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Zhang Z, Jackson SL, Steele EM, Hayes DK, Yang Q. Relationship Between Ultra-Processed and Minimally Processed Food Intake and Cardiovascular Health Among US Women of Reproductive Age. J Womens Health (Larchmt) 2024. [PMID: 38386796 DOI: 10.1089/jwh.2023.0739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Objectives: Ultra-processed food (UPF) intake is associated with worse cardiovascular health (CVH), but associations between unprocessed/minimally processed foods (MPFs) and CVH are limited, especially among women of reproductive age (WRA). Materials and Methods: For 5,773 WRA (20-44 years) in National Health and Nutrition Examination Survey (NHANES) 2007-2018, we identified UPFs and MPFs using the Nova classification and based on 24-hour dietary recalls. We calculated usual percentages of calories from UPFs and MPFs using the National Cancer Institute's usual intake method. Seven CVH metrics were scored, and CVH levels were grouped by tertile. We used multivariable linear and multinomial logistic regression to assess associations between UPFs and MPFs and CVH. Results: The average usual percentage of calories from UPFs and MPFs was 57.2% and 29.3%, respectively. There was a graded, positive association between higher UPF intake and higher odds of poor CVH: adjusted odds ratios (aORs) for the lowest versus highest CVH were 1.74 (95% confidence interval: 1.51-2.01), 2.67 (2.07-3.44) and 4.66 (3.13-6.97), respectively, comparing quartile 2 (Q2)-Q4 to the lowest quartile (Q1) of UPF intake. Higher MPF intake was associated with lower odds of poor CVH: aORs for the lowest CVH were 0.61 (0.54-0.69), 0.39 (0.31-0.50), and 0.21 (0.14-0.31). Patterns of association remained consistent across subgroups and in sensitivity analyses. Conclusions: Higher UPF intake was associated with worse CVH, while higher MPF intake was associated with better CVH among WRA in the United States. Our analyses highlight an opportunity for WRA to improve nutrition and their CVH.
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Affiliation(s)
- Zefeng Zhang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Euridice Martinez Steele
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | - Donald K Hayes
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Quanhe Yang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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2
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Neri D, Gabe KT, Costa CDS, Martinez Steele E, Rauber F, Marchioni DM, da Costa Louzada ML, Levy RB, Monteiro CA. A novel web-based 24-h dietary recall tool in line with the Nova food processing classification: description and evaluation. Public Health Nutr 2023; 26:1997-2004. [PMID: 37548217 PMCID: PMC10564608 DOI: 10.1017/s1368980023001623] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 07/04/2023] [Accepted: 07/29/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE This paper describes the first web-based self-completed 24-h recall designed to categorise food intake according to Nova groups - Nova24h - and its agreement with a reference tool in estimating the dietary relative contribution of the four Nova food groups (% of total energy intake). DESIGN Comparisons of estimates of dietary relative contributions of Nova groups obtained by Nova24h and one standard interviewer-led 24-h recall. SETTING Nationwide adult cohort study in Brazil. PARTICIPANTS The subjects were 186 participants of the NutriNet Brasil Cohort Study (n 186). RESULTS No statistically significant differences were observed between the Nova24h and the reference tool mean contributions of unprocessed or minimally processed foods (52·3 % v. 52·6 %), processed culinary ingredients (11·6 % v. 11·9 %), processed foods (17·1 % v. 14·7 %) and ultra-processed foods (19·0 % v. 20·9 %). Intraclass correlation coefficients between individual estimates obtained for each Nova group showed moderate to good agreement (0·54-0·78). Substantial or almost perfect agreement between the tools was seen regarding the ability to rank participants according to quintiles of contribution of each Nova group (PABAK 0·69-0·81). CONCLUSIONS Nova24h is a suitable tool for estimating the dietary relative energy contribution of Nova food groups in the NutriNet Brasil cohort. New studies are necessary to verify its adequacy in other populations.
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Affiliation(s)
- Daniela Neri
- Center for Epidemiological Studies in Health and Nutrition, University of Sao Paulo (Nupens/USP), Sao Paulo, Brazil
| | - Kamila Tiemann Gabe
- Center for Epidemiological Studies in Health and Nutrition, University of Sao Paulo (Nupens/USP), Sao Paulo, Brazil
| | - Caroline Dos Santos Costa
- Center for Epidemiological Studies in Health and Nutrition, University of Sao Paulo (Nupens/USP), Sao Paulo, Brazil
| | - Euridice Martinez Steele
- Center for Epidemiological Studies in Health and Nutrition, University of Sao Paulo (Nupens/USP), Sao Paulo, Brazil
| | - Fernanda Rauber
- Center for Epidemiological Studies in Health and Nutrition, University of Sao Paulo (Nupens/USP), Sao Paulo, Brazil
| | - Dirce Maria Marchioni
- Department of Nutrition, School of Public Health, University of São Paulo, Sao Paulo, Brazil
| | - Maria Laura da Costa Louzada
- Center for Epidemiological Studies in Health and Nutrition, University of Sao Paulo (Nupens/USP), Sao Paulo, Brazil
- Department of Nutrition, School of Public Health, University of São Paulo, Sao Paulo, Brazil
| | - Renata Bertazzi Levy
- Center for Epidemiological Studies in Health and Nutrition, University of Sao Paulo (Nupens/USP), Sao Paulo, Brazil
- Department of Preventive Medicine, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Carlos Augusto Monteiro
- Center for Epidemiological Studies in Health and Nutrition, University of Sao Paulo (Nupens/USP), Sao Paulo, Brazil
- Department of Nutrition, School of Public Health, University of São Paulo, Sao Paulo, Brazil
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3
