Ultra-processed and fast food consumption, exposure to phthalates during pregnancy, and socioeconomic disparities in phthalate exposures.

BACKGROUND: Consuming ultra-processed foods may increase exposure to phthalates, a group of endocrine disruptors prevalent in food contact materials. OBJECTIVES: Investigate associations between ultra-processed food intake and urinary phthalates during pregnancy, and evaluate whether ultra-processed foods mediate socioeconomic disparities in phthalate exposures. METHODS: In a socioeconomically diverse sample of 1031 pregnant women from the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) Study in the urban South, the Block Food Frequency Questionnaire was administered and urinary phthalate metabolites were measured in the second trimester. Linear regressions modeled associations between phthalates and overall ultra-processed food consumption, individual ultra-processed foods, and exploratory factor analysis dietary patterns. Causal mediation analyses examined whether ultra-processed food intake mediates relationships between socioeconomic disparities and phthalate exposures. RESULTS: Ultra-processed foods constituted 9.8-59.0 % (mean = 38.6 %) of participants' diets. 10 % higher dietary proportion of ultra-processed foods was associated with 13.1 % (95 %CI: 3.4 %-22.9 %) higher molar sum concentrations of di(2-ethylhexyl) phthalate metabolites (ΣDEHP). 10 % higher consumption of minimally-processed foods was associated with lower ΣDEHP (10.8 %: 3.4 %-22.9 %). Ultra- and minimally-processed food consumption were not associated with non-DEHP metabolites. Standard deviation higher consumptions of hamburger/cheeseburger, French fries, soda, and cake were associated with 10.5 % (4.2 %-17.1 %), 9.2 % (2.6 %-16.2 %), 7.4 % (1.4 %-13.6 %), and 6.0 % (0.0 %-12.4 %), respectively, higher ΣDEHP. Exploratory factor analysis corroborated positive associations of processed food with ΣDEHP, and uncovered a healthy dietary pattern associated with lower urinary ΣDEHP, mono(2-ethyl-5-hydroxyhexyl) (MEHHP), mono(2-ethyl-5-carboxypentyl) (MECPP), mono(2-carboxymethylhexyl) (MCMHP), and mono-isononyl (MINP) phthalates. Significant indirect effects indicated that lower income and education levels were associated with 1.9 % (0.2 %-4.2 %) and 1.4 % (0.1 %-3.3 %) higher ΣDEHP, respectively, mediated via increased ultra-processed food consumption. CONCLUSIONS: Consumption of ultra-processed foods may increase exposure to phthalates. Policies to reduce dietary phthalate exposures from food packaging and processing are needed, as socioeconomic barriers can preclude dietary recommendations as a sole means to reduce phthalate exposures.

Risk assessment of bisphenol related compounds in canned convenience foods, olives, olive oil, and canned soft drinks in Turkey.

The presence of Bisphenol A (BPA), Bisphenol A Diglycidyl Ether (BADGE), and their derivatives in seventy-nine samples of food products available in Turkish stores was determined using ultra performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Among Bisphenol A and its analogues, BPA was the most detected migrant with 56.97%. Fish products had the highest level of BPA with 0.102 mg/kg although only three fish samples exceeded the Specific Migration Limit (SML) for BPA of 0.05 mg/kg of food. The BPF, BPS, and BPB in all analyzed foods ranged between 0-0.021, 0-0.036, and 0.072 mg/kg, respectively. BADGE derivates, BADGE·2H2O and cyclo-di-BADGE (CdB) were present in 57 and 52 samples with concentrations ranging between 0-0.354, and 0-1.056 mg/kg, respectively. All the analyzed traditional Turkish ready-to-eat meals and fish products were contaminated with BADGE·2H2O and CdB. The overall levels of BADGE and the derivates were below the specific migration limit. CdB was found at higher concentrations in traditional Turkish ready-to-eat meals, up to 1.056 mg/kg. The CdB concentration in most of the samples was above the highest figure with 0.05 mg/kg authorized by the German Federal Institute for Risk Assessment. The predominant chlorinated derivative was BADGE·H2O·HCl which was found in thirty-seven samples in the range of 0.007-0.061 mg/kg.

