruits, white and red meat, and eggs and greater consumption of ultra-processed foods and beverages.

The impact of ultra-processed foods on obesity and cardiometabolic comorbidities in children and adolescents: a systematic review

CONTEXT

Over the past few decades, traditional foods have been displaced by ultra-processed foods (UPFs), with the latter being associated with health problems.

OBJECTIVE

This scoping systematic review aimed to identify the relationship between UPF intake and overweight/obesity as well as other cardiometabolic risk factors during childhood and adolescence.

DATA SOURCES

The guidance for this protocol is the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P). A systematic search was undertaken on PubMed, Scopus, and Cochrane Library electronic databases based on prespecified inclusion and exclusion criteria up to 6 February 2022.

DATA EXTRACTION

A total of 17 observational studies-9 cross-sectional, 7 cohort-longitudinal, and 1 study reporting both cross-sectional and longitudinal outcomes-among children and adolescents aged ≤18 years were eligible for inclusion in this review. Fourteen studies evaluated the consumption of UPFs in association with overweight/obesity and 9 studies examined the association of UPF consumption and cardiometabolic-related risk factors.

DATA ANALYSIS

Most studies (14/17) showed that an increase in UPFs was associated with a higher prevalence of overweight/obesity and cardiometabolic comorbidities among children and adolescents, whereas 4 of 17 studies (3 cross-sectional and 1 cohort) found no association. Most cohort and cross-sectional studies showed good quality according to the National Institutes of Health and Newcastle-Ottawa quality assessment, respectively.

CONCLUSION

The positive association found between UPFs and overweight/obesity and cardiometabolic comorbidities among children and adolescents raises concerns for future health. Further investigation is recommended to explore the role of specific types of UPFs on cardiometabolic conditions and to identify the amount of daily intake that increase risk in order to shape appropriate public health policies.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42022316432.

Ultra-Processed Food Consumption and Gastrointestinal Cancer Risk: A Systematic Review and Meta-Analysis

INTRODUCTION

Ultra-processed food (UPF) intake has been associated with a higher risk of obesity, hypertension, type 2 diabetes, and cardiovascular diseases. The initial data on the relationship between UPF consumption and cancer risk were derived from retrospective observational studies with conflicting results. This systematic review and meta-analysis of prospective cohort studies aimed to investigate the association between UPF consumption and gastrointestinal cancer risk.

METHODS

PubMed, Embase, and Cochrane databases were searched for prospective cohort studies that compared the highest vs the lowest level of UPF consumption according to NOVA food classification and reported the risk of gastrointestinal cancers by subsite. The association with cancer was quantified as hazard ratios (HR) using a random-effects model.

RESULTS

Five prospective cohort studies were included in this review comprising 1,128,243 participants (241,201 participants in the highest and 223,366 in the lowest levels of UPF consumption). The mean follow-up ranged from 5.4 to 28 years. The highest UPF consumption was significantly associated with an increased risk of colorectal cancer (HR 1.11; 95% confidence interval [CI] 1.03-1.21; P = 0.01; I2 = 31%), colon cancer (HR 1.12; 95% CI 1.02-1.23; P = 0.02; I2 = 0%), and non-cardia gastric cancer (HR 1.43; 95% CI 1.02-2.00; P = 0.04; I2 = 0%) compared with the lowest UPF intake. However, no association was found between high UPF consumption and hepatocellular, esophageal, pancreatic, gastric cardia, and rectal cancer.

DISCUSSION

The highest level of UPF consumption was significantly associated with colorectal and non-cardia gastric cancer.

Higher consumption of ultra-processed foods is associated with obesity and abdominal obesity in socially vulnerable Brazilian women

This study aimed to assess the consumption of ultra-processed foods (UPF) and identify their association with obesity and abdominal obesity in adult women of reproductive age living in situations of social vulnerability in Maceió, Northeastern Brazil. This was a cross-sectional study carried out between October 2020 and May 2021. An anthropometric evaluation was carried out to assess obesity and abdominal obesity. A dietary assessment was also conducted using a 24-h food recall to determine the calorie intake from UPF. To estimate intra-individual variability in food consumption, the probabilistic Multiple Source Method was used. These data in the form of tertiles were used to analyse the association between the consumption of UPF and obesity and abdominal obesity. Logistic regressions were used to analyse the association. A directed acyclic graph (DAG) was created for this analysis. This study included 1702 women of which 53.7% were 31 years old or older, and 74.2% lived in poverty. It identified that 36.5% and 38.1% of the women had obesity and abdominal obesity, respectively, and that an average of 33.8% of calories consumed came from UPF. In the analysis of association guided by the DAG, it was observed that women with a high-calorie intake from UPF had a 1.3 times higher probability of being obese. It was also observed that women with a moderate and high-calorie intake from UPF were 1.4 and 1.3 times more likely, respectively, to have abdominal obesity. Thus, it can be concluded that socially vulnerable women in Brazil have a relatively high consumption of UPF and that this condition increases the probability of obesity in this population group.

The association between ultra-processed food and common pregnancy adverse outcomes: a dose-response systematic review and meta-analysis

OBJECTIVES

Given the increasing incidence of negative outcomes during pregnancy, our research team conducted a dose-response systematic review and meta-analysis to investigate the relationship between ultra-processed foods (UPFs) consumption and common adverse pregnancy outcomes including gestational diabetes mellitus (GDM), preeclampsia (PE), preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA) infants. UPFs are described as formulations of food substances often modified by chemical processes and then assembled into ready-to-consume hyper-palatable food and drink products using flavors, colors, emulsifiers, and other cosmetic additives. Examples include savory snacks, reconstituted meat products, frozen meals that have already been made, and soft drinks.

METHODS

A comprehensive search was performed using the Scopus, PubMed, and Web of Science databases up to December 2023. We pooled relative risk (RR) and 95% confidence intervals (CI) using a random-effects model.

RESULTS

Our analysis (encompassing 54 studies with 552,686 individuals) revealed a significant association between UPFs intake and increased risks of GDM (RR = 1.19; 95% CI: 1.10, 1.27; I2 = 77.5%; p < 0.001; studies = 44; number of participants = 180,824), PE (RR = 1.28; 95% CI: 1.03, 1.59; I2 = 80.0%; p = 0.025; studies = 12; number of participants = 54,955), while no significant relationships were found for PTB, LBW and SGA infants. Importantly, a 100 g increment in UPFs intake was related to a 27% increase in GDM risk (RR = 1.27; 95% CI: 1.07, 1.51; I2 = 81.0%; p = 0.007; studies = 9; number of participants = 39,812). The non-linear dose-response analysis further indicated a positive, non-linear relationship between UPFs intake and GDM risk Pnonlinearity = 0.034, Pdose-response = 0.034), although no such relationship was observed for PE (Pnonlinearity = 0.696, Pdose-response = 0.812).