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Steele EM, Whitmill MA, Amos A, Oaks ZA, McGurk R, Dance MJ, Mazur L, Weiner AA, Marks LB, Chera BS, Sud S. Incident Learning in an Academic Radiation Oncology Practice during the COVID Era. Int J Radiat Oncol Biol Phys 2023; 117:e440-e441. [PMID: 37785430 DOI: 10.1016/j.ijrobp.2023.06.1617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Incident learning is key to developing and maintaining quality and safety in healthcare. We aimed to characterize acute and sustained changes in incident submissions, point of incident origin/detection, severity and associated contributing factors during the COVID-19 pandemic. HYPOTHESIS The frequency and pattern of incident origin/detection were changed by altered workflows in response to COVID-19. MATERIALS/METHODS Events from our experienced incident learning system were analyzed between three 12-month intervals: pre-COVID (March 1, 2019 - February 29, 2020), early-COVID (March 1, 2020 - February 28, 2021), and late-COVID (March 1, 2021 - February 28, 2022). In addition to review by the department quality and safety committee, at least two physicians reviewed all incidents. Using descriptive statistics and chi-square test as applicable, we compared the reporting rates, incident severity, contributing factors, points of origin/ detection according to time the pre-specified time intervals prior to and during COVID. RESULTS See Table. CONCLUSION During COVID the number of reported incidents, particularly incidents reaching the patient, markedly declined. The number of incidents per patient increased with early-COVID altered workflows. This suggests that existing quality and safety checks were effective during early-COVID. The point of incident origin was similar across time periods. During early-COVID, the point of incident detection shifted to earlier points in the care pathway (e.g., pre-RT chart checks vs chart checks during RT), p<0.001. During late-COVID, as clinical workflows adapted, the point of detection shifted to later in the care pathway consistent with pre-COVID patterns. During COVID, workload was implicated in fewer incidents (in the setting of reduced treatment volumes), while communication and hand-offs were more frequently cited as contributing factors (in the setting of remote work). Our data supports the utility of consistent standards, minimizing inter-provider variations and maintaining robust quality and safety checks to optimize communication and safe patient care in radiation oncology.
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Affiliation(s)
- E M Steele
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - M A Whitmill
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - A Amos
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - Z A Oaks
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - R McGurk
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - M J Dance
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - L Mazur
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - A A Weiner
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - L B Marks
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - B S Chera
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC
| | - S Sud
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
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4
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Steele EM, Payne MM, Weiner AA, Casey DL, Shen C. Factors Associated with Short Interval from Treatment to Death in Patients Treated with Stereotactic Body Radiotherapy for Lung Metastases: Experience at a Large Academic Facility. Int J Radiat Oncol Biol Phys 2023; 117:e152. [PMID: 37784737 DOI: 10.1016/j.ijrobp.2023.06.973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Stereotactic body radiotherapy (SBRT) is increasingly used to treat patients with lung metastases, as several studies have demonstrated a survival benefit in patients with oligometastatic disease, while in other cases it is used for palliation as in the re-irradiation setting. With increasing use, we queried whether SBRT is given more frequently toward the end of life for patients with lung metastases and assessed factors associated with a shorter interval from SBRT to death. MATERIALS/METHODS A sample of patients who received stereotactic body radiation therapy (SBRT) to lung metastases between 2014-2022 at a single academic institution were identified. Medical records were reviewed for patient demographic, disease, and treatment details, including age, sex, race, insurance status, Karnofsky performance status (KPS), and time from SBRT to death. Descriptive statistics including chi-square and t-test analyses were used to compare patients who did versus did not die within 180 days of completion of SBRT. RESULTS A total of 81 episodes of SBRT for lung metastases were identified. Of these, median age was 68 years (range 22-86), 82.7% had KPS >70, a majority had Medicare/Medicaid (61.7%, 50/81) or private insurance (33.3%, 27/81), and 63% were male. Only 9 of the 81 patients (11.1%) died within 180 days of SBRT completion. Death within 180 days occurred in 7.3% of treatments prior to 2018 compared to 15.0% of more recent treatments, but this difference was not statistically significant (p = 0.27; Table 1). Non-White race, KPS ≤70, and lack of insurance were all associated with increased likelihood of death within 180 days of SBRT (p<0.001 all comparisons). CONCLUSION Few patients treated with SBRT for lung metastases in our series died within 180 days of SBRT completion, and there did not appear to be a significant increase in 180-day mortality post-SBRT in recent years. While limited by the small number of events, race, KPS, and insurance status were significantly associated with likelihood of death within 180 days of SBRT. Additional work is needed to better appreciate what patients may benefit from SBRT for lung metastases. Table 1: Characteristics of patients that did versus did not die within 180 days of SBRT for lung metastases.
