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

BACKGROUND & AIMS: Ultra-processed food (UPF) intake has increased sharply over the last few decades and has been consistently asserted to be implicated in the development of non-communicable diseases. We aimed to evaluate and update the existing observational evidence for associations between ultra-processed food (UPF) consumption and human health. METHODS: We searched Medline and Embase from inception to March 2023 to identify and update meta-analyses of observational studies examining the associations between UPF consumption, as defined by the NOVA classification, and a wide spectrum of health outcomes. For each health outcome, we estimated the summary effect size, 95% confidence interval (CI), between-study heterogeneity, evidence of small-study effects, and evidence of excess-significance bias. These metrics were used to evaluate evidence credibility of the identified associations. RESULTS: This umbrella review identified 39 meta-analyses on the associations between UPF consumption and health outcomes. We updated all meta-analyses by including 122 individual articles on 49 unique health outcomes. The majority of the included studies divided UPF consumption into quartiles, with the lowest quartile being the reference group. We identified 25 health outcomes associated with UPF consumption. For observational studies, 2 health outcomes, including renal function decline (OR: 1.25; 95% CI: 1.18, 1.33) and wheezing in children and adolescents (OR: 1.42; 95% CI: 1.34, 1.49), showed convincing evidence (Class I); and five outcomes were reported with highly suggestive evidence (Class II), including diabetes mellitus, overweight, obesity, depression, and common mental disorders. CONCLUSIONS: High UPF consumption is associated with an increased risk of a variety of chronic diseases and mental health disorders. At present, not a single study reported an association between UPF intake and a beneficial health outcome. These findings suggest that dietary patterns with low consumption of UPFs may render broad public health benefits.

Impact of a Special Operations Forces Basic Training on Body Composition and Energy Expenditure.

INTRODUCTION: The Belgian Special Operations Regiment undergoes an 8-week basic training course (SOF Basic Course) following the Military Initiation Phase. The aims of the present study were to estimate energy expenditure and changes in body composition during SOF Basic Course. MATERIALS AND METHODS: A multi frequency body composition analyser assessed baseline and endpoint body composition. For the purpose of estimating energy expenditure, 41 participants were fitted with triaxial accelerometers. T-tests were performed on paired and unpaired samples in order to estimate statistical significance. Effect size was estimated with Cohen's d. RESULTS: SOF Basic Course was completed by 88 out of 126 participants. The participants' mean (SD) age was 25.0 (4.1) years, weight was 77.6 (8.6) kg, and body fat percentage was 15.3% (3.3). Body weight of completers decreased from 78.3 (8.8) kg to 76.4 (8.0) kg (P = 0.01). Also, body fat decreased by 3.1 (1.8) kg (P = 0.01), and muscle mass increased by 1.2 (1.7) kg (P = 0.01). There was a decrease in body fat percentage from 15.3% (3.3) to 11.6% (3.4) (P = 0.01), with a Cohen's effect size of 1.86.The loss of 3.1 kg of body fat corresponds to a loss of 21,700.0 kcal (90.3 MJ) or 362.0 kcal.d-1 (1.5 MJ.d-1). The mean (SD) energy expenditure by physical activity was 1,943.0 (653.8) kcal.d-1 (14.6 [2.7] MJ.d-1). The average (SD) total energy expenditure was 4,088.0 (710.0) kcal.d-1 (36.8 [3.8] MJ.d-1). CONCLUSION: Tactical athletes must perform in hypo-energetic environment. Research in the future should investigate the impact of increased energy intake on body composition.

East-Greenland traditional nutrition: a reanalysis of the Høygaard et al. nutritional data (1936-1937).