Ultra-processed foods and mortality: analysis from the Prospective Urban and Rural Epidemiology study.

BACKGROUND: Higher intake of ultra-processed foods (UPFs) has been associated with increased risk of CVD and mortality in observational studies from Western countries but data from non-Western countries are limited. OBJECTIVES: We aimed to assess the association between consumption of UPFs and risk of mortality and major CVD in a cohort from multiple world regions. DESIGN: This analysis includes 138,076 participants without a history of CVD between the ages of 35 and 70 y living on 5 continents, with a median follow-up of 10.2 y. We used country-specific validated food-frequency questionnaires to determine individuals' food intake. We classified foods and beverages based on the NOVA classification into UPFs. The primary outcome was total mortality (CV and non-CV mortality) and secondary outcomes were incident major cardiovascular events. We calculated hazard ratios using multivariable Cox frailty models and evaluated the association of UPFs with total mortality, CV mortality, non-CV mortality, and major CVD events. RESULTS: In this study, 9227 deaths and 7934 major cardiovascular events were recorded during the follow-up period. We found a diet high in UPFs (≥2 servings/d compared with 0 intake) was associated with higher risk of mortality (HR: 1.28; 95% CI: 1.15, 1.42; P-trend < 0.001), CV mortality (HR: 1.17; 95% CI: 0.98, 1.41; P-trend = 0.04), and non-CV mortality (HR: 1.32; 95% CI 1.17, 1.50; P-trend < 0.001). We did not find a significant association between UPF intake and risk of major CVD. CONCLUSIONS: A diet with a high intake of UPFs was associated with a higher risk of mortality in a diverse multinational study. Globally, limiting the consumption of UPFs should be encouraged.

Occurrence of Perfluoroalkyl and Polyfluoroalkyl Substances in Ice Cream, Instant Noodles, and Bubble Tea.

Food consumption is a significant exposure route to perfluoroalkyl and polyfluoroalkyl substances (PFAS). The concentrations of 27 PFAS in fast food were determined by ultrahigh-performance liquid chromatography-high resolution mass spectrometry. In ice cream, instant noodles, and bubble tea, some PFAS were detected, among which perfluorooctanoic acid, perfluoro-n-butanoic acid, and 6:2 polyfluoroalkyl phosphate monoester showed relatively high concentrations. PFAS migrating from bubble tea cups to the food simulant of 50% ethanol aqueous solution showed a difference compared with those migrating into bubble tea matrices. The migration of 27 PFAS to bubble tea samples indicated that long storage time increased PFAS levels (up to 4.8 times) and so did high storage temperature (up to 7.3 times). The hazard ratio, defined as the ratio of the estimated daily intake and the reference dose, was calculated, and it suggests that the total PFAS exposure risk due to consumption of bubble tea should be of concern.

Estimation of Sodium Availability and Food Sources from 2018 to 2019 and Its Trends during the 2004-2019 Period in Costa Rica.

Sodium availability and food sources in 2018−2019 were estimated and trends analyzed for 15 years (2004−2019) in Costa Rica. Food purchase records from the National Household Income and Expenditure Survey (ENIGH) 2018−2019 were converted to energy and sodium using food composition tables measuring "apparent consumption". Foods were classified by sodium content. ENIGH is a probabilistic, stratified, two-stage and replicated national survey, carried out regularly by the national statistics institution. Results from the 2004−2005 and 2012−2013 ENIGHs came from previous analysis. Differences between periods were determined through descriptive and inferential statistics. The available sodium adjusted to 2000 kcal/person/day was 3.40, 3.86, and 3.84 g/person/day (g/p/d) for periods 2004−2005, 2013−2014, and 2018−2019, respectively. In this last period, this was 3.94 urban and 3.60 g/p/d rural (p < 0.05), with a non-linear increase with income. During 2004−2019 sodium from salt and salt-based condiments increased from 69.5 to 75.5%; the contribution of common salt increased, from 60.2 to 64.8% and condiments without added salt from 9.3 to 10.7%. From 2012−2013 to 2018−2019, processed and ultra-processed foods with added sodium intake increased from 14.2 to 16.9% and decreased in prepared meals (7.2 to 2.8%). Costa Rica has been successful in reducing salt/sodium available for consumption; after a 12% increase of salt consumption between 2004−2005 and 2012−2013, to a level almost twice as high as recommended, it has stabilized in the last period.