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Affiliation(s)
- E M Steele
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - M M Payne
- University of North Carolina, Chapel Hill, NC
| | - A A Weiner
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - D L Casey
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - C Shen
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
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5
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Zhao L, Zhang X, Martinez Steele E, Lo CH, Zhang FF, Zhang X. Higher ultra-processed food intake was positively associated with odds of NAFLD in both US adolescents and adults: A national survey. Hepatol Commun 2023; 7:e0240. [PMID: 37655983 PMCID: PMC10476803 DOI: 10.1097/hc9.0000000000000240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/01/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND The effect of ultra-processed foods (UPF) on NAFLD remains unclear. Related evidence for adult NAFLD is limited and no study has yet evaluated UPF's impact on NAFLD in adolescence. METHODS We used data from the National Health and Nutrition Examination Survey (2017-2018) with 806 adolescents and 2734 adults. UPF intake was estimated using dietary data from two 24-hour dietary recalls. NAFLD was defined by transient elastography. Logistic regression was used to estimate the multivariable OR and 95% CI for associations between UPF and NAFLD with survey weight adjustments. RESULTS The mean UPF intake was 812 g/d in adolescents and 823 g/d in adults. A total of 12.4% of the adolescents and 35.6% of the adults had NAFLD. Higher UPF intake was associated with higher odds of NAFLD in both adolescents (OR Quintile 5 vs. Quartile 1 = 2.34, 95% CI, 1.01, 5.41; ptrend = 0.15) and adults (OR Quintile 5 vs. Quintile 1 = 1.72, 95% CI, 1.01, 2.93; ptrend = 0.002). In adults, ~68% and 71% of the association between UPF intake and NAFLD was mediated by body mass index and waist circumference (all p-values < 0.001), respectively. The results were similar for adolescents but not statistically significant. A higher UPF intake was associated with lower levels of serum albumin and higher levels of C-reactive protein in adults. CONCLUSIONS Higher UPF intake was linked to higher NAFLD odds in both adolescents and adults, mainly because of elevated body fatness. If confirmed, reducing UPF intake may help prevent NAFLD in both adolescents and adults.
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Affiliation(s)
- Longgang Zhao
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Xinyuan Zhang
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Euridice Martinez Steele
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | - Chun-Han Lo
- Internal Medicine and Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, Nevada, USA
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Xuehong Zhang
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
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6
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Martinez Steele E, Khandpur N, Moran A. Abstract P415: Trends in Ultra-Processed Food Intake by Supplemental Nutrition Assistance Program Participation in the U.S. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Introduction:
The Supplemental Nutrition Assistance Program (SNAP) plays an important role in shaping the diet of low-income individuals and families. Trends in ultra-processed food intake (UPF) among SNAP participants and non-participants has not been studied.
Hypothesis:
Compared to non-participants, SNAP participants would have a higher UPF intake; purchases would be larger for foods from SNAP-eligible versus ineligible venues.
Methods:
Data from NHANES survey cycles 2003-2004 through 2017-2018 were used. Dietary recalls from individuals ≥1 year of age were categorized according to Nova classification. Venues from which individuals reported buying food were grouped as SNAP-eligible (ex. grocery/supermarkets, convenience stores) or SNAP-ineligible venues (ex. restaurant/cafeteria). SNAP participation status was self-reported and categorized as SNAP participants; income-eligible nonparticipants (no SNAP + family income ≤130% of federal poverty line, FPL); lower-income, ineligible non-participants (no SNAP + family income >130% - ≤300% of FPL); higher-income ineligible non-participants (no SNAP + family income >300% FPL). UPF (% of total daily kcal) across eight survey cycles was examined using multivariable linear regression, stratified by SNAP participation status. Heterogeneous trends across SNAP participation status were tested by Wald F models. Trends were examined for UPF purchased from different venues. Analyses were conducted in youths (ages 1-19) and adults (≥ 20), separately.
Results:
The sample included 54979 participants from 2003-2004 through 2017-2018. The % of energy from UPF increased over time in both youth (Δ
2018-2003
, 4.3%; 95% CI, 2.9% - 5.8%; P
linear trend
< .001) and adults (Δ
2018-2003
, 2.5%; 95% CI, 0.2% - 4.9%; P
linear trend
= .002). There were no differences between SNAP participants, income-eligible non-participants, lower-income ineligible and higher-income non-participants. The mean contribution of UPF from SNAP-eligible venues decreased in both youth (Δ
2018-2003
, -2.6%; 95% CI, -6.1% - 0.9%; P
linear trend
= .001) and adults (Δ
2018-2003
, -2.3%; 95% CI, -5.0% - 0.8%; P
cubic trend
< .001) with no differences by SNAP participation. UPF purchases from fast-food restaurants increased in youth (Δ
2018-2003
, 2.2%; 95% CI, -0.4% - 4.8%; P
quadratic trend
= .036) and adults (Δ
2018-2003
, 2.9%; 95% CI, 0.6% - 5.1%; P
cubic trend
= .007), while those from schools remained unchanged. There were no differences by SNAP participation status.
Conclusions:
Total UPF consumption increased between 2003-2004 and 2017-2018 and were seen among both participants of SNAP and among income-eligible and ineligible non-participants. UPF were increasingly sourced from SNAP ineligible venues. SNAP benefit allotments should account for secular changes in dietary patterns by enabling the purchase of healthier processed and prepared foods.