Greenlandic traditional nutrition was unique in the arctic environment. The aim of the present study was to reanalyse the Høygaard et al. data, focusing on two micronutrients object of discussion, i.e. Ca and vitamin C. Høygaard et al. left Copenhagen in August 1936 and stayed in East-Greenland until August 1937. The members of the expedition recorded nutritional intake whilst residing in families. However, the nutritional intake was analysed on a household level. In total, thirty-five adults and fourty-one children participated. Median total energy expenditure in kcal per d was estimated at 2978 and 2627 for male and female adults, respectively, and 1997 for children and adolescents. Median (IQR) energy consumption in kcal per d was 3881 (1568) for male and 2910 (882) for female adults. This was 2442 (857) and 2023 (1122) for male and female children and adolescents. Median (IQR) Ca intake in mg.d-1 was 555 (1110) for male and 484 (883) for female adults. This was 458 (747) and 358 (838) for male and female children and adolescents. Median (IQR) vitamin C intake in mg.d-1 was 79 (77) for male and 59 (56) for female adults. This was 44 (47) and 60 (52) for male and female children and adolescents. In this study, the importance of traditional foods in reaching an acceptable energy balance was emphasised, together with the confirmation of a low Ca intake in East-Greenland traditional dietary pattern, and the important role of algae consumption in Inuit traditional dietary pattern to avoid scurvy.

Do psychological factors relate to movement-evoked pain in people with musculoskeletal pain? A systematic review and meta-analysis.

BACKGROUND: A growing body of evidence has demonstrated the importance of implementing movement-evoked pain in conventional pain assessments, with a significant role for psychological factors being suggested. Whether or not to include these factors in the assessment of movement-evoked pain has not yet been determined. OBJECTIVES: The aim of this systematic review is to explore the association between psychological factors and movement-evoked pain scores in people with musculoskeletal pain. METHODS: For this systematic review with meta-analysis, four electronic databases (PubMed, Medline, WOS, and Scopus) were searched. Cross-sectional studies, longitudinal cohort studies, and randomized controlled trials investigating the association between movement-evoked pain and psychological factors in adults with musculoskeletal pain were considered. Meta-analysis was conducted for outcomes with homogeneous data from at least 2 studies. Fischer-Z transformations were used as the measure of effect. Quality of evidence was assessed using the National Institutes of Health's Quality assessment tool for observational cohort and cross-sectional studies and Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. RESULTS: Meta-analyses and grading the quality of evidence revealed moderate evidence for a relation between movement-evoked pain and depressive symptoms (Fisher-z=0.27; 95%CI: 0.17, 0.36; 5 studies (n=440)), pain-related fear (Fisher-z=0.35; 95%CI: 0.26, 0.44; 6 studies (n=492)), and pain catastrophizing (Fisher-z=0.47; 95%CI: 0.36, 0.58; 4 studies (n=312)) in people with musculoskeletal pain. CONCLUSIONS: Movement-evoked pain is weakly to moderately associated to depressive symptoms, pain-related fear, and pain catastrophizing in people with musculoskeletal pain.

Plant-based dietary patterns in Flemish adults: a 10-year trend analysis.

PURPOSE: Although the beneficial health effects of plant-based dietary patterns are evident, it is not clear if population-wide dietary patterns are shifting in a more plant-based direction. This study evaluated trends in dietary patterns among Flemish adults over a 10-year period. Furthermore, differences in socio-demographic characteristics between different dietary pattern groups were explored. METHODS: A time series design, during which five different representative cohorts (2011, 2013, 2016, 2018 and 2020; N = 4859) were surveyed through an online questionnaire, was used to evaluate trends in dietary patterns over the past decade. RESULTS: Findings show that the vast majority of participants were omnivorous as measured at the different time points. The proportion of flexitarians increased over time, while the opposite was true for omnivores. The proportion of vegetarians and vegans, on the other hand, remained stable. Eating more plant-based diet was associated with female sex, younger age, higher education and living in urban areas. CONCLUSIONS: In contrast to the stricter plant-based dietary patterns, a modest shift from the omnivorous towards the flexitarian dietary pattern was observed over the past decennium in the Flemish adult population. Campaigns might benefit from targeting older and lower educated male living in rural areas.

Vitamin C in East-Greenland traditional nutrition: a reanalysis of the Høygaard nutritional data (1936-1937).