Higher Ultra-Processed Food Consumption Is Associated with Greater High-Sensitivity C-Reactive Protein Concentration in Adults: Cross-Sectional Results from the Melbourne Collaborative Cohort Study.

Background: Few studies have examined associations between ultra-processed food intake and biomarkers of inflammation, and inconsistent results have been reported in the small number of studies that do exist. As such, further investigation is required. Methods: Cross-sectional baseline data from the Melbourne Collaborative Cohort Study (MCCS) were analysed (n = 2018). We applied the NOVA food classification system to data from a food frequency questionnaire (FFQ) to determine ultra-processed food intake (g/day). The outcome was high-sensitivity C-reactive protein concentration (hsCRP; mg/L). We fitted unadjusted and adjusted linear regression analyses, with sociodemographic characteristics and lifestyle- and health-related behaviours as covariates. Supplementary analyses further adjusted for body mass index (kg/m2). Sex was assessed as a possible effect modifier. Ultra-processed food intake was modelled as 100 g increments and the magnitude of associations expressed as estimated relative change in hsCRP concentration with accompanying 95% confidence intervals (95%CIs). Results: After adjustment, every 100 g increase in ultra-processed food intake was associated with a 4.0% increase in hsCRP concentration (95%CIs: 2.1−5.9%, p < 0.001). Supplementary analyses showed that part of this association was independent of body mass index (estimated relative change in hsCRP: 2.5%; 95%CIs: 0.8−4.3%, p = 0.004). No interaction was observed between sex and ultra-processed food intake. Conclusion: Higher ultra-processed food intake was cross-sectionally associated with elevated hsCRP, which appeared to occur independent of body mass index. Future prospective and intervention studies are necessary to confirm directionality and whether the observed association is causal.

Modelo preclínico de obesidad basado en alimentos altamente procesados y de alta palatabilidad / Preclinical model of obesity based on ultra-processed and highly palatable foods

Resumen Introducción: el alarmante incremento de la obesidad en todo el mundo y en Costa Rica responde principalmente a modificaciones en la composición de la dieta habitual de las personas. La presente investigación tuvo como objetivo implementar un protocolo de alimentación formulado a partir de alimentos altamente procesados y de alta palatabilidad (APAP) consumidos por la población costarricense para, luego, evaluar sus efectos en la conducta alimentaria y en parámetros biométricos y bioquímicos. Metodología: ratas adultas macho Wistar se asignaron a dos grupos. Al primero se le administró alimento estándar para roedores (grupo DC) y al segundo, alimentos APAP (grupo APAP), durante ocho semanas. Resultados: a lo largo de ese periodo, los animales expuestos a los APAP exhibieron mayor ingesta y energía, caracterizadas por un alto consumo de grasas y uno menor de proteínas y fibra; además, mostraron un incremento significativo en los diversos parámetros de obesidad (e. g., peso corporal y ganancia de peso, índice de Lee y adiposidad central) y niveles descriptivamente superiores de glucosa y triglicéridos en sangre, pero notablemente menores de colesterol total. Conclusiones: los resultados indican que una dieta basada en los alimentos APAP más frecuentes en la población costarricense es capaz de inducir hiperfagia y obesidad. Así, este modelo constituye una herramienta prometedora para ahondar en el estudio de las factores neurobiológicos y metabólicos relacionados con la obesidad por el sobreconsumo de alimentos APAP.