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Gomes Gonçalves N, Vidal Ferreira N, Khandpur N, Martinez Steele E, Bertazzi Levy R, Andrade Lotufo P, Bensenor IM, Caramelli P, Alvim de Matos SM, Marchioni DM, Suemoto CK. Association Between Consumption of Ultraprocessed Foods and Cognitive Decline. JAMA Neurol 2023; 80:142-150. [PMID: 36469335 PMCID: PMC9857155 DOI: 10.1001/jamaneurol.2022.4397] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/07/2022] [Indexed: 12/12/2022]
Abstract
Importance Although consumption of ultraprocessed food has been linked to higher risk of cardiovascular disease, metabolic syndrome, and obesity, little is known about the association of consumption of ultraprocessed foods with cognitive decline. Objective To investigate the association between ultraprocessed food consumption and cognitive decline in the Brazilian Longitudinal Study of Adult Health. Design, Setting, and Participants This was a multicenter, prospective cohort study with 3 waves, approximately 4 years apart, from 2008 to 2017. Data were analyzed from December 2021 to May 2022. Participants were public servants aged 35 to 74 years old recruited in 6 Brazilian cities. Participants who, at baseline, had incomplete food frequency questionnaire, cognitive, or covariate data were excluded. Participants who reported extreme calorie intake (<600 kcal/day or >6000 kcal/day) and those taking medication that could negatively interfere with cognitive performance were also excluded. Exposures Daily ultraprocessed food consumption as a percentage of total energy divided into quartiles. Main Outcomes and Measures Changes in cognitive performance over time evaluated by the immediate and delayed word recall, word recognition, phonemic and semantic verbal fluency tests, and Trail-Making Test B version. Results A total of 15 105 individuals were recruited and 4330 were excluded, leaving 10 775 participants whose data were analyzed. The mean (SD) age at the baseline was 51.6 (8.9) years, 5880 participants (54.6%) were women, 5723 (53.1%) were White, and 6106 (56.6%) had at least a college degree. During a median (range) follow-up of 8 (6-10) years, individuals with ultraprocessed food consumption above the first quartile showed a 28% faster rate of global cognitive decline (β = -0.004; 95% CI, -0.006 to -0.001; P = .003) and a 25% faster rate of executive function decline (β = -0.003, 95% CI, -0.005 to 0.000; P = .01) compared with those in the first quartile. Conclusions and Relevance A higher percentage of daily energy consumption of ultraprocessed foods was associated with cognitive decline among adults from an ethnically diverse sample. These findings support current public health recommendations on limiting ultraprocessed food consumption because of their potential harm to cognitive function.
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Affiliation(s)
| | - Naomi Vidal Ferreira
- Adventist University of São Paulo, Engenheiro Coelho, Brazil
- Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
| | - Neha Khandpur
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Renata Bertazzi Levy
- Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Paulo Andrade Lotufo
- Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, Brazil
| | - Isabela M. Bensenor
- Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, Brazil
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Research Unit, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Dirce M. Marchioni
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
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Zhang Z, Kahn HS, Jackson SL, Steele EM, Gillespie C, Yang Q. Associations between ultra- or minimally processed food intake and three adiposity indicators among US adults: NHANES 2011 to 2016. Obesity (Silver Spring) 2022; 30:1887-1897. [PMID: 35924441 PMCID: PMC10083896 DOI: 10.1002/oby.23507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/16/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Ultraprocessed food (UPF) intake is associated with BMI, but effects on regional adipose depots or related to minimally processed food (MPF) intake are unknown. METHODS Data included 12,297 adults in the National Health and Nutrition Examination Survey (NHANES), 2011 to 2016. This study analyzed associations between usual percentage of kilocalories from UPFs and MPFs and three adiposity indicators: supine sagittal abdominal diameter to height ratio (SADHtR, estimates visceral adiposity); waist circumference to height ratio (WHtR, estimates abdominal adiposity); and BMI, using linear and multinomial logistic regression. RESULTS Standardized β coefficients per 10% increase in UPF intake were 0.0926, 0.0846, and 0.0791 for SADHtR, WHtR, and BMI, respectively (all p < 0.001; p > 0.26 for pairwise differences). For MPF intake, the β coefficients were -0.0901, -0.0806, and -0.0688 (all p < 0.001; p > 0.18 pairwise). Adjusted odds ratios (95% CI) for adiposity tertile 3 versus tertile 1 (comparing UPF intake quartiles 2, 3, and 4 to quartile 1) were 1.33 (1.22-1.45), 1.67 (1.43-1.95), and 2.24 (1.76-2.86), respectively, for SADHtR; 1.31 (1.19-1.44), 1.62 (1.37-1.91), and 2.13 (1.63-2.78), respectively, for WHtR; and 1.27 (1.16-1.39), 1.53 (1.31-1.79), and 1.96 (1.53-2.51), respectively, for BMI. MPF intake showed inverse associations with similar trends in association strength. CONCLUSIONS Among US adults, abdominal and visceral adiposity indictors were positively associated with UPFs and inversely associated with MPFs.
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Affiliation(s)
- Zefeng Zhang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Henry S Kahn
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Euridice Martinez Steele
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | - Cathleen Gillespie
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Quanhe Yang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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9
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R Cardoso B, Machado P, Steele EM. Association between ultra-processed food consumption and cognitive performance in US older adults: a cross-sectional analysis of the NHANES 2011-2014. Eur J Nutr 2022; 61:3975-3985. [PMID: 35778619 DOI: 10.1007/s00394-022-02911-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/09/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE This study evaluated the association between ultra-processed food (UPF) consumption and cognitive performance among older US adults. METHODS This cross-sectional study assessed 3632 participants aged 60+ years from the National Health and Nutrition Examination Survey (NHANES) 2011-14. Cognitive performance was assessed using the Consortium to Establish a Registry for Alzheimer's Disease (CERAD), Word Learning test, Animal Fluency test, and the Digit Symbol Substitution test (DSST). Dietary intake was assessed using two 24-h diet recalls. Food items were classified according to the NOVA system, a classification based on the nature, extent, and purpose of industrial food processing. Linear regression models were used to evaluate the association of dietary share of UPF (% of daily energy intake) (categorized as tertiles) and cognitive test scores, adjusting for socio-demographic variables, physical activity, smoking status, and chronic diseases (cardiovascular diseases, diabetes, and depression). Models excluding participants with pre-existing diseases were carried out to address potential reverse causality. RESULTS On average, UPF accounted for 53% of total energy intake, ranging from 33 to 70% across extreme tertiles. Inverted U-shape association between UPF consumption and Animal fluency and DSST was observed. No significant associations were observed between the UPF intake tertiles and the cognitive test results. Nonetheless, UPF consumption was significantly associated with worse performance in Animal Fluency in older adults without pre-existing diseases (P < 0.05). CONCLUSION UPF consumption was associated with worse performance in Animal Fluency among older people without pre-existing diseases. Decreasing UPF consumption may be a way to improve impaired cognition among older adults.