Greenlandic traditional nutrition was an almost exclusive meat dietary pattern. Høygaard et al. stayed in East-Greenland between August 1936 and August 1937. The four members of the expedition resided in Tasisaq and recorded nutritional intake by residing in families. However, data were analysed on a household level. The aim of the present study is to reanalyse the Høygaard et al. data according to modern scientific standards. In total 21 males and 14 females participated. Median (IQR) vitamin C intake was 79 (77) mg.day-1 for males and 59 (56) mg.day-1 for females. Consumption of meat and organs from seals gave 21 mg.d-1 vitamin C, comparable to vitamin C from algae. Narwhal skin and eyes had a marginal contribution to the vitamin C consumption. The number of adults consuming algae during the research days was 67% for males and 71% for females, this was 24% and 21% for narwhal skin. The main conclusions of the present study are the important role of algae consumption in Greenlandic traditional dietary pattern to avoid scurvy, and that foods traditionally seen as important sources of vitamin C like eyes from seals and narwhal skin, played a minor role in meeting the vitamin C requirements.

East-Greenland traditional nutrition: a reanalysis of the Inuit energy balance and the macronutrient consumption from the Høygaard nutritional data (1936-1937).

Greenlandic traditional nutrition was unique in the arctic environment because it was an almost exclusive meat dietary pattern. Høygaard et al. left Copenhagen in August 1936, and stayed in East Greenland until August 1937. The four members of the expedition resided in Tasisaq and visited eight settlements around where nutritional intake was recorded by residing in families. However, the nutritional intake was analysed on a household level. The aim of the present study is to reanalyse the Høygaard et al. data according to modern scientific standards.In total, 21 males and 14 females participated. Median (IQR) energy consumption was 3881 (1568) kcal.day-1 for males and 2910 (882) kcal.day-1 for females. Without the five participants living near trading centres, this was 3268 (219) kcal.day-1 and 2634 (723) kcal.day-1, respectively. Expressed in energy-percent, the macronutrient consumptions were 34% for protein, 37% for fat and 29% for carbohydrates. Without imported food, this was 41%, 49% and 10%, respectively.The main findings of the present study are, as expected, that the food consumed came mainly from traditional hunting, was low in plant foods and extremely low in carbohydrates. The Inuit succeeded to stay in apparently healthy conditions with a traditional meat-based dietary pattern.

Energy Balance and Energy Availability During a Selection Course for Belgian Paratroopers.

INTRODUCTION: Adequate energy supply is a prerequisite for optimal performances and recovery. The aims of the present study were to estimate energy balance and energy availability during a selection course for Belgian paratroopers. METHODS: Energy expenditure by physical activity was measured with accelerometer (ActiGraph GT3X+, ActiGraph LLC, Pensacola, FL, USA) and rest metabolic rate in Cal.d-1 with Tinsley et al.'s equation based on fat-free mass = 25.9 × fat-free mass in kg + 284. Participants had only access to the French individual combat rations of 3,600 Cal.d-1, and body fat mass was measured with quadripolar impedance (Omron BF508, Omron, Osaka, Japan). Energy availability was calculated by the formula: ([energy intake in foods and beverages] - [energy expenditure physical activity])/kg FFM-1.d-1, with FFM = fat-free mass. RESULTS: Mean (SD) age of the 35 participants was 25.1 (4.18) years, and mean (SD) percentage fat mass was 12.0% (3.82). Mean (SD) total energy expenditure, i.e., the sum of rest metabolic rate, dietary-induced thermogenesis, and physical activity, was 5,262 Cal.d-1 (621.2), with percentile 25 at 4,791 Cal.d-1 and percentile 75 at 5,647 Cal.d-1, a difference of 856 Cal.d-1. Mean daily energy intake was 3,600 Cal.d-1, giving a negative energy balance of 1,662 (621.2) Cal.d-1. Mean energy availability was 9.3 Cal.kg FFM-1.d-1. Eleven of the 35 participants performed with a negative energy balance of 2,000 Cal.d-1, and only five participants out of 35 participants performed at a less than 1,000 Cal.d-1 negative energy balance level. CONCLUSIONS: Energy intake is not optimal as indicated by the negative energy balance and the low energy availability, which means that the participants to this selection course had to perform in suboptimal conditions.

Efforts needed for preventing breast and colorectal cancer through changes in dietary patterns.