Abstract Introduction. The alarming increase in obesity both worldwide and in Costa Rica is mainly due to changes in the composition of the usual diet of the population. The goal of our research was to implement a feeding protocol formulated from ultra-processed and highly palatable foods (UPHP) consumed by the Costa Rican population and to evaluate the effects of the UPHP diet on eating behavior and biometric and biochemical parameters. Methods: Adult male Wistar rats were assigned to two groups. One group was given standard rodent chow (DC group) while the other group received UPHP foods (UPHP group) for eight weeks. Results: Throughout this period, animals exposed to the UPHP diet exhibited higher food and energy intake characterized by high consumption of fat and lower consumption of protein and fiber. Animals in the UPHP group also showed a significant increase in obesity parameters (e.g., body weight and bodyweight gain, Lees index, and central adiposity). Furthermore, the UPHP group had descriptively higher levels of blood glucose and triglycerides and significantly lower levels of total cholesterol. Conclusions: Our results indicate that a feeding protocol based on the most frequent food choices of the Costa Rican population is capable of inducing hyperphagia and obesity. This model constitutes a promising tool to delve into the study of the neurobiological and metabolic factors related to obesity induced by overconsumption of UPHP foods.

[Correlation analysis between children and adolescents watching food TV advertising and fast food consumption].

Based on the open data of China Health and Nutrition Survey (CHNS), 249 children, adolescents and 249 heads of families who completed two rounds of surveys in 2011 and 2015 were selected in this study. According to the fast food consumption of children and adolescents, they were divided into fast food consumption group and non-fast food consumption group. Logistic regression model was used to analyze the relationship between children and adolescents watching Food TV advertising and fast food consumption. After adjusting relevant factors, the results showed that children and adolescents requiring their parents to buy food in TV advertisements (OR=3.122, P=0.001), parents buying food for their children in TV advertisements (OR=4.717, P=0.036), children and adolescents buying food in TV advertisements themselves (OR=3.728, P=0.041), children and adolescents' preference for food in TV advertisements (OR=2.946, P=0.044) and the frequency of children and adolescents reported by their parents asking their parents to buy food in TV advertisements (OR=3.113, P=0.002) were associated with children and adolescents' fast food consumption.

MALDI mass spectrometry imaging: From constituents in fresh food to ingredients, contaminants and additives in processed food.

Mass Spectrometry imaging (MS imaging) provides spatial information for a wide range of compound classes in different sample matrices. We used MS imaging to investigate the distribution of components in fresh and processed food, including meat, dairy and bakery products. The MS imaging workflow was optimized to cater to the specific properties and challenges of the individual samples. We successfully detected highly nonpolar and polar constituents such as beta-carotene and anthocyanins, respectively. For the first time, the distributions of a contaminant and a food additive were visualized in processed food. We detected acrylamide in German gingerbread and investigated the penetration of the preservative natamycin into cheese. For this purpose, a new data analysis tool was developed to study the penetration of analytes from uneven surfaces. Our results show that MS imaging has great potential in food analysis to provide relevant information about components' distributions, particularly those underlying official regulations.

Novel powder-XRD method for detection of acrylamide in processed foods.

Acrylamide (AA) is a toxin in food systems associated with neurotoxicity, carcinogenicity, genotoxicity, and cardiotoxicity. While several approaches exist, this work details the first-of-its-kind application of Powder X-Ray Diffraction (PXRD) for the detection of AA in food systems. A new methodology was validated as per ICH guidelines. Various x-ray tube combinations such as current (25-45 mA), voltage (25-45 kV), and scanning parameters such as step size (0.006-0.10°) and time-per-step (50-150 s) were experimented on 10-80° angle 2theta (2θ). In this investigation, more diffracted peaks were detected on time per step 151.210 [s], 0.0135[°] step size @ 35 mA/45 kV through phase quantification. The developed method was successfully applied to real processed food samples for qualitative analysis of AA. In addition, the influence of oil frying temperature-time conditions on AA content was studied. Overall, this work highlights the prospects of PXRD-based food quality and safety evaluation.