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Affiliation(s)
- Barbara R Cardoso
- Department of Nutrition, Dietetics and Food, Monash University, 264 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia.
| | - Priscila Machado
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, VIC, Australia
| | - Euridice Martinez Steele
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, Av. Dr. Arnaldo, 715, São Paulo, 01246-907, Brazil. .,Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil.
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Garzillo JMF, Poli VFS, Leite FHM, Steele EM, Machado PP, Louzada MLDC, Levy RB, Monteiro CA. Ultra-processed food intake and diet carbon and water footprints: a national study in Brazil. Rev Saude Publica 2022; 56:6. [PMID: 35239844 PMCID: PMC8859933 DOI: 10.11606/s1518-8787.2022056004551] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE To study the association between ultra-processed food consumption and carbon and water footprints of the Brazilian diet. METHODS Cross-sectional analysis on data collected in 2008–2009 on a probabilistic sample of the Brazilian population aged ≥ 10 years (n = 32,886). Individual food intake was assessed using two 24-hour food records, on non-consecutive days. The environmental impact of individual diets was calculated by multiplying the amount of each food by coefficients that quantify the atmospheric emissions of greenhouse gases in grams of carbon dioxide equivalent (carbon footprint) and freshwater use in liters (water footprint), both per gram or milliliter of food. The two coefficients consider the food life cycle ‘from farm to fork.’ Crude and adjusted linear regression models and tests for linear trends assessed the association between the ultra-processed food contribution to total energy intake (quintiles) and the diet carbon and water footprints. Potential confounders included age, sex, education, income, and region. Total energy intake was assessed as a potential mediation variable. RESULTS In the crude models, the dietary contribution of ultra-processed foods was linearly associated with the carbon and water footprints of the Brazilian diet. After adjustment for potential confounders, the association remained significant only regarding the diet water footprint, which increased by 10.1% between the lowest and highest quintile of the contribution of ultra-processed foods. Additional adjustment for total energy intake eliminated this association indicating that the dietary contribution of ultra-processed foods increases the diet water footprint by increasing energy intake. CONCLUSIONS The negative impact of ultra-processed foods on the diet water footprint, shown for the first time in this study, adds to the negative impacts of these foods, already demonstrated regarding dietary nutrient profiles and the risk for several chronic non-communicable diseases. This reinforces the recommendation to avoid ultra-processed foods made in the official Brazilian Dietary Guidelines and increasingly in dietary guidelines of other countries.
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Affiliation(s)
| | | | | | - Euridice Martinez Steele
- Universidade de São Paulo. Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde. São Paulo, SP, Brasil
| | | | - Maria Laura da Costa Louzada
- Universidade de São Paulo. Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde. São Paulo, SP, Brasil.,Universidade de São Paulo. Faculdade de Saúde Pública. Departamento de Nutrição. São Paulo, SP, Brasil
| | - Renata Bertazzi Levy
- Universidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Preventiva. São Paulo, SP, Brasil
| | - Carlos Augusto Monteiro
- Universidade de São Paulo. Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde. São Paulo, SP, Brasil.,Universidade de São Paulo. Faculdade de Saúde Pública. Departamento de Nutrição. São Paulo, SP, Brasil
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11
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Zhang Z, Jackson SL, Steele EM, Gillespie C, Yang Q. Relationship Between Ultraprocessed Food Intake and Cardiovascular Health Among U.S. Adolescents: Results From the National Health and Nutrition Examination Survey 2007-2018. J Adolesc Health 2022; 70:249-257. [PMID: 34716093 PMCID: PMC10063320 DOI: 10.1016/j.jadohealth.2021.09.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/14/2021] [Accepted: 09/22/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Studies of the association between ultraprocessed foods (UPF) and cardiovascular disease risk factors have been mainly focused on the adult population. This study examined the association between usual percentage of calories (%kcal) from UPF and the American Heart Association's seven cardiovascular health (CVH) metrics among U.S. adolescents aged 12-19 years. METHODS We used data from the National Health and Nutrition Examination Survey 2007-2018 (n = 5,565). The NOVA food system was used to classify UPF according to the extent and purpose of food processing. Each CVH metric was given a score of 0, 1, or 2 (poor, intermediate, or ideal health, respectively). Scores of six metrics were summed (excluding diet) to categorize CVH as low (0-7), moderate (8-10), or high (11-12). The National Cancer Institute's methods were used to estimate usual %kcal from UPF. Multivariable linear regression and multinomial logistic regression were used to evaluate the association between UPF and CVH. RESULTS Among youth, 12.1% had low CVH, 56.3% moderate, and 31.6% high. The mean usual %kcal from UPF was 65.7%. Every 5% increase in calories from UPF was associated with .13 points lower CVH scores (p < .001). Comparing Q2, Q3, and Q4 to Q1 of UPF intake, the adjusted odds ratios for low versus high CVH were 1.43 (95% confidence interval 1.16-1.76), 1.86 (1.29-2.66), and 2.59 (1.49-4.55), respectively. The pattern of association was largely consistent across subgroups. CONCLUSIONS U.S. adolescents consume about two thirds of daily calorie from UPF. There was a graded inverse association between %kcal from UPF and CVH score.