BACKGROUND: Prospective cohort studies on diet and cancer report risk associations as hazard ratios. But hazard ratios do not inform on the number of people who need to alter their dietary behaviours for preventing cancer. The objective of this study is to estimate the number of people that need to alter their diet for preventing one additional case of female breast or colorectal cancer. METHODS: Based on the largest prospective studies done in the USA and in Europe, we computed the number of subjects who need to alter their diet. RESULTS: For preventing one case of breast cancer, European women should increase their fruit consumption by 100 g/day during 33 000 person-years, and US women by 60 g/day during 10 600 person-years. For vegetables, European women should increase their consumption by 160 g/day during 26 900 person-years and US women by 100 g/day during 19 000 person-years. For preventing one case of colorectal cancer, European subjects should decrease their red meat consumption by 20 g/day during 26 100 person-years, and US subjects by 30 g/day during 8170 person-years. For processed meat, European subjects should decrease their consumption by 20 g/day during 17 400 person-years, and US subjects by 10 g/day during 7940 person-years. CONCLUSIONS: Large number of subjects would need to alter their intake of fruits, vegetables, red and processed meat during many years in order to prevent one additional breast or colorectal cancer.

Nutritional intervention in chronic pain: an innovative way of targeting central nervous system sensitization?

INTRODUCTION: Few treatment programs for chronic pain nowadays take a dietary pattern or adipose status into account. AREAS COVERED: An important role of neuroinflammation in chronic pain is now well established, at least in part due to increased central nervous system glial activation. Based on preclinical studies, it is postulated that the interaction between nutrition and central sensitization is mediated via bidirectional gut-brain interactions. This model of diet-induced neuroinflammation and consequent central sensitization generates a rationale for developing innovative treatments for patients with chronic pain. Methods: An umbrella approach to cover the authors' expert opinion within an evidence-based viewpoint. EXPERT OPINION: A low-saturated fat and low-added sugar dietary pattern potentially decreases oxidative stress, preventing Toll-like receptor activation and subsequent glial activation. A low-saturated fat and low-added sugar diet might also prevent afferent vagal nerve fibers sensing the pro-inflammatory mediators that come along with a high-(saturated) fat or energy-dense dietary pattern, thereby preventing them to signal peripheral inflammatory status to the brain. In addition, the gut microbiota produces polyamines, which hold the capacity to excite N-methyl-D-aspartate receptors, an essential component of the central nervous system sensitization. Hence, a diet reducing polyamine production by the gut microbiota requires exploration as a therapeutic target for cancer-related and non-cancer chronic pain.

Dietary Intake, Hydration Status, and Body Composition of Three Belgian Military Groups.

INTRODUCTION: Malnutrition, suboptimal hydration, and inadequate body composition can have negative consequences on soldiers' performance and health. A recent consensus statement concerning "soldiers' physical performance" points to the scarcity of data in specific military populations. Therefore, the aim of the present study was to assess and compare dietary intake, hydration status, and body composition of three military groups during their specific military training. MATERIALS AND METHODS: Eighty-five soldiers (ie, 21 in a qualification course to join the Special Forces [SF], 22 Infantrymen [Chasseurs Ardennais, CA], and 42 Recruits [REs]) participated in this 3- to 4-day study. Body mass was assessed before and after each study period. All soldiers self-reported their dietary intakes, from which energy and macronutrient intakes were calculated. In addition, their morning urine samples were collected daily to assess urine specific gravity (USG) as a measure of hydration status. Fat mass was estimated at the end of the study using bioelectrical impedance analysis. RESULTS: All groups lost significant amounts of body mass (ie, mean losses ranging between 1.3 and 1.7 kg). Macronutrient intakes were not fully met in respect to the recommendations. Most notably, REs' fat intake was high (ie, 42.3 [±1.6] energy percent [E%]), while their carbohydrate intake was low (ie, 44.5 [±2.1] E%). Furthermore, saturated fat intakes were high among all groups (ie, group means ranging between 13.6 and 21.4 E%). USG values indicated suboptimal hydration status was prevalent in all groups. Most noteworthy, for SF, only 5.4% of the USG values indicated optimal hydration. The average fat mass (%) for SF, CA, and RE was 11.2 (±3.1), 18.8 (±5.1), and 19.4 (±5.0), respectively. CONCLUSION: The present study showed that military men are not always adequately fed nor hydrated. These issues should be resolved by creating nutritional packages, and individual dietary and hydration strategies, all in function of military planning and weather conditions.