Development and validation of an ionic chromatography method for nitrite determination in processed foods and estimation of daily nitrite intake in Korea.

A simple ionic chromatography method for nitrite analysis in processed food products was developed and validated. Nitrite in the sample was extracted using 80 °C distilled deionized water and centrifuged. Purification of nitrite from sample solution was performed using OnGuard II Ag, OnGuard II RP and OnGuard II Na cartridge connected in order. Determination of nitrite was carried out using IonPac AG9-HC (4 × 50 mm) and IonPac AS9-HC (4 × 250 mm) columns and a 9 mM sodium carbonate mobile phase. The validated results showed good linearity (r2 > 0.999), recoveries (83.7-107.6%) and precision (1.3-5.1%). The levels of nitrite in processed food products were between n.d. to 33.5 mg/kg, and nitrite was detected in ham, sausage and bacon products. The mean nitrite intake was 2.7% of the Acceptable Daily Intake (ADI, 0.07 mg/kg bw/day) for the Korean population. The method was suitable for the analysis of nitrite in processed foods.

Exposure assessment of benzoic acid from processed foods in South Korea.

To evaluate the dietary exposure to benzoic acid of Korean consumers, the daily intake of benzoic acid was estimated using benzoic acid concentrations from processed food survey data in South Korea and food consumption data from the Korean National Health and Nutrition Examination Survey in 2018. The results were compared with the acceptable daily intake (ADI) stipulated by the Joint FAO/WHO Expert Committee on Food Additives. In addition, we estimated the effects and risk of benzoic acid intake, which may be increased by including amounts of naturally occurring benzoic acid recently established by the Ministry of Food and Drug Safety. Benzoic acid analyses were conducted in South Korea in 2020 for a total of 127,628 samples; it was detected in 1,803 samples, a detection rate of 1.4%. The mean contents of total samples and detected samples were 1.3 mg/kg and 89.4 mg/kg, respectively. The estimated daily intake (EDI) of benzoic acid for average consumers using a mean value of detected samples was 207.3 µg/kg.bw/day, which is 4.1% of ADI. The EDI of benzoic acid for high consumers (95th percentile) of processed foods among the consumers was 1,406.7 µg/kg.bw/day, which is 28.1% of the ADI. As a result of estimating the intake of benzoic acid, which may be increased by a newly established standard on natural occurrence in South Korea, the theoretical maximum EDI of benzoic acid was 109.9 µg/kg.bw/day, which is 2.2% of the ADI.

Phthalate and novel plasticizer concentrations in food items from U.S. fast food chains: a preliminary analysis.

BACKGROUND: Fast food consumption is associated with biomarkers of ortho-phthalates exposures. However, the chemical content of fast food is unknown; certain ortho-phthalates (i.e., di-n-butyl phthalate (DnBP) and di(2-ethylhexyl) phthalate (DEHP)) have been phased out and replaced with other plasticizers (e.g., dioctyl terephthalate (DEHT)). OBJECTIVE: We conducted a preliminary study to examine ortho-phthalate and replacement plasticizer concentrations in foods and food handling gloves from U.S. fast food restaurants. METHODS: We obtained hamburgers, fries, chicken nuggets, chicken burritos, cheese pizza (n = 64 food samples) and gloves (n = 3) from restaurants and analyzed them for 11 chemicals using gas chromatography mass spectrometry. RESULTS: We found DEHT at the highest concentrations in both foods (n = 19; median = 2510 µg/kg; max = 12,400 µg/kg) and gloves (n = 3; range: 28-37% by weight). We detected DnBP and DEHP in 81% and 70% of food samples, respectively. Median DEHT concentrations were significantly higher in burritos than hamburgers (6000 µg/kg vs. 2200 µg/kg; p < 0.0001); DEHT was not detected in fries. Cheese pizza had the lowest levels of most chemicals. SIGNIFICANCE: To our knowledge, these are the first measurements of DEHT in food. Our preliminary findings suggest that ortho-phthalates remain ubiquitous and replacement plasticizers may be abundant in fast food meals. IMPACT STATEMENT: A selection of popular fast food items sampled in this study contain detectable levels of replacement plasticizers and concerning ortho-phthalates. In addition, food handling gloves contain replacement plasticizers, which may be a source of food contamination. These results, if confirmed, may inform individual and regulatory exposure reduction strategies.

