Ultra-processed food consumption and risk of diabetes: results from a population-based prospective cohort.

AIMS/HYPOTHESIS: Understanding the impact of the overall construct of ultra-processed foods on diabetes risk can inform dietary approaches to diabetes prevention. In this study, we aimed to evaluate the association between ultra-processed food consumption and risk of diabetes in a community-based cohort of middle-aged adults in the USA. We hypothesised that a higher intake of ultra-processed foods is associated with a higher risk of incident diabetes. METHODS: The study included 13,172 participants without diabetes at baseline (1987-1989) in the Atherosclerosis Risk in Communities (ARIC) study. Dietary intake was assessed with a 66-item semiquantitative food frequency questionnaire, and foods were categorised by processing level using the Nova classification system. Ultra-processed food was analysed categorically (quartiles of energy-adjusted intake) and continuously (per one additional serving/day). We used Cox regression to evaluate the association of ultra-processed food intake with risk of diabetes with adjustment for sociodemographic characteristics, total energy intake, health behaviours and clinical factors. RESULTS: Over a median follow-up of 21 years, there were 4539 cases of incident diabetes. Participants in the highest quartile of ultra-processed food intake (8.4 servings/day on average) had a significantly higher risk of diabetes (HR 1.13; 95% CI 1.03, 1.23) compared with participants in the lowest quartile of intake after adjustment for sociodemographic, lifestyle and clinical factors. Each additional serving of ultra-processed food consumed daily was associated with a 2% higher risk of diabetes (HR 1.02; 95% CI 1.00, 1.04). Highest quartile consumption of certain ultra-processed food groups, including sugar- and artificially sweetened beverages, ultra-processed meats and sugary snacks, was associated with a 29%, 21% and 16% higher risk of diabetes, respectively, compared with the lowest quartile. CONCLUSIONS/INTERPRETATION: We found that a higher intake of ultra-processed food was associated with higher risk of incident diabetes, particularly sugar- and artificially sweetened beverages, ultra-processed meats and sugary snacks. Our findings suggest interventions reducing ultra-processed food consumption and specific food groups may be an effective strategy for diabetes prevention.

Manufactured meals: The challenges of ultraprocessed foods.

In this Editorial on behalf of the PLOS Medicine Editors, Alexandra Tosun discusses how ultra-processed food has found itself at the center of a growing storm of criticism, the complexities of the ongoing nutrition debate and why stakeholders must be held to higher standards.

Ultraprocessed food (UPF), health, and mechanistic uncertainty: What should we be advising the public to do about UPFs?

In this perspective, we discuss why current mechanistic uncertainty on ultraprocessed foods (UPFs) and health acts as a major challenge to providing informed dietary guidelines and public advice on UPFs. Based on the balance of current evidence, we do not believe it is appropriate to be advising consumers to avoid all UPFs and we await further evidence to inform consumer guidance on the need to limit consumption of specifics foods based on their degree or type of processing.

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

INTRODUCTION: Ultra-processed food (UPF) intake has been associated with a higher risk of obesity, hypertension, type 2 diabetes, and cardiovascular diseases. The initial data on the relationship between UPF consumption and cancer risk were derived from retrospective observational studies with conflicting results. This systematic review and meta-analysis of prospective cohort studies aimed to investigate the association between UPF consumption and gastrointestinal cancer risk. METHODS: PubMed, Embase, and Cochrane databases were searched for prospective cohort studies that compared the highest vs the lowest level of UPF consumption according to NOVA food classification and reported the risk of gastrointestinal cancers by subsite. The association with cancer was quantified as hazard ratios (HR) using a random-effects model. RESULTS: Five prospective cohort studies were included in this review comprising 1,128,243 participants (241,201 participants in the highest and 223,366 in the lowest levels of UPF consumption). The mean follow-up ranged from 5.4 to 28 years. The highest UPF consumption was significantly associated with an increased risk of colorectal cancer (HR 1.11; 95% confidence interval [CI] 1.03-1.21; P = 0.01; I2 = 31%), colon cancer (HR 1.12; 95% CI 1.02-1.23; P = 0.02; I2 = 0%), and non-cardia gastric cancer (HR 1.43; 95% CI 1.02-2.00; P = 0.04; I2 = 0%) compared with the lowest UPF intake. However, no association was found between high UPF consumption and hepatocellular, esophageal, pancreatic, gastric cardia, and rectal cancer. DISCUSSION: The highest level of UPF consumption was significantly associated with colorectal and non-cardia gastric cancer.

Ultra-Processed Food, Disease Activity, and Inflammation in Ulcerative Colitis: The Manitoba Living With IBD Study.

INTRODUCTION: The purpose of this study was to investigate the relationship between ultra-processed food (UPF) consumption and (i) symptomatic disease and (ii) intestinal inflammation among adults with inflammatory bowel disease (IBD). METHODS: We identified participants (Crohn's disease [CD] and ulcerative colitis [UC]) from the Manitoba Living with IBD study. Active disease was defined using the IBD Symptom Inventory (score >14 for CD; >13 for UC); fecal calprotectin was measured for intestinal inflammation (>250 µg/g). Diet data were collected using the Harvard Food Frequency Questionnaire. UPF consumption was determined by the NOVA classification system. Percentage of energy consumption from UPFs was calculated and divided into 3 tertiles (T1 = low; T3 = high). Multiple linear regression analysis was used for active disease and inflammation predicted by UPF consumption. RESULTS: Among 135 participants (65% with CD), mean number of episodes of active disease (14.2 vs 6.21) and active inflammation (1.6 vs 0.6) was significantly higher among participants with UC in T3 compared with T1 of UPF consumption ( P < 0.05). When adjusting for age, sex, disease type, and duration, number of episodes of active disease was lower in T1 compared with T3 (ß = -7.11, P = 0.02); similarly, number of episodes of intestinal inflammation was lower in T1 (ß = -0.95, P = 0.03). No significant differences were observed among participants with CD. DISCUSSION: UPF consumption may be a predictor of active symptomatic disease and inflammation among participants with UC. Reducing UPF consumption is a dietary strategy that can be suggested for minimizing symptoms and inflammation among people living with IBD.

The consumption of ultra-processed foods was associated with adiposity, but not with metabolic indicators in a prospective cohort study of Chilean preschool children.

BACKGROUND: Increasing consumption of ultra-processed foods (UPF) has been identified as a risk factor for obesity and various diseases, primarily in adults. Nonetheless, research in children is limited, especially regarding longitudinal studies with metabolic outcomes. We aimed to evaluate the longitudinal association between consumption of UPF, adiposity, and metabolic indicators in Chilean preschool children. METHODS: We conducted a prospective analysis of 962 children enrolled in the Food and Environment Chilean Cohort (FECHIC). Dietary data were collected in 2016 at age 4 years with 24-h recalls. All reported foods and beverages were classified according to the NOVA food classification, and the usual consumption of UPF in calories and grams was estimated using the Multiple Source Method. Adiposity (z-score of body mass index [BMI z-score], waist circumference [WC], and fat mass [in kg and percentage]) and metabolic indicators (fasting glucose, insulin, HOMA-IR, triglycerides, total cholesterol, and cholesterol fractions) were measured in 2018, at the age of 6 years. Linear regression models ((0) crude, (1) adjusted for covariables, and (2) adjusted for covariables plus total caloric intake) were used to evaluate the association between UPF and outcomes. All models included inverse probability weights to account for the loss to the follow-up. RESULTS: At 4 years, usual consumption of UPF represented 48% of the total calories and 39% of the total food and beverages grams. In models adjusted for covariables plus caloric intake, we found a positive association between UPF and BMI z-score (for 100 kcal and 100 g, respectively: b = 0.24 [95%CI 0.16-0.33]; b = 0.21 [95%CI 0.10-0.31]), WC in cm (b = 0.89 [95%CI 0.41-1.37]; b = 0.86 [95%CI 0.32-1.40]), log-fat mass in kg b = 0.06 [95%CI 0.03-0.09]; b = 0.04 [95%CI 0.01-0.07]), and log-percentage fat mass (b = 0.03 [95%CI 0.01-0.04]; b = 0.02 [95%CI 0.003-0.04]), but no association with metabolic indicators. CONCLUSIONS: In this sample of Chilean preschoolers, we observed that higher consumption of UPF was associated with adiposity indicators 2 years later, but not with metabolic outcomes. Longer follow-up might help clarify the natural history of UPF consumption and metabolic risks in children.

Time-varying exposure to food retailers and cardiovascular disease hospitalization and mortality in the netherlands: a nationwide prospective cohort study.

BACKGROUND: Very few studies to date investigated the prospective association of changes in exposure to the food environment with cardiovascular disease (CVD) risk. We aim to explore if time-varying exposure to the food environment was associated with hospitalization and mortality due to total and specific types of CVD in The Netherlands. METHODS: In this prospective cohort study, 4,641,435 Dutch adults aged 35 + years who did not change residence in 2002-2018 were identified through registry data. Exposure to the food environment was defined as time-varying Food Environment Healthiness Index (FEHI) scores (range: - 5 to 5) and time-varying kernel density of specific food retailers (e.g., fast food outlets, supermarkets) around the home location between 2004 and 2018. The main outcome measures were hospitalization and mortality due to overall CVD, stroke, HF, and CHD occurring between 2004 and 2020, based on hospital and death registries. RESULTS: In Cox regression models, each unit increase in the FEHI was associated with a lower hospitalization and mortality of CVD (hospitalization hazard ratio (HRh) = 0.90 (0.89 to 0.91), mortality hazard ratio (HRm) = 0.85 (0.82 to 0.89)), CHD (HRh = 0.88 (0.85 to 0.91), HRm = 0.80 (0.75 to 0.86)), stroke (HRh = 0.89 (0.84 to 0.93)), HRm = 0.89 (0.82 to 0.98)), and HF (HRh = 0.90 (0.84-0.96), HRm = 0.84 (0.76 to 0.92)). Increased density of local food shops, fast food outlets, supermarkets, and convenience stores and decreased density of food delivery outlets and restaurants were associated with a higher risk of CVD, CHD, stroke, and HF hospitalization and mortality. CONCLUSIONS: In this observational longitudinal study, changes in exposure to a healthier food environment over 14 years were associated with a risk reduction in CVD hospitalization and mortality, in particular in urbanized areas and for younger adults and those with higher incomes.

Ultra-processed food consumption and renal cell carcinoma incidence and mortality: results from a large prospective cohort.

BACKGROUND: Growing evidence shows that ultra-processed food consumption is associated with the risk of cancer. However, prospective evidence is limited on renal cell carcinoma (RCC) incidence and mortality. In this study, we aimed to examine the association of ultra-processed food consumption and RCC incidence and mortality in a large cohort of US adults. METHODS: A population-based cohort of 101,688 participants were included from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Ultra-processed food items were confirmed by using the NOVA food classification system. The consumption of ultra-processed food was expressed as a percentage of total food intake (g/day). Prospective associations were calculated using Cox regression. Restricted cubic spline regression was used to assess nonlinearity. Subgroup analyses were performed to investigate the potential effect modifiers on the incidence and mortality of RCC. RESULTS: A total of 410 participants developed RCC during a total of 899,731 person-years of follow-up (median 9.41 years) and 230 RCC deaths during 1,533,930 person-years of follow-up (median 16.85 years). In the fully adjusted model, participants in the highest compared with the lowest quintiles of ultra-processed food consumption had a higher risk of RCC (HR quartile 4 vs 1:1.42; 95% CI: 1.06-1.91; Ptrend = 0.004) and mortality (HR quartile 4 vs. quartile 1: 1.64; 95% CI: 1.10-2.43; Ptrend = 0.027). Linear dose-response associations with RCC incidence and mortality were observed for ultra-processed food consumption (all Pnonlinearity > 0.05). The reliability of these results was supported by sensitivity and subgroup analyses. CONCLUSION: In conclusion, higher consumption of ultra-processed food is associated with an increased risk of RCC incidence and mortality. Limiting ultra-processed food consumption might be a primary prevention method of RCC.

Causality or confounding? Applying E values to examine associations between ultra-processed food consumption and risk of weight gain.

BACKGROUND: Ultra-processed food (UPF) consumption is associated prospectively with weight gain and obesity in observational studies of adults. Unaccounted for confounding is a risk when attempting to make causal inference from observational studies. Limited research has examined how feasible it is that unmeasured confounding may explain associations between UPF consumption and weight gain in observational research. METHODS