Energy availability and nutrition during a Special Force Qualification Course (Q-Course).

INTRODUCTION: The Special Forces (SF) are an elite military group usually engaged in physically demanding field operations, resulting among others in high daily energy requirements. Optimising energy supply and nutritional requirements is therefore mandatory for success. The aim of this study was to estimate energy availability and nutrition during a Qualification Course (Q-Course) for Belgian SF. METHODS: 21 participants recorded all foods and beverages consumed during four days in a structured food diary. Energy expenditure was measured with an accelerometer and fat mass measured with quadripolar impedance. Energy availability was calculated by the following formula: (energy intake by foods and beverages - energy expenditure for physical activity)/kg FFM/day (FFM, fat-free mass). RESULTS: The mean (SD) total energy expenditure was 4926 kcal/day (238), with a minimum of 4645 kcal/day and a maximum of 5472 kcal/day. The mean (SD) total energy consumption was 4186 kcal/day (842), giving an energy balance ranging from -2005 kcal/day to 1113 kcal/day. The mean (SD) energy availability was 17 kcal/kg FFM/day, with a minimum of 1 kcal/kg FFM/day and a maximum of 44 kcal/kg FFM/day. The mean (SD) intake of carbohydrates was 6.8 g/kg body weight/day (1.5). CONCLUSIONS: During this studied Q-Course, energy intake was not optimal as demonstrated by an overall negative energy balance and low energy availability. High interindividual variations in energy intake were found, highlighting the importance of providing SF members nutritional education.

Low 10-year reproducibility of glycaemic index and glycaemic load in a prospective cohort study.

When relating glycaemic index (GI) and glycaemic load (GL) to health outcomes, many prospective cohort studies assess the nutritional exposure only once in time, that is, at the start of the study, presuming a stability in nutritional consumption during the course of the study. The aim of this study is to investigate the reproducibility of GI and GL. This is a prospective cohort study in which 562 middle-aged Belgian adults noted all foods and drinks consumed during 3 d in 2002 and 2012. GI and GL were calculated after reference tables. The Pearson correlation coefficients between 2002 and 2012 were 0·27 for GI and 0·41 for GL. For GI, 33 % of the participants remained in the same quintile between 2002 and 2012, whereas 31 % moved to a non-adjacent quintile. For GL, this was 34 and 28 %, respectively. The lowest and the highest quintiles of GI were the most stable, with 40 and 44 % of the participants staying in the same quintile. This was only 22 % for the fourth quintile. The same tendency was present for GL - that is, the most extreme quintiles were the most stable. This study shows 10-year correlation coefficients for GI and GL below 0·50. Multiple nutritional assessments and limiting the analysis to the extreme quintiles of GI and GL will limit a possible misclassification in the prospective cohort studies owing to the low reproducibility.

The effect of a portion size intervention on French fries consumption, plate waste, satiety and compensatory caloric intake: an on-campus restaurant experiment.

BACKGROUND: One of the driving factors of dietary overconsumption throughout the last decennia is the increase of food portion sizes. Larger portions induce higher daily energy intake, so reducing portion size may reduce intake of excess calories. However, real-life studies about the effects of portion size reduction are lacking. Therefore, this study examined the effect of a French fries portion size reduction on French fries consumption, French fries plate waste, satiety and caloric intake during the subsequent afternoon among university students and employees in a Belgian on-campus restaurant setting. Moreover, this study evaluated consumers' perception about the portion size reduction. METHODS: The study took place over a two-time (i.e. baseline and intervention week) 4-day period (Tuesday-Friday) in the on-campus restaurant where ±1200 meals are served every day. French fries' portions were reduced by 20% by replacing the usual porcelain bowl served during the baseline week (±200 g) with smaller volume paper bags during the intervention week (±159 g) in a pre-post real-life experiment. French fries consumption and plate waste were measured in 2056 consumers at baseline and 2175 consumers at intervention. Additionally, interviews were conducted directly after lunch and again between 4 and 6 p.m. on the same day to assess satiety and caloric intake at pre and post in a small subsample of both French fries consumers (n = 19) and non-French fries consumers (n = 14). Post-intervention, the same subsample was interviewed about their perception of the portion size reduction (n = 28). RESULTS: Total French fries intake decreased by 9.1%, and total plate waste decreased by 66.4%. No differences were found in satiety or caloric intake between baseline and intervention week among the French fries' consumers. The majority (n = 24, 86%) of French fries consumers noticed the reduction in portion size during the intervention. Although most participants (n = 19, 68%) perceived the reduced portion size as sufficient, only a minority of participants (n = 9, 32%) indicated post-intervention that they would agree with a permanent implementation. CONCLUSIONS: Reducing portion size may lead to reduced caloric intake, without changing perceived levels of satiety.