Some Ultra-Processed Foods Are Needed for Nutrient Adequate Diets: Linear Programming Analyses of the Seattle Obesity Study.

Typical diets include an assortment of unprocessed, processed, and ultra-processed foods, along with culinary ingredients. Linear programming (LP) can be used to generate nutritionally adequate food patterns that meet pre-defined nutrient guidelines. The present LP models were set to satisfy 22 nutrient standards, while minimizing deviation from the mean observed diet of the Seattle Obesity Study (SOS III) sample. Component foods from the Fred Hutch food frequency questionnaire comprised the market basket. LP models generated optimized 2000 kcal food patterns by selecting from all foods, unprocessed foods only, ultra-processed foods only, or some other combination. Optimized patterns created using all foods contained less fat, sugar, and salt, and more vegetables compared to the SOS III mean. Ultra-processed foods were the main sources of added sugar, saturated fat and sodium. Ultra-processed foods also contributed most vitamin E, thiamin, niacin, folate, and calcium, and were the main sources of plant protein. LP models failed to create optimal diets using unprocessed foods only and ultra-processed foods only: no mathematical solution was obtained. Relaxing the vitamin D criterion led to optimized diets based on unprocessed or ultra-processed foods only. However, food patterns created using unprocessed foods were significantly more expensive compared to those created using foods in the ultra-processed category. This work demonstrates that foods from all NOVA categories can contribute to a nutritionally adequate diet.

Sodium Content of Foods Sold in the Spanish Market. Results from the BADALI Project.

High sodium/salt intake is a risk factor for Non-Communicable Diseases (NCDs). Excess sodium intake has been associated with high coronary heart disease, stroke and high blood pressure. The sodium daily intake is above the recommendations in the world as well as in Spain. Reducing salt content in processed foods and ready meals is one of the main strategies for reducing sodium intake. The aim of the present work is to characterise the presence of sodium in foods sold in the Spanish market. We also study a possible shift in sodium content in products over the last few years. For this purpose, 3897 products included in the BADALI food database were analysed, classified into 16 groups (G). We found that 93.3% of all foods displayed the sodium/salt content in the nutrition declaration. Meat-processed and derivatives (G8) had the highest mean and median values for sodium content, followed by snacks (G15) and sauces (G14). Only 12.7% of foods were sodium-free (≤5 mg/100 g or 100 mL), 32.4% had very low sodium (≤40 mg/100 g or 100 mL) and 48.2% were low in sodium (≤120 mg/100 g or 100 mL). On the contrary, 47.2% were high in sodium according to the Pan American Health Organisation Nutrient Profile Model (PAHO-NPM), while there were 31.9% according to the Chile-NPM. The agreement between the two NPMs was considered 'substantial' (κ = 0.67). When sodium content was compared over the years, no decrease was observed. This analysis was performed in the entire food population, by food group and in matched products. Therefore, more effort should be made by all parties involved in order to decrease the sodium/salt intake in the population.

Analysis of Fat Content with Special Emphasis on Trans Isomers in Frequently Consumed Food Products in Egypt: The First Steps in the Trans Fatty Acid Elimination Roadmap.