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Affiliation(s)
- Zefeng Zhang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Euridice Martinez Steele
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil; Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | - Cathleen Gillespie
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Quanhe Yang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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12
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Livingston AS, Cudhea F, Wang L, Steele EM, Du M, Wang YC, Pomeranz J, Mozaffarian D, Zhang FF. Effect of reducing ultraprocessed food consumption on obesity among US children and adolescents aged 7-18 years: evidence from a simulation model. BMJ Nutr Prev Health 2022; 4:397-404. [PMID: 35028511 PMCID: PMC8718854 DOI: 10.1136/bmjnph-2021-000303] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 06/14/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Children and adolescents in the USA consume large amounts of daily calories from ultraprocessed foods (UPFs). Recent evidence links UPF consumption to increased body fat in youth. We aimed to estimate the potential impact of reducing UPF consumption on childhood obesity rate in the USA. METHODS We developed a microsimulation model to project the effect of reducing UPF consumption in children's diet on reducing the prevalence of overweight or obesity among US youth. The model incorporated nationally representative data on body mass index (BMI) percentile and dietary intake of 5804 children and adolescents aged 7-18 years from the National Health and Nutrition Examination Survey 2011-2016, and the effect of reducing UPF consumption on calorie intake from a recent randomised controlled trial. Uncertainties of model inputs were incorporated using probabilistic sensitivity analysis with 1000 simulations. RESULTS Reducing UPFs in children's diet was estimated to result in a median of -2.09 kg/m2 (95% uncertainty interval -3.21 to -0.80) reduction in BMI among children and adolescents aged 7-18 years. The median prevalence of overweight (BMI percentile ≥85th) and obesity (BMI percentile ≥95th percentile) was reduced from 37.0% (35.9%, 38.1%) to 20.9% (15.1%, 29.9%) and from 20.1% (19.2%, 21.0%) to 11.0% (7.86%, 15.8%), respectively. Larger BMI and weight reductions were seen among boys than girls, adolescents than children, non-Hispanic black and Hispanic youth than non-Hispanic white youth, and those with lower levels of parental education and family income. CONCLUSIONS Reducing UPF consumption in children's diet has the potential to substantially reduce childhood obesity rate among children and adolescents in the USA.
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Affiliation(s)
- Anne Scott Livingston
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Frederick Cudhea
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Lu Wang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Euridice Martinez Steele
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil.,Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | - Mengxi Du
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Y Claire Wang
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Jennifer Pomeranz
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York, USA
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.,Tufts Institute for Global Obesity Research, Boston, Massachusetts, USA
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13
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Garzillo JMF, Machado PP, Leite FHM, Steele EM, Poli VFS, Louzada MLDC, Levy RB, Monteiro CA. Carbon footprint of the Brazilian diet. Rev Saude Publica 2021; 55:90. [PMID: 34910024 PMCID: PMC8621484 DOI: 10.11606/s1518-8787.2021055003614] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To estimate the carbon footprint of the Brazilian diet and of sociodemographic strata of this population. METHODS Carbon footprint of the diet was estimated based on data from two 24-hour diet records, obtained in 2008 and 2009, from a probabilistic sample of the Brazilian population aged 10 years and over (n = 34,003) and on environmental impact coefficients of food and culinary preparations consumed in Brazil (gCO2e/kg). Means with 95% confidence intervals of food consumption (kcal/person/day) and the carbon footprint of the diet (gCO2e/person/day and in gCO2e/2,000kcal) were calculated for the population as a whole and for strata according to sex, age, income, education, macro-regions and Federative Unit. Linear regression models were used to identify significant differences (p < 0.05) in the dietary carbon footprint of different sociodemographic strata. RESULTS The average carbon footprint of the Brazilian diet was 4,489gCO2e/person/day. It was higher for males, for the age group from 20 to 49 years and for the North and Midwest regions, and tended to increase with income and education. The pattern of association of footprint with sociodemographic variables did not change substantially with adjustment for differences in the amount of food consumed, except for a reduction in the relative excess of the footprint among males and an increase in the relative excess of the footprint in the Midwest region. CONCLUSION The carbon footprint of the Brazilian diet exceeds by about 30% the footprint of the human diet, which could simultaneously meet the nutritional requirements of a healthy diet and the global goal of containing the increase in the planet's average temperature. The pattern of association of this footprint with sociodemographic variables can help identify priority targets for public actions aimed at reducing the environmental impacts of food consumption in Brazil.
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Affiliation(s)
| | | | | | - Euridice Martinez Steele
- Universidade de São Paulo. Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde. São Paulo, SP, Brasil
| | | | | | - Renata Bertazzi Levy
- Universidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Preventiva. São Paulo, SP, Brasil
| | - Carlos Augusto Monteiro
- Universidade de São Paulo. Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde. São Paulo, SP, Brasil
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14
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Yang Q, Zhang Z, Steele EM, Moore LV, Jackson SL. Ultra-Processed Foods and Excess Heart Age Among U.S. Adults. Am J Prev Med 2020; 59:e197-e206. [PMID: 33012621 PMCID: PMC10924299 DOI: 10.1016/j.amepre.2020.06.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION A high percentage of total calories from ultra-processed foods has been associated with several cardiovascular disease risk factors. No study has examined the association between ultra-processed foods and heart age. This study examines the association between ultra-processed foods and excess heart age (difference between estimated heart age and chronological age) among U.S. adults. METHODS The National Health and Nutrition Examination Survey (2009-2016) data for participants aged 30-74 years without cardiovascular disease or stroke (n=12,640) was used. Ultra-processed food was assigned based on NOVA classification of food processing, with ultra-processed food being the highest level. This study estimated the usual percentage of calories from ultra-processed foods and used sex-specific Framingham heart age algorithms to calculate heart age. The multivariable linear or logistic regression was used to examine the association between ultra-processed foods and excess heart age or likelihood of excess heart age being ≥10 years. Data analyses were conducted in 2020. RESULTS The median usual percentage of calories from ultra-processed foods was 54.5% (IQR=45.8%‒63.1%). Adjusted excess heart age increased from 7.0 years (95% CI=6.4, 7.6) in the lowest quintile (Q1) to 9.9 years (95% CI=9.2, 10.5) in the highest quintile (Q5) (p<0.001). Compared with Q1, AORs for excess heart age of ≥10 years were 1.16 (95% CI=1.08, 1.25) in Q2, 1.29 (95% CI=1.14, 1.46) in Q3, 1.43 (95% CI=1.20, 1.71) in Q4, and 1.66 (95% CI=1.29, 2.14) in Q5 (p<0.001). The pattern of association was largely consistent across subgroups. CONCLUSIONS U.S. adults consumed more than half of total daily calories from ultra-processed foods. A higher percentage of calories from ultra-processed foods was associated with higher excess heart age and likelihood of excess heart age of ≥10 years.