CONCLUSION

In summary, both prior to and during pregnancy, chronic and excessive intake of UPFs is associated with an increased risk of GDM and PE. However, further observational studies, particularly among diverse ethnic groups with precise UPFs consumption measurement tools, are imperative for a more comprehensive understanding.

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

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

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

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

Ultra-processed foods consumption among a USA representative sample of middle-older adults: a cross-sectional analysis

The study evaluated the association between ultra-processed foods (UPF) and nutrient intake and identified the socio-demographic characteristics associated with UPF consumption among a nationally representative sample of middle-older adults. Dietary assessment was collected in 2013 using a validated FFQ. The Nova system was used to classify food and drinks into UPF. The percentage of dietary energy from UPF was calculated and used throughout the analyses, and average nutrient intake across quintiles of UPF was evaluated. The determinants associated with the dietary caloric contribution of UPF intake were investigated using linear regression models. A cross-sectional analysis of a nationally representative study of Americans over the age of 50, the Health and Retirement Study, was conducted. The analysis included 6220 participants. The mean age was 65 (se 0·28) years, with 55 % being female. UPF intake accounted for 51 % (se 0·25) of total intake. An increase in the percentage of (%UPF) consumption was correlated with an increase in calories, carbohydrates, saturated fat and sugar, and a decrease in fibre, vitamins and minerals. %UPF intake was inversely associated with being Hispanic, higher income, physical activity, vegetarian diet and Mediterranean diet but positively associated with very low food insecurity. UPF represented half of the calories consumed. A higher %UPF intake was associated with a lower nutrient profile, suggesting decreasing %UPF intake as a strategy to improve the nutritional quality of middle-older adults. A few socio-demographic factors were associated with %UPF, which would help in planning strategies to reduce UPF consumption.

Global burden of osteoarthritis in adults aged 30 to 44 years, 1990 to 2019: results from the Global Burden of Disease Study 2019

BACKGROUND

Osteoarthritis (OA) is a common orthopedic disorder, and its incidence has been increasing among young adults in recent years. The purpose of this study is to investigate the global, regional, and national trends in OA burden and variation among individuals aged 30 to 44 from 1990 to 2019.

METHODS

Data on the incidence, prevalence, and years lived with disability (YLDs) related to OA were sourced from the Global Burden of Disease Study 2019 among individuals aged 30 to 44. These measures were stratified by gender, region, country, and socio-demographic index (SDI). Additionally, we analyzed YLDs attributable to risk factors.

RESULTS

In 2019, there were a total of 32,971,701 cases of OA among individuals aged 30 to 44 years worldwide, with an additional 7,794,008 new incident cases reported. OA of the knee was the primary contributor to both incidence and prevalence rates over the past three decades. From 1990 to 2019, both males and females in countries with high SDI and high-middle SDI showed upward trends in age-standardized incidence, prevalence, and YLDs rates. In 2019, the United States of America had the highest age-standardized incidence, prevalence, and YLDs rates. Elevated body-mass index (BMI) was found to be the most prevalent risk factor for osteoarthritis-related YLDs. Age-standardized YLDs rates were positively associated with SDI.

CONCLUSIONS

OA remains a significant disease burden on individuals aged 30 to 44, with modifiable risk factors such as unhealthy lifestyle and obesity representing key targets for future interventions aimed at reducing the impact of this condition on younger generations.

Variation in ultra-processed food consumption from 6 to 15 years, body weight and body composition at 15 years of age at The Pelotas 2004 Birth Cohort

BACKGROUND

The association of ultra-processed food (UPF) consumption with obesity and adipose tissue in children/adolescents remains poorly understood.

OBJECTIVE

To assess the association of UPF consumption with excessive weight (EW-defined as BMI-for-age ≥+1 z-score) and body composition at 15 years.

METHODS

In a birth cohort, daily UPF consumption was estimated by Food Frequency Questionnaires at 6 and 15 years. Those in the higher tercile of UPF consumption at both follow-ups were the 'always-high consumers'. Air-displacement plethysmography provided fat mass (FM-kg), fat-free mass (FFM-kg), %FM, %FFM, FM index (FMI-kg/m2 ) and FFM index (FFMI-kg/m2 ). Logistic regression and linear regression were used to estimate, respectively, odds ratios and beta coefficients.

RESULTS

Amongst 1584 participants, almost one in every seven were always-high consumers. In crude analyses, there was no association between variation in UPF consumption and EW, and body fat parameters were lower in the always-high consumer group than amongst the always-low consumers, in both sexes. With adjustment for confounders, the odds ratio for EW was higher in the always-high consumer than amongst the always-low consumer group, and the direction of the associations with FM parameters was reversed: males from the always-high consumer group presented almost twice as high FM (10.5 vs. 18.6 kg; p < 0.001) and twice as high FMI (3.4 vs. 6.3 kg/m2 ; p < 0.001) than the always-low consumer group, and females from the always-high consumer group presented on average 32% more FM and FMI than the always-low consumer group.

CONCLUSIONS

In crude and adjusted analyses there was a strong association between high UPF consumption from childhood to adolescence, EW and higher body fat parameters at 15 years, but its deleterious association with body adiposity was only uncovered after adjusting for confounders.

Epidemiology of gout - Global burden of disease research from 1990 to 2019 and future trend predictions

Background

Understanding the global burden of gout in the past and future can provide important references for optimizing prevention and control strategies in healthcare systems.

Objectives

This study aimed to report variations in the global disease burden and risk factors of gout in 204 countries and territories from 1990 to 2019.

Design

We conducted a retrospective analysis of gout based on the latest Global Burden of Disease (GBD) 2019 database.

Methods

We collected data on the prevalence, incidence, and disability-adjusted life years (DALYs) of gout from 1990 to 2019. The data were then stratified by age, sex, and economic development level. Decomposition analysis, frontier analysis, and prediction models were used to analyze the changes and influencing factors influencing each indicator.

Results

Globally, there were 53,871,846.4 [95% uncertainty interval (UI): 43,383,204.6-66,342,327.3] prevalent cases, 92,228,86.8 (95% UI: 7419,132.1-11,521,165) incident cases, and 1673,973.4 (95% UI: 1,068,061.1-2,393,469.2) cases of DALYs of gout in 2019, more than double those in 1990. Moreover, the pace of increase in the age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR), and age-standardized DALY rate (ASDR) accelerated during 1990-2019, with estimated annual percentage changes (EAPC) of 0.94 [95% confidence interval (CI): 0.85-1.03], 0.77 (95% CI: 0.69-0.84), and 0.93 (95% CI: 0.84-1.02), respectively, especially among men. The disease burden of gout has increased in all the other 20 GBD regions in the past 30 years, except Western Sub-Saharan Africa. The highest risk of high body mass index (BMI) and kidney dysfunction was in high-income countries such as North America and East Asia. The global prevalence rate, incidence rate, and DALYs rate of gout in 2030 will reach 599.86, 102.96 per 100,000 population, and 20.26 per 100,000 population, respectively, roughly the same as in 2019.