Trans Fatty Acid (TFA) intake is a risk factor for coronary heart diseases and cancer. Egypt, considered among the highest TFA consumers in the world, lacks proper dietary analysis of TFAs. This cross-sectional study aimed to analyze TFAs in traditional and frequently consumed food products. A market survey was conducted to identify products and brands that are mostly consumed in major governorates in Egypt. Laboratory analysis allowed for the profiling of TFAs, and saturated and unsaturated fatty acids. Products having more than 2 g of TFA/100 g of fat were considered to have an elevated TFA content. Commonly consumed food items (n = 208) in the Egyptian market were identified. On average, 34% of the products exceeded the TFA limit. Sambosk meat, a traditional meat item, had the highest TFA content of 5.2%, followed by foods fried with used oils. Oriental sweets had a TFA content three times higher than that of doughnuts. The fast-food group had the largest proportion of TFA-rich products, followed by the canned and frozen item groups and confectionaries. This study revealed that around one third of products in the Egyptian market have a high TFA content. This calls for urgent legislative action to regulate composition.

An Innovative Machine Learning Approach to Predict the Dietary Fiber Content of Packaged Foods.

Underconsumption of dietary fiber is prevalent worldwide and is associated with multiple adverse health conditions. Despite the importance of fiber, the labeling of fiber content on packaged foods and beverages is voluntary in most countries, making it challenging for consumers and policy makers to monitor fiber consumption. Here, we developed a machine learning approach for automated and systematic prediction of fiber content using nutrient information commonly available on packaged products. An Australian packaged food dataset with known fiber content information was divided into training (n = 8986) and test datasets (n = 2455). Utilization of a k-nearest neighbors machine learning algorithm explained a greater proportion of variance in fiber content than an existing manual fiber prediction approach (R2 = 0.84 vs. R2 = 0.68). Our findings highlight the opportunity to use machine learning to efficiently predict the fiber content of packaged products on a large scale.

Menu Engineering and Dietary Behavior Impact on Young Adults' Kilocalorie Choice.

The obesity pandemic is associated with increased consumption of restaurant food. Labeling of menus is an intervention used to provide consumers with kilocalorie (calorie) information in hopes of them making healthier food choices. This study evaluated the relationship between young adults' calorie choices on restaurant menus and menu design, dietary behaviors, and demographic characteristics. A 3 (fast-casual restaurants) × 4 (menu-designs based on menu engineering theories) between-subjects (n = 480, 18-24-year olds) experimental design was used. The relationship between the participants' calorie choices (high versus low) and menu design, stage of change, gender, race, educational level and weight status was evaluated using logistic regression. All independent variables had at least one category that had greater odds (CI 95% ± 5%) of subjects choosing a lower calorie entree, except education level and race/ethnic group. Normal weight and overweight subjects had greater odds of choosing lower calorie entrees than those that were obese. In addition, subjects that had started to control their calorie intake for less than six months or had sustained this change for at least six months, had greater odds of choosing lower calorie entrees compared to others. Including a green symbol and calories on fast casual restaurant menus may influence some young adults to choose lower calorie entrees.

What Is the Nutritional Composition of Ultra-Processed Food Marketed in Italy?

The present study aimed to provide a descriptive analysis of the nutrient profile of ultra-processed foods (UPFs) marketed in Italy according to three front-of-pack labeling (FOPL) schemes implemented by France, i.e., the Nutriscore; by the United Kingdom, i.e., Multiple Traffic Lights (MTL); and by Italy, i.e., the NutrInform battery. The analysis was made in fourteen food product categories, corresponding to 124 foods. The application of the Nutriscore scheme showed that a significant proportion of foods (23%) were awarded an A or B. Furthermore, the analysis according to the MTL showed that food products that were above the threshold ("red") for fat, saturated fats, sugars, and salt ranged from 13% to 31%. Interestingly, even though all foods considered in the analysis were UPF, they were heterogeneous in nutritional composition, as demonstrated by the FOPL schemes applied, showing that UPF represent a heterogeneous group of foods with different characteristics. Such a finding may have relevant implications for epidemiological studies that analyze the association between UPF consumption and health outcomes, suggesting the need for better characterization of the effects of UPF intake on human health.