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Affiliation(s)
- Quanhe Yang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Zefeng Zhang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Euridice Martinez Steele
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil; Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | - Latetia V Moore
- Division of Nutrition Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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15
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Rauber F, Louzada MLDC, Martinez Steele E, Rezende LFMD, Millett C, Monteiro CA, Levy RB. Ultra-processed foods and excessive free sugar intake in the UK: a nationally representative cross-sectional study. BMJ Open 2019; 9:e027546. [PMID: 31662351 PMCID: PMC6830631 DOI: 10.1136/bmjopen-2018-027546] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES To describe dietary sources of free sugars in different age groups of the UK population considering food groups classified according to the NOVA system and to estimate the proportion of excessive free sugars that could potentially be avoided by reducing consumption of their main sources. DESIGN AND SETTING Cross-sectional data from the UK National Diet and Nutrition Survey (2008-2014) were analysed. Food items collected using a 4-day food diary were classified according to the NOVA system. PARTICIPANTS 9364 individuals aged 1.5 years and above. MAIN OUTCOME MEASURES Average dietary content of free sugars and proportion of individuals consuming more than 10% of total energy from free sugars. DATA ANALYSIS Poisson regression was used to estimate the associations between each of the NOVA food group and intake of free sugars. We estimated the per cent reduction in prevalence of excessive free sugar intake from eliminating ultra-processed foods and table sugar. Analyses were stratified by age group and adjusted for age, sex, ethnicity, survey year, region and equivalised household income (sterling pounds). RESULTS Ultra-processed foods account for 56.8% of total energy intake and 64.7% of total free sugars in the UK diet. Free sugars represent 12.4% of total energy intake, and 61.3% of the sample exceeded the recommended limit of 10% energy from free sugars. This percentage was higher among children (74.9%) and adolescents (82.9%). Prevalence of excessive free sugar intake increased linearly across quintiles of ultra-processed food consumption for all age groups, except among the elderly. Eliminating ultra-processed foods could potentially reduce the prevalence of excessive free sugar intake by 47%. CONCLUSION Our findings suggest that actions to reduce the ultra-processed food consumption generally rich in free sugars could lead to substantial public health benefits.
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Affiliation(s)
- Fernanda Rauber
- Departamento de Nutrição, Universidade de Sao Paulo, Sao Paulo, Brazil
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Maria Laura da Costa Louzada
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de Sao Paulo, Sao Paulo, Brazil
- Departamento de Políticas Públicas e Saúde Coletiva, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Euridice Martinez Steele
- Departamento de Nutrição, Universidade de Sao Paulo, Sao Paulo, Brazil
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Leandro F M de Rezende
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de Sao Paulo, Sao Paulo, Brazil
- Escola Paulista de Medicina, Departamento de Medicina Preventiva, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Christopher Millett
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de Sao Paulo, Sao Paulo, Brazil
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Carlos A Monteiro
- Departamento de Nutrição, Universidade de Sao Paulo, Sao Paulo, Brazil
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Renata B Levy
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de Sao Paulo, Sao Paulo, Brazil
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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16
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Baraldi LG, Martinez Steele E, Canella DS, Monteiro CA. Consumption of ultra-processed foods and associated sociodemographic factors in the USA between 2007 and 2012: evidence from a nationally representative cross-sectional study. BMJ Open 2018; 8:e020574. [PMID: 29525772 PMCID: PMC5855172 DOI: 10.1136/bmjopen-2017-020574] [Citation(s) in RCA: 215] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/05/2018] [Accepted: 01/31/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To compare ultra-processed food consumption across sociodemographic groups and over time (2007-2008, 2009-2010, 2011-2012) in the USA. DESIGN Cross-sectional study. SETTING National Health and Nutrition Examination Survey (NHANES) 2007-2012. PARTICIPANTS All individuals aged ≥2 years with at least one 24-hour dietary recall were included (n=23 847). MAIN OUTCOME MEASURES Average dietary contribution of ultra-processed foods (expressed as a percentage of the total caloric value of the diet), obtained after classifying all food items according to extent and purpose of industrial food processing using NOVA classification. DATA ANALYSIS Linear regression was used to evaluate the association between sociodemographic characteristics or NHANES cycles and dietary contribution of ultra-processed foods. RESULTS Almost 60% of calories consumed in the period 2007-2012 came from ultra-processed foods. Consumption of ultra-processed foods decreased with age and income level, was higher for non-Hispanic whites or non-Hispanic blacks than for other race/ethnicity groups and lower for people with college than for lower levels of education, all differences being statistically significant. Overall contribution of ultra-processed foods increased significantly between NHANES cycles (nearly 1% point per cycle), the same being observed among males, adolescents and high school education-level individuals. CONCLUSIONS Ultra-processed food consumption in the USA in the period 2007-2012 was overall high, greater among non-Hispanic whites or non-Hispanic blacks, less educated, younger, lower-income strata and increased across time.