Factors associated with fruit and vegetable and total fat intake in university students: A cross-sectional explanatory study.

AIM: This study assessed sociodemographics, general health, personal and environmental factors associated with fruit and vegetable (F&V) and total fat intake in Belgian university students. METHODS: In total, 185 students completed a self-reported online questionnaire assessing daily F&V and fat intake, as well as sociodemographic, personal and environmental variables related to F&V and fat intake. Mean F&V and fat consumption were compared with Belgian recommendations. Multiple linear regression analyses were conducted to identify factors associated with F&V and fat intake. RESULTS: Respectively, 90.3 and 50.8% of students failed to meet the recommendations for F&V and fat consumption. Agreeing more with the fact that one should eat F&V on most days of the week (individual subjective norm), finding it less difficult to eat F&V at home or at university (perceived behavioural control) and experiencing more modelling were associated with higher F&V consumption. Increasing age, higher educational level of the father and higher individual subjective norm about eating low-fat foods were associated with lower fat intake. CONCLUSIONS: Future interventions aiming to improve dietary intake among university students should focus on younger students with lower socioeconomic status and should enhance students' subjective norm and behavioural control concerning healthy eating.

Effect of vitamin D supplementation on non-skeletal disorders: a systematic review of meta-analyses and randomised trials.

Randomised trials reported up to Dec 31, 2012, did not confirm that vitamin D supplementation could protect from non-skeletal health conditions affecting adults, as was expected on the basis of data from observational studies. To examine whether the more recently published meta-analyses and trials would change past conclusions, we systematically reviewed meta-analyses of vitamin D supplementation and non-skeletal disorders published between Jan 1, 2013, and May 31, 2017, that included study participants of all ages, including pregnant women. We also searched for randomised trials not included in meta-analyses. We identified 87 meta-analyses, of which 52 were excluded because they contained less recent literature or were of suboptimal quality. We retrieved 202 articles on trials that were not included in meta-analyses. Recent meta-analyses reinforce the finding that 10-20 µg per day of vitamin D can reduce all-cause mortality and cancer mortality in middle-aged and older people. Although vitamin D doses were greater than those assessed in the past, we found no new evidence that supplementation could have an effect on most non-skeletal conditions, including cardiovascular disease, adiposity, glucose metabolism, mood disorders, muscular function, tuberculosis, and colorectal adenomas, or on maternal and perinatal conditions. New data on cancer outcomes were scarce. The compilation of results from 83 trials showed that vitamin D supplementation had no significant effect on biomarkers of systemic inflammation. The main new finding highlighted by this systematic review is that vitamin D supplementation might help to prevent common upper respiratory tract infections and asthma exacerbations. There remains little evidence to suggest that vitamin D supplementation has an effect on most conditions, including chronic inflammation, despite use of increased doses of vitamin D, strengthening the hypothesis that low vitamin D status is a consequence of ill health, rather than its cause. We further hypothesise that vitamin D supplementation could exert immunomodulatory effects that strengthen resistance to acute infections, which would reduce the risk of death in debilitated individuals. We identified many meta-analyses of suboptimal quality, which is of concern. Future systematic reviews on vitamin D should be based on data sharing so that data for participants with the same outcomes measured in the same way can be pooled to generate stronger evidence.