Conclusion

With the development of society, the disease burden of gout will become increasingly severe. It is very important to study the accurate epidemiological data on gout for clinical diagnosis and treatment and health policy.

The Influence of the School Neighborhood Food Retail Environment on Unhealthy Food Purchasing Behaviors Among Adolescents: A Systematic Review

INTRODUCTION

Adolescents are often exposed to food retailers selling unhealthy food items during their lunch breaks and school commutes. This systematic review examines the influence of school neighborhood food retail environments on adolescent food purchasing.

METHODS

A systematic search of 6 databases. Observational studies published from January 2012 to December 2022 that measured food availability, accessibility, or exposure, measured food purchasing, and focused on adolescents (aged 10-19 years) were eligible for inclusion.

RESULTS

Twelve studies with 97 findings were included. Thirty-one findings indicated that a school neighborhood with a high density of unhealthy food retail, a school with unhealthy food retail nearby, or exposure to unhealthy food retail on the journey to/from school was associated with higher prevalence and frequency of unhealthy food purchases.

DISCUSSION

Adolescents' food purchasing behaviors may be meaningfully affected by their school neighborhood food retail environment; however, the included studies have many methodological shortcomings.

IMPLICATIONS FOR RESEARCH AND PRACTICE

Results identify the need for new studies that measure food purchasing, use comprehensive definitions of food retail environments, and adopt more rigorous methods to approximate exposure to food retail. More robust evidence would strengthen the rationale for policy or program interventions and potentially indicate specific targets for intervention.

Children, young people and the Commercial Determinants of Health

The commercial determinants of health (CDoH) have a significant impact on the health and well-being of children and young people (subsequently referred to as young people). While most research has focused on the influence of harmful industry marketing on young people, more recent CDoH frameworks have emphasized that a range of commercial systems and practices may influence health and well-being. Focusing on the impact of traditional and digital media, contemporary marketing strategies and corporate production and consumption processes, the following article outlines the impact of the CDoH on the health and wellbeing of young people. The article also provides evidence about how young people conceptualize the impact of corporate actors on health, and their involvement in advocacy strategies to respond. The article recommends that when collaborating with young people to understand the impacts of and responses to the CDoH, we should seek to diversify investigations towards the impact of a range of corporate tactics, systems and structures, rather than simply focusing on the impacts of advertising. This should include considering areas and priorities that young people identify as areas for action and understanding why some young people are more vulnerable to commercial tactics than others. Youth are powerful allies in responding to the CDoH. Public health and health promotion stakeholders could do more to champion the voices of young people and allow them to be active participants in the decisions that are made about harmful commercial practices and health.

Metabolic hormones are integral regulators of female reproductive health and function

The female reproductive system is strongly influenced by nutrition and energy balance. It is well known that food restriction or energy depletion can induce suppression of reproductive processes, while overnutrition is associated with reproductive dysfunction. However, the intricate mechanisms through which nutritional inputs and metabolic health are integrated into the coordination of reproduction are still being defined. In this review, we describe evidence for essential contributions by hormones that are responsive to food intake or fuel stores. Key metabolic hormones-including insulin, the incretins (glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1), growth hormone, ghrelin, leptin, and adiponectin-signal throughout the hypothalamic-pituitary-gonadal axis to support or suppress reproduction. We synthesize current knowledge on how these multifaceted hormones interact with the brain, pituitary, and ovaries to regulate functioning of the female reproductive system, incorporating in vitro and in vivo data from animal models and humans. Metabolic hormones are involved in orchestrating reproductive processes in healthy states, but some also play a significant role in the pathophysiology or treatment strategies of female reproductive disorders. Further understanding of the complex interrelationships between metabolic health and female reproductive function has important implications for improving women's health overall.

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

Background

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

Methods

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

Results

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

Conclusion

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

Impact and implications

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

Consumption of ultra-processed products is associated with vitamin D deficiency in Brazilian adults and elderly

Although studies show that the intake of ultra-processed products (UPP) has a negative impact on health, diet quality and dietary vitamin D, its influence on serum concentrations of this vitamin remains unknown; therefore, it is essential to verify the association between the UPP consumption and vitamin D deficiency. This is a cross-sectional, household, population-based study, carried out with 229 individuals aged 20 years or older, residents of the city of Teresina, Piauí, Brazil. Socio-demographic, lifestyle, food consumption and anthropometric data were collected. Food consumption was obtained using a 24-h food recall, and foods were grouped according to the NOVA classification. Plasma concentrations of calcidiol-25 (OH) D3 were determined by HPLC. Crude and adjusted binary logistic regression was applied to estimate the association between UPP consumption and vitamin D deficiency. Most individuals aged 20-39 years were vitamin D deficient (52·1 %). UPP contributed 19·9 % to the energetic intake of the participant's diet. This contribution was higher for individuals with vitamin D deficiency (22·5 %, P = 0·04). In addition, a high intake of UPP was associated with twice the risk of vitamin D deficiency in comparison with low consumption of UPP (OR: 2·05; CI 1·06, 4·50; P: 0·04). Our results suggest that the consumption of UPP may have a negative impact on serum concentrations of vitamin D; more studies are needed.

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.

Understanding the dynamics of the obesity transition associated with physical activity, sedentary lifestyle, and consumption of ultra-processed foods in Colombia

OBJECTIVE

We investigate the obesity transition at the country- and regional-levels, by age, gender, and socioeconomic status (SES) and its relationship to three health behavior attributes, including physical activity (PA), sedentary activities (ST), and consumption of ultra-processed foods (CUPF) within the urban population of Colombia, from 20,010 to 2050.

METHODS

The study is informed by cross-sectional data from ENSIN survey. We used these data to develop a system dynamics model that simulates the dynamics of obesity by body mass index (BMI) categories, gender, and SES. This model also uses a conservative co-flow structure for three health-related behaviors (PA, ST, and CUPF).

RESULTS

At the national level, our results indicate that the burden of obesity is shifting towards populations with lower SES as the gross domestic product (GDP) increases, particularly women aged 20-59 years with lower SES. Among this group of women, the highest burden of obesity is among those who do not meet the PA, ST and CUPF recommendations. At the regional level, our findings suggest that the regions are at different stages in the obesity transition.

CONCLUSIONS

The burden of obesity is shifting towards women with lower SES as GDP increases at the national level and across several regions. This obesity transition is paralleled by a high prevalence of women from low SES groups who do not meet the minimum recommendations for PA, CUPF, and ST. Our findings can be used by decision-makers to inform age- and SES- specific policies seeking to tackle the obesity.

Trends in food consumption by adults in a Brazilian northeastern state

Objective

The economic and political crisis experienced by Brazil, together with the COVID-19 pandemic, may have negatively impacted the food consumption of Brazilian families over recent years. This study aimed to analyze trends in food consumption among adults in a Brazilian northeastern state.

Methods

This was an epidemiological study which involved the analysis of data from the Food and Nutrition Surveillance System (SISVAN) relating to the food consumption of adults (20-59 years-of-age) in the state of Ceará in 2015 and 2020. Data are presented by frequency distribution.

Results

In the year 2015-2020, the food consumption of 14,840 adults were registered in SISVAN. There was evidence of a decline in the habit of having three main meals a day (-63.5%), mainly among women (-67.9%). Between 2015 and 2020, there was a decline in the consumption of beans (-7.4%) and an increase in the consumption of fruits (68.2%) and vegetables (82.9%). When considering ultra-processed foods, there was a significant increase in the consumption of hamburgers and sausages (83.3%), cookies (39.1%) and sweetened beverages (25.5%).

Conclusions

Our findings indicate that the habit of having three main meals a day decreased between 2015 and 2020 in the adult population of Ceará, as determined by public data available in SISVAN, especially among women. In addition, there was an increase in the consumption of ultra-processed foods. Therefore, health interventions aimed at nutritional education and the fight against hunger are essential to face these challenges that affect society.

Planetary Health, Nutrition, and Chronic Kidney Disease: Connecting the Dots for a Sustainable Future

The increasing consumption of ultra-processed food (UPF) and the global chain of food production have a negative impact on human health and planetary health. These foods have been replacing the consumption of nonprocessed healthy foods. This shift has not only worsened human health by increasing the risk of the development of noncommunicable diseases, but also resulted in environmental perturbations. This review aims to bring awareness of the problems caused by the industrialized food production chain, addressing the negative effects it has on the environment and human health, with special reference to chronic kidney disease (CKD). We discuss possible solutions focusing on the benefits of adopting plant-based diets with low UPF content to promote a sustainable and healthy food production and diet for patients with CKD. For a sustainable future we need to "connect the dots" of planetary health, food production, and nutrition in the context of CKD.

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

INTRODUCTION

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

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.

Ultra-Processed Food Consumption and Risk of Overweight or Obesity in Chinese Adults: Chinese Food Consumption Survey 2017-2020

Overweight and obesity have increased rapidly in the past few decades in China, and less research has focused on the association between the consumption of ultra-processed foods (UPFs) and overweight or obesity in Chinese adults. The objective of this study was to determine the relationship of UPF consumption with the risk of overweight or obesity in Chinese adults. Residents aged 18 years and above who participated in the nationally representative survey Chinese Food Consumption Survey in 2017-2020 were included in this study. Dietary intake data were collected via non-consecutive three-day 24 h dietary recalls and weighing household foods and condiments. According to the NOVA food classification system, UPFs were classified depending on the purpose and extent of food processing. Multiple logistic regression and multivariate-adjusted restricted cubic spline (RCS) regressions were performed to estimate the association between UPF consumption (categorized into quartiles: quartile 1 (Q1), quartile 2 (Q2), quartile 3 (Q3), and quartile 4 (Q4)) and risk of overweight or obesity. A total of 38,658 adults aged 18 years and above participated in the present study. The prevalence of overweight and obesity in adults was 33.0% (95% CI: 32.91-33.10) and 9.6% (95% CI 9.55-9.67), respectively. After a multivariable adjustment, the risk of overweight or obesity was increased by 10% in Q3 (OR: 1.10, 95% CI: 1.04-1.17) compared to Q1 as a reference. Women (OR: 1.10, 95% CI: 1.01-1.20) and adults living in small and medium-sized cities (OR: 1.13, 95% CI: 1.01-1.26) with higher UPF consumption had higher odds of overweight or obesity. Nevertheless, the effect of higher UPF consumption on the risk of overweight or obesity was relatively weak for overall adults in China. The top three categories of subgroups consumption of UPFs were 1: sugar-sweetened beverages; 2: sauces, cheeses, spreads, and gravies; and 3: ultra-processed breads and breakfast cereals. These findings provide evidence that higher UPF consumption was positively associated with overweight or obesity, which was defined based on Chinese criteria among women and adults living in small and medium-sized cities in China. Further studies, such as intervention trials, are needed to identify the mechanism of correlation between the consumption of UPFs and health-related outcomes in Chinese adults. From a public health perspective, with the prevalence of overweight and obesity growing and the increase in UPF consumption in Chinese adults, it is necessary to promote healthy food intake and a balanced diet through active nutritional education actions for overweight and obesity prevention and control.

Consumption of ultraprocessed food is associated with higher blood pressure among 6-year-old children from southern Brazil

Ultraprocessed foods (UPF) consumption plays a critical role in the development of chronic diseases, but evidence of their effect on children's health is limited. We hypothesized that the consumption of UPF can influence blood pressure levels in 6-year-old children. This study is a secondary analysis of a randomized field trial in Brazil that is registered at clinicaltrial.gov (NCT00635453). Dietary intake was obtained using 2 multiple-pass 24-hour recalls when 305 children were 3 and 6 years old. We classified foods according to the NOVA system and determined the percentage of total energy intake derived from ultraprocessed foods. We collected anthropometric measures from and evaluated systolic and diastolic blood pressures of 6-year-old children. Linear regression analysis was used to assess the association between UPF consumption and blood pressure levels. UPF represented 40.3% (interquartile range, 34.1-48.5) of the total energy intake at 3 years and 45.2% (interquartile range, 41.5-53.2) at 6 years. The adjusted linear regression analyses showed that systolic blood pressure was associated with UPF consumption at 6 years (P = .05), birth weight (P = .02), waist circumference (P < .01), and physical activity (P = .04), whereas diastolic blood pressure was associated with UPF consumption at 3 and 6 years (P = .01 and P < .01, respectively), birth weight (P = .05), and waist circumference (P < .01). Our data suggest that UPF consumption played a role in increasing 6-year-old children's blood pressure. These results reinforce the importance of effective strategies to prevent the excessive consumption of UPF in childhood.

Association between Consumption of Ultra-Processed Food and Body Composition of Adults in a Capital City of a Brazilian Region

The present study investigates the relationship between the consumption of ultra-processed foods (UPF) and anthropometric indices of body composition in adults and seniors living in Teresina, the state capital of an area in northeastern Brazil. The article seeks to address two questions: Is UPF consumption linked to worsening body composition in different age groups? Do anthropometric indicators of body composition change with the increasing consumption of UPF? The study is a cross-sectional, household, population study, carried out with 490 adults and seniors. The food consumption was obtained with a 24 h food recall, and the foods were classified using NOVA. Anthropometric indicators evaluated were waist-to-height ratio, triceps skinfold thickness, arm circumference, corrected arm muscle area, subscapular skinfold thickness, and calf circumference. The association between energy contribution of UPF with anthropometric indicators was verified with a simple and multiple linear regression analysis. Individuals aged 20 to 35 years showed a significant association between UPF consumption and skinfold thickness (ß: 0.04; CI: 0.03/0.09), demonstrating an increase in this subcutaneous body fat marker with higher UPF consumption. Moreover, in participants aged 36 to 59 years, an inverse correlation between UPF intake and muscle mass markers, arm circumference (ß: -0.02; confidence interval: -0.03/-0.01), and corrected arm muscle area (ß: -0.07; confidence interval: -0.12/-0.02) were observed. Such results suggest there is decreased muscle mass with increasing UPF consumption. This is the first study that verified an association between UPF consumption and low-cost body composition indicators in different age groups.

Can the complementary feeding method be a strategy to reduce the offer of ultra-processed foods?

OBJECTIVE

To verify the prevalence of the offer of ultra-processed foods (UPFs), and to analyze their associated factors in the child's first year of life.

METHODS

Cross-sectional study with 119 mother-infant pairs. At 5.5 months of the child, the mothers received guidance on complementary feeding (CF) according to three methods: Parent-Led Weaning (PLW), Baby-Led Introduction to SolidS (BLISS), or mixed (a combination of PLW and BLISS). At nine and 12 months, the mothers answered a questionnaire about the offer of UPFs. The NOVA classification, which classifies foods according to the nature, extent, and purposes of the industrial processes to which they are subjected, was used to list the UPFs. Descriptive statistics and multivariate Poisson regression, following a multilevel hierarchical model according to the proximity to the outcome, were used to estimate the association between dependent and independent variables.

RESULTS

The prevalence of UPF consumption was 63% (n = 75) in the first year of life. Receiving guidance on healthy CF in the BLISS method showed to be a protective factor for offering UPFs (RR 0.72; CI95 0.52-0.99). Attending less than six prenatal consultations was a risk factor for the UPFs provision (RR 1.39; CI95 1.07-1.80).

CONCLUSION

The prevalence of UPFs offered in the first year of life in this study can be considered high, and future interventions aimed at avoiding UPFs offered in this population should consider the CF method.

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

BACKGROUND AND AIMS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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.

The Impact of Nutrition, Physical Activity, Beneficial Microbes, and Fecal Microbiota Transplant for Improving Health

The recognition that microbes are integral to human life has led to studies on how to manipulate them in favor of health outcomes. To date, there has been no conjoint recommendation for the intake of dietary compounds that can complement the ingested organisms in terms of promoting an improved health outcome. The aim of this review is to discuss how beneficial microbes in the form of probiotics, fermented foods, and donor feces are being used to manage health. In addition, we explore the rationale for selecting beneficial microbial strains and aligning diets to accommodate their propagation in the gut. A pilot clinical trial design is presented to examine the effects of probiotics and exercise in patients with phenylketonuria (PKU); it is the most common inborn error of amino acid metabolism, and it is a complication that requires lifelong dietary intervention. The example design is provided to illustrate the importance of using omics technology to see if the intervention elevates neuroactive biogenic amines in the plasma; increases the abundance of Eubacterium rectale, Coprococcus eutactus, Akkermansia muciniphila, or Butyricicoccus; and increases Escherichia/Shigella in the gut, all as markers of improved health. By emphasizing the combined importance of diet, microbial supplements, and the gut microbiome, we hope that future studies will better align these components, not only to improve outcomes, but also to enhance our understanding of the mechanisms.

A Qualitative Evaluation of a Community-Based Intervention on Health-Related Behaviors in Disadvantaged Women

Purpose: Grounded in social ecological model and self-determination theory, the aim of this study was to qualitatively evaluate the first and second year follow-ups of a community-based healthy lifestyle programme on health-related behaviors, and outcomes in disadvantaged adult women. Methods: Eleven disadvantaged adult women (M = 37.72; SD = 8.34) (seven of them from the Roma population) participated in this community-based participatory action research. Discussion groups, semi-structured interviews, and field notes were used to assess the effects of the intervention programme on health-related behaviors and health outcomes through thematic analysis. Results: Women perceived improvements in PA-related variables, healthy eating, and other health-related outcomes throughout two years. Most women mentioned these behavior changes in the first year, while others perceived them in the second year. Conclusions: These findings highlight the importance of developing contextual and culturally tailored interventions that address the specific problems and needs that emerge from ethnic groups. Given that some of these behavior changes were only mentioned by most of these women in the second year, long-term interventions seem to be ideally required in this population.

Ultra-Processed Food Intake and Risk of Colorectal Cancer: A Matched Case-Control Study

Colorectal cancer (CRC) is the third most prevalent and the second fatal cancer in the world. Ultra-processed foods (UPFs) are suggested to be related to various non-communicable diseases including cancers. However, studies on the relationship between UPFs and CRC are scarce. The aim of this study was to determine the association between consumption of UPFs and CRC. In a case-control study conducted in four hospitals in Tehran, Iran, consumption of UPFs in 71 CRC patients and 142 controls (patients with non-neoplastic diseases) were compared. Using 125-item semi-quantitative food frequency questionnaire, dietary intakes were assessed. We used Multivariate logistic regression to estimate the association between UPFs intake and risk of CRC. Intake of nondairy beverages (P = 0.009), processed meat and fast food (P = 0.04) was significantly higher in those in the highest tertile of UPFs intake compared to the lowest tertile. In addition, intake of UPFs was associated with higher risk of CRC. The association remained constant after adjustment for BMI, income, smoking, type of job, educational level, and physical activity (OR, 3.32; 95% CI, 1.44-7.61; P = 0.003). Results of this study indicate that the intake of UPFs is associated with increased odds of CRC.

Relation of Minimally Processed Foods and Ultra-Processed Foods with the Mediterranean Diet Score, Time-Related Meal Patterns and Waist Circumference: Results from a Cross-Sectional Study in University Students

Ultra-processed foods are associated with chronic diseases, cardiometabolic factors and obesity. According to the NOVA system, foods are classified into four categories (from 1 = unprocessed to 4 = ultra-processed foods). The purpose of the present study was to assess the consumption of minimally processed foods (MPF) and ultra-processed foods (UPF) in university students and their relationship with obesity, Mediterranean diet adherence and meal patterns. In total, 346 students (269 women) of the University of Peloponnese participated. A food frequency questionnaire was used, and the MedDietScore was calculated. The % energy contribution of MPF and UPF was calculated. The identification of meal patterns was performed via principal component analysis. Both multivariate regression and Spearman's correlations were used to measure the association of UPF/MPF consumption with anthropometric indices (body mass index, BMI and waist circumference, WC), Mediterranean diet adherence and early/late meal patterns. UPF and MPF provided 40.7 ± 13.6% and 44.3 ± 11.9% (mean ± standard deviation) of energy intake, respectively. In multi-adjusted linear regression models UPF consumption (% energy) was positively associated with WC in men but it was not related to BMI (total sample, men, women). UPF consumption was negatively related to the MedDietScore (Spearman rho = -0.214, p < 0.001) and an "early eating" pattern (Spearman rho = -0.120, p = 0.029) and positively associated with a "late eating" meal pattern (Spearman rho = 0.190, p = 0.001). MPF consumption was positively associated with the MedDietScore (Spearman rho = 0.309, p < 0.001) and an "early eating" pattern (Spearman rho = 0.240, p < 0.001). In conclusion, UPF consumption was positively related to WC in male university students. Nutritional and sociodemographic correlates of UPF consumption, such as low Mediterranean diet adherence and having a "late eating" pattern serve as a basis to better understand the UPF consumption-central obesity relation in young adults and should be considered in nutrition education programs for young adults.

Effectiveness of a minimally processed food-based nutritional counselling intervention on weight gain in overweight pregnant women: a randomized controlled trial

PURPOSE

This study aimed at evaluating the effectiveness of a nutritional counselling intervention based on encouraging the consumption of unprocessed and minimally processed foods, rather than ultra-processed products, and the practice of physical activities to prevent excessive gestational weight gain in overweight pregnant women.

METHODS

This was a two-armed, parallel, randomized controlled trial conducted in primary health units of a Brazilian municipality from 2018 to 2021. Overweight, adult pregnant women (n = 350) were randomly assigned to control (CG) or intervention groups (IG). The intervention consisted of three individualized nutritional counselling sessions based on encouraging the consumption of unprocessed and minimally processed foods rather than ultra-processed products, following the NOVA food classification system, and the practice of physical activities. The primary outcome was the proportion of women whose weekly gestational weight gain (GWG) exceeded the Institute of Medicine guidelines. Adjusted logistic regression models were employed.

RESULTS

Complete data on weight gain were available for 121 women of the IG and 139 of the CG. In modified intention-to-treat analysis, there was a lower chance of the IG women having excessive GWG [OR 0.56 (95% CI 0.32, 0.98), p = .04], when compared to the CG. No between-group differences were observed for the other maternal outcomes investigated.

CONCLUSION

The present study was unprecedented in demonstrating that nutritional counselling based on the NOVA food classification system, together with encouraging the practice of physical activity, is effective in preventing excessive weight gain in overweight pregnant women.

TRIAL REGISTRATION

Registered on July 30th 2018 at Brazilian Registry of Clinical Trials (RBR-2w9bhc).

Nutritional Analysis of the Spanish Population: A New Approach Using Public Data on Consumption

Official population consumption data are frequently used to characterize the diet of countries; however, this information may not always be representative of reality. This study analyses the food consumption of the Spanish population by reconstructing the whole food chain. The results have been compared with the data provided by the National Consumption Panel to which the food losses/waste reported in the literature along the distribution chain have been added. The difference between them allowed a new calculation of the estimated food consumption that was subjected to a dietary-nutritional analysis. Most of the foods were consumed more than those officially reported (range of 5-50%). The unhealthy ratios of consumed foods and recommended servings were: meat products (Rcr = 3.6), fruits and legumes (Rcr = 0.5), and nuts (Rcr = 0.14). Caloric intake surpasses needs. The results were consistent with the data on the prevalence of overweight and obesity in Spain, as well as with the prevalence of associated diseases. To make a judgment about the quality of a country's diet, it is necessary to have reliable data on food consumption, as well as energy and nutrient intake. This study encourages other authors to implement this method to verify and quantify the possible difference between official and real consumption data.

The intake of ultra-processed foods, all-cause, cancer and cardiovascular mortality in the Korean Genome and Epidemiology Study-Health Examinees (KoGES-HEXA) cohort

The relationship between ultra-processed food (UPF) intake and mortality is unknown in Asian countries, yet the intake of UPF is on the rise in these countries. This study examined the association of UPF intake with all-cause, cancer and cardiovascular disease (CVD) mortality. Participants were 113,576 adults who responded to a 106-item food frequency questionnaire during recruitment of the 2004-2013 Health Examinees (HEXA) study, a prospective cohort study in Korea. UPF were defined using the NOVA classification and evaluated as quartiles of the proportion of UPF in the diet (% total food weight). Multivariable Cox regression and restricted cubic spline models were used to examine the association of UPF intake with all-cause and cause specific mortality. A total of 3456 deaths were recorded during a median follow-up of 10.6 (interquartile range, 9.5-11.9) years. There was no evidence of an association of UPF intake with all-cause, cancer or CVD mortality comparing the highest with the lowest quartiles of UPF intake (all-cause mortality, men: hazard ratio [HR] 1.08, 95% confidence interval [CI] 0.95-1.22; women: HR 0.95, 95% CI 0.81-1.11; cancer mortality, men: HR 1.02, 95% confidence interval [CI] 0.84-1.22; women: HR 1.02, 95% CI 0.83-1.26; CVD mortality, men: HR 0.88, 95% CI 0.64-1.22; women: HR 0.80, 95% CI 0.53-1.19). However, the risk of all-cause mortality increased in both men and women with high consumption of ultra-processed red meat and fish (men, HR 1.26, 95% CI 1.11-1.43); women, HR 1.22 95% CI 1.05-1.43); and in men with high consumption of ultra-processed milk (HR 1.13, 95% CI 1.01-1.26); and soymilk drink (HR 1.12, 95% CI 1.00-1.25). We found no evidence of an association between total UPF intake and all-cause, cancer or CVD mortality, but ultra-processed red meat and fish in both sexes, and milk and soymilk drinks in men were positively associated with all-cause mortality.

Does the concept of "ultra-processed foods" help inform dietary guidelines, beyond conventional classification systems? NO

The Nova classification of ultra-processed foods (UPFs) rests on poorly defined food processes and the presence of food additives from a chemically heterogeneous group, easily leading to misclassification. UPFs are claimed to promote overconsumption of energy and obesity due to high palatability, but little evidence supports effects beyond those that can be accounted for by nutrient composition, energy density, and food matrices. Observational studies link dietary intake of UPFs with obesity, but none have demonstrated independent associations after controlling for likely confounders. A highly cited randomized controlled feeding study that compared a UPF diet with an unprocessed diet showed a rapidly weaning effect on energy intake that can be entirely explained by more conventional and quantifiable dietary factors, including energy density, intrinsic fiber, glycemic load, and added sugar. Clearly, many aspects of food processing can affect health outcomes, but conflating them into the notion of ultra-processing is unnecessary, because the main determinants of chronic disease risk are already captured by existing nutrient profiling systems. In conclusion, the Nova classification adds little to existing nutrient profiling systems; characterizes several healthy, nutrient-dense foods as unhealthy; and is counterproductive to solve the major global food production challenges.

Characterization of the degree of food processing in the European Prospective Investigation into Cancer and Nutrition: Application of the Nova classification and validation using selected biomarkers of food processing

Background

Epidemiological studies have demonstrated an association between the degree of food processing in our diet and the risk of various chronic diseases. Much of this evidence is based on the international Nova classification system, which classifies food into four groups based on the type of processing: (1) Unprocessed and minimally processed foods, (2) Processed culinary ingredients, (3) Processed foods, and (4) "Ultra-processed" foods (UPF). The ability of the Nova classification to accurately characterise the degree of food processing across consumption patterns in various European populations has not been investigated so far. Therefore, we applied the Nova coding to data from the European Prospective Investigation into Cancer and Nutrition (EPIC) in order to characterize the degree of food processing in our diet across European populations with diverse cultural and socio-economic backgrounds and to validate this Nova classification through comparison with objective biomarker measurements.

Methods

After grouping foods in the EPIC dataset according to the Nova classification, a total of 476,768 participants in the EPIC cohort (71.5% women; mean age 51 [standard deviation (SD) 9.93]; median age 52 [percentile (p)25-p75: 58-66] years) were included in the cross-sectional analysis that characterised consumption patterns based on the Nova classification. The consumption of food products classified as different Nova categories were compared to relevant circulating biomarkers denoting food processing, measured in various subsamples (N between 417 and 9,460) within the EPIC cohort via (partial) correlation analyses (unadjusted and adjusted by sex, age, BMI and country). These biomarkers included an industrial transfatty acid (ITFA) isomer (elaidic acid; exogenous fatty acid generated during oil hydrogenation and heating) and urinary 4-methyl syringol sulfate (an indicator for the consumption of smoked food and a component of liquid smoke used in UPF).

Results

Contributions of UPF intake to the overall diet in % grams/day varied across countries from 7% (France) to 23% (Norway) and their contributions to overall % energy intake from 16% (Spain and Italy) to >45% (in the UK and Norway). Differences were also found between sociodemographic groups; participants in the highest fourth of UPF consumption tended to be younger, taller, less educated, current smokers, more physically active, have a higher reported intake of energy and lower reported intake of alcohol. The UPF pattern as defined based on the Nova classification (group 4;% kcal/day) was positively associated with blood levels of industrial elaidic acid (r = 0.54) and 4-methyl syringol sulfate (r = 0.43). Associations for the other 3 Nova groups with these food processing biomarkers were either inverse or non-significant (e.g., for unprocessed and minimally processed foods these correlations were -0.07 and -0.37 for elaidic acid and 4-methyl syringol sulfate, respectively).

Conclusion

These results, based on a large pan-European cohort, demonstrate sociodemographic and geographical differences in the consumption of UPF. Furthermore, these results suggest that the Nova classification can accurately capture consumption of UPF, reflected by stronger correlations with circulating levels of industrial elaidic acid and a syringol metabolite compared to diets high in minimally processed foods.

Underreporting of energy intake is not associated with the reported consumption of NOVA-classified food groups in socially vulnerable women

Few studies have investigated which types of food are least reported among underreporters of energy intake (EI). This study assessed the association between the underreporting of EI and the consumption report of food groups according to NOVA classification in women in social vulnerability. EI was measured through three 24-h dietary recalls administered by the research team. Total energy expenditure (TEE) was evaluated using the doubly labelled water method. The percentage of EI arising from each NOVA group food classification (unprocessed/minimally processed foods, culinary ingredients, processed foods and ultra-processed foods [UPF]) was calculated. The agreement between the EI and the TEE was assessed using the ratio EI:TEE. Associations were assessed with Pearson's correlation and multivariable linear regression, adjusted for age, education and body fat. The sample (63 women, age: 30.8 years, Body Mass Index: 27.6 kg/m² ) reported an EI of 1849 kcal and a TEE of 2223 kcal, with a mean EI:TEE of 0.85. There were no significant correlations between the EI:TEE and the reported food intake according to NOVA classifications. Multivariable linear regression also did not show any significant associations (UPF: 8.47, 95% CI: [-3.65; 20.60] %kcal; Processed: -6.85, [-19.21; 7.71] %kcal; Culinary ingredients: 1.30 [-5.10; 7.71] %kcal; Unprocessed/minimally processed: -2.92 [-10.98; 5.13] %kcal). In conclusion, socially vulnerable women that underreport their EI do not report a lower intake of any specific group of foods according to NOVA classification.

Self-initiated dietary changes reduce general somatic and mental symptoms in a relatively healthy Dutch population

The risk for development of non-communicable diseases (NCDs) can be predicted by somatic or mental symptoms and dietary alterations aimed at improvement of those symptoms could potentially delay development of NCDs. The goal of this study was to identify whether self-initiated dietary changes could reduce mental and somatic symptoms in relatively healthy individuals. Participants (n = 494) recruited from the Dutch population filled out weekly questionnaires on dietary intake, somatic and mental symptoms and physical activity at baseline and during dieting for four weeks. There was a significant reduction in mental and somatic symptoms, body weight, and waist circumference at four weeks, whereas physical activity remained unchanged. Five dietary patterns were identified by principal component analysis labelled “Processed foods”, “Animal source foods”, “Wheel of Five”, “Traditional Dutch”, and “Party”. Reduction in mental symptoms was correlated to increased physical activity and increased intake of Wheel of Five foods. Reduction in somatic symptoms was correlated to body weight loss and less Processed foods, more Wheel of Five foods, and lower intake of fat and protein. Higher intake of protein and fat and lower intake of carbohydrates, however, were correlated to body weight loss. In conclusion this research showed that a self-initiated dietary change can lead to a significant reduction of mental and somatic symptoms.

Interaction between ultra-processed food intake and genetic risk score on mental health and sleep quality

PURPOSE

Mental health and sleep quality are associated with genetics and nutrient and energy intake. The present study examined the association between ultra-processed food (UPF) intake and genetic risk score (GRS) and their interactions on mental health and sleep quality in Iranian women.

METHODS

A cross-sectional study was conducted on 278 overweight and obese females aged between 18 and 56 years. According to the NOVA classification system, 37 food groups and beverages were collected using a 147-item semi-quantitative food frequency questionnaire (FFQ). The blood parameters of all participants were assessed. Mini-column kit (type G; Genall; Exgene) and the PCR-RFLP method were used to extract DNA and determine gene polymorphism, respectively. Three single nucleotide polymorphisms (SNPs), including Caveolin_1 (Cav_1), Melanocortin4 receptor (MC4R), and cryptochrome circadian regulator 1 (CRY1), were used to calculate GRS. The individual risk allele (0, 1, 2) for each SNP was calculated using the incremental genetic model.

RESULTS

After controlling for confounders, a significant interaction was found for depression (β = 0.026, 95% CI 0.003, 0.049, P = 0.028) and depression anxiety stress scales (DASS) score (β = 0.059, 95% CI 0.001, 0.117, P = 0.046) on the NOVA classification system and GRS.

CONCLUSIONS

The findings of this study showed a significant interaction between GRS and the NOVA classification system on mental disorders, including depression, DASS score and stress. There was also a significant relationship between the NOVA classification system and anxiety, DASS score, sleep quality and depression. Furthermore, a partially significant association was observed between GRS and stress.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Description of Ultra-Processed Food Intake in a Swiss Population-Based Sample of Adults Aged 18 to 75 Years

Ultra-processed foods (UPFs) are associated with lower diet quality and several non-communicable diseases. Their consumption varies between countries/regions of the world. We aimed to describe the consumption of UPFs in adults aged 18−75 years living in Switzerland. We analysed data from the national food consumption survey conducted among 2085 participants aged 18 to 75 years. Foods and beverages resulting from two 24-h recalls were classified as UPFs or non-UPFs according to the NOVA classification, categorized into 18 food groups, and linked to the Swiss Food Composition Database. Overall, the median energy intake [P25−P75] from UPFs was 587 kcal/day [364−885] or 28.7% [19.9−38.9] of the total energy intake (TEI). The median intake of UPFs relative to TEI was higher among young participants (<30 years, p = 0.001) and those living in the German-speaking part of Switzerland (p = 0.002). The food groups providing the most ultra-processed calories were confectionary, cakes & biscuits (39.5% of total UPF kcal); meat, fish & eggs (14.9%); cereal products, legumes & potatoes (12.5%), and juices & soft drinks (8.0%). UPFs provided a large proportion of sugars (39.3% of total sugar intake), saturated fatty acids (32.8%), and total fats (31.8%) while providing less than 20% of dietary fibre. Consumption of UPFs accounted for nearly a third of the total calories consumed in Switzerland. Public health strategies to reduce UPF consumption should target sugary foods/beverages and processed meat.

Association between ultra-processed food consumption and gut microbiota in senior subjects with overweight/obesity and metabolic syndrome

The production and consumption of ultra-processed foods (UPF) has increased considerably during the last years worldwide. Collective evidence shows the association between UPF consumption and adverse health outcomes, including inflammatory gastro-intestinal disorders and obesity. The gut microbiota has been suggested as potential mediator of the effects of UPF consumption on metabolism and health. However, few studies have been conducted in order to elucidate these aspects. Therefore, the aim of the present study was to assess the cross-sectional associations between UPF consumption and gut microbiota in a population of senior subjects (n = 645) within the frame of the PREDIMED-Plus trial. Eligible participants were men and women (aged 55-75 years), without documented history of cardiovascular disease at enrollment, with overweight/obesity (body mass index ≤ 27 and <40 kg/m²) and metabolic syndrome. Using the information of food frequency questionnaires, the consumption of UPF, expressed as a percentage of total dietary energy intake in kcal/day, was calculated considering those food items classified in group 4 of NOVA system. Population was categorized according to tertiles of UPF consumption. Taxonomic fecal microbiota information, along with blood biochemical parameters, anthropometric measurements and clinical data were obtained. Bioinformatics analysis was performed to study the association between fecal microbiota composition and UPF consumption. We observed that subjects allocated in the highest tertile of UPF consumption (21.4 ± 5.0 % kcal/day) presented lower adherence to MedDiet (p < 0.001) and higher total energy intake (p < 0.001). The taxonomic analysis of the fecal microbiota revealed a significant (Benjamini-Hochberg adjusted p < 0.2) positive association between specific taxa and tertiles (T) of UPF consumption: Alloprevotella (p = 0.041 vs. T2; p = 0.065 vs. T3), Negativibacillus (p = 0.096 vs. T3), Prevotella (p = 0.116 vs. T3), and Sutterella (p = 0.116 vs. T2). UPF consumption was positively associated with lower adherence to MedDiet and higher total energy intake in senior subjects with overweight obesity and metabolic syndrome. In addition, positive association with specific fecal microbiota taxa related to inflammatory gastro-intestinal diseases and low consumption of fruits and vegetables, was observed.

Maternal consumption of ultra-processed foods and subsequent risk of offspring overweight or obesity: results from three prospective cohort studies

OBJECTIVE

To assess whether maternal ultra-processed food intake during peripregnancy and during the child rearing period is associated with offspring risk of overweight or obesity during childhood and adolescence.

DESIGN

Population based prospective cohort study.

SETTING

The Nurses' Health Study II (NHSII) and the Growing Up Today Study (GUTS I and II) in the United States.

PARTICIPANTS

19 958 mother-child (45% boys, aged 7-17 years at study enrollment) pairs with a median follow-up of 4 years (interquartile range 2-5 years) until age 18 or the onset of overweight or obesity, including a subsample of 2925 mother-child pairs with information on peripregnancy diet.

MAIN OUTCOME MEASURES

Multivariable adjusted, log binomial models with generalized estimating equations and an exchangeable correlation structure were used to account for correlations between siblings and to estimate the relative risk of offspring overweight or obesity defined by the International Obesity Task Force.

RESULTS

2471 (12.4%) offspring developed overweight or obesity in the full analytic cohort. After adjusting for established maternal risk factors and offspring's ultra-processed food intake, physical activity, and sedentary time, maternal consumption of ultra-processed foods during the child rearing period was associated with overweight or obesity in offspring, with a 26% higher risk in the group with the highest maternal ultra-processed food consumption (group 5) versus the lowest consumption group (group 1; relative risk 1.26, 95% confidence interval 1.08 to 1.47, P for trend<0.001). In the subsample with information on peripregnancy diet, while rates were higher, peripregnancy ultra-processed food intake was not significantly associated with an increased risk of offspring overweight or obesity (n=845 (28.9%); group 5 v group 1: relative risk 1.17, 95% confidence interval 0.89 to 1.53, P fortrend=0.07). These associations were not modified by age, sex, birth weight, and gestational age of offspring or maternal body weight.

CONCLUSIONS

Maternal consumption of ultra-processed food during the child rearing period was associated with an increased risk of overweight or obesity in offspring, independent of maternal and offspring lifestyle risk factors. Further study is needed to confirm these findings and to understand the underlying biological mechanisms and environmental determinants. These data support the importance of refining dietary recommendations and the development of programs to improve nutrition for women of reproductive age to promote offspring health.