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Affiliation(s)
- Larissa Galastri Baraldi
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | - Euridice Martinez Steele
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | - Daniela Silva Canella
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
- Department of Applied Nutrition, Institute of Nutrition, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Carlos Augusto Monteiro
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
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17
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Louzada MLDC, Baraldi LG, Steele EM, Martins APB, Canella DS, Moubarac JC, Levy RB, Cannon G, Afshin A, Imamura F, Mozaffarian D, Monteiro CA. Consumption of ultra-processed foods and obesity in Brazilian adolescents and adults. Prev Med 2015; 81:9-15. [PMID: 26231112 DOI: 10.1016/j.ypmed.2015.07.018] [Citation(s) in RCA: 346] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 07/17/2015] [Accepted: 07/21/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the relationship between the consumption of ultra-processed foods and obesity indicators among Brazilian adults and adolescents. METHODS We used cross-sectional data on 30,243 individuals aged ≥10 years from the 2008-2009 Brazilian Dietary Survey. Food consumption data were collected through 24-h food records. We classified food items according to characteristics of food processing. Ultra-processed foods were defined as formulations made by the food industry mostly from substances extracted from foods or obtained with the further processing of constituents of foods or through chemical synthesis, with little if any whole food. Examples included candies, cookies, sugar-sweetened beverages, and ready-to-eat dishes. Regression models were fitted to evaluate the association of the consumption of ultra-processed foods (% of energy intake) with body-mass-index, excess weight, and obesity status, controlling for socio-demographic characteristics, smoking, and physical activity. RESULTS Ultra-processed foods represented 30% of the total energy intake. Those in the highest quintile of consumption of ultra-processed foods had significantly higher body-mass-index (0.94 kg/m(2); 95% CI: 0.42,1.47) and higher odds of being obese (OR=1.98; 95% CI: 1.26,3.12) and excess weight (OR=1.26; 95% CI: 0.95,1.69) compared with those in the lowest quintile of consumption. CONCLUSION Our findings support the role of ultra-processed foods in the obesity epidemic in Brazil.
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Affiliation(s)
- Maria Laura da Costa Louzada
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, Av. Dr. Arnaldo, 715, 2° floor, São Paulo 01246-907, Brazil; Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de São Paulo, Av. Dr. Arnaldo, 715, S27, São Paulo 01246-907, Brazil.
| | - Larissa Galastri Baraldi
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, Av. Dr. Arnaldo, 715, 2° floor, São Paulo 01246-907, Brazil; Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de São Paulo, Av. Dr. Arnaldo, 715, S27, São Paulo 01246-907, Brazil.
| | - Euridice Martinez Steele
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, Av. Dr. Arnaldo, 715, 2° floor, São Paulo 01246-907, Brazil; Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de São Paulo, Av. Dr. Arnaldo, 715, S27, São Paulo 01246-907, Brazil.
| | - Ana Paula Bortoletto Martins
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de São Paulo, Av. Dr. Arnaldo, 715, S27, São Paulo 01246-907, Brazil.
| | - Daniela Silva Canella
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de São Paulo, Av. Dr. Arnaldo, 715, S27, São Paulo 01246-907, Brazil.
| | - Jean-Claude Moubarac
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de São Paulo, Av. Dr. Arnaldo, 715, S27, São Paulo 01246-907, Brazil.
| | - Renata Bertazzi Levy
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de São Paulo, Av. Dr. Arnaldo, 715, S27, São Paulo 01246-907, Brazil; Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455, S27, São Paulo 01246-903, Brazil.
| | - Geoffrey Cannon
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de São Paulo, Av. Dr. Arnaldo, 715, S27, São Paulo 01246-907, Brazil.
| | - Ashkan Afshin
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, United States.
| | - Fumiaki Imamura
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0SP, UK.
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, United States.
| | - Carlos Augusto Monteiro
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, Av. Dr. Arnaldo, 715, 2° floor, São Paulo 01246-907, Brazil; Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de São Paulo, Av. Dr. Arnaldo, 715, S27, São Paulo 01246-907, Brazil.
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18
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Bernetti R, Owen R, Harness J, Holme RA, Hovden R, Owen RL, Schopmeyer HH, Steele EM, Wolff P. Titratable Acidity in Corn Syrup: Collaborative Study. J AOAC Int 1983. [DOI: 10.1093/jaoac/66.6.1395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Six sets of blind duplicate samples of commercial corn syrups, including high fructose corn syrups, were distributed to 9 collaborating laboratories. Samples were titrated with alkali, according to the AOAC method, to a phenolphthalein "faint pink" end point as well as being assayed by a modified method specifying a larger sample, more dilute alkali, and electrometric end points at pH 6.0,7.0, and 8.3. Repeatabilities and reproducibilities were about as poor in the AOAC method as in the modified method at pH 8.3, but improved considerably when the modified electrometric end point method was carried out to pH 6.0. The method calling for electrometric titratable acidity at pH 6.0 end point was adopted official first action, and the present method, 31.217, was deleted.
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Affiliation(s)
- Raffaele Bernetti
- Corn Refiners Association, 1001 Connecticut Ave, NW, Washington, DC 20036
| | - Roger Owen
- Corn Refiners Association, 1001 Connecticut Ave, NW, Washington, DC 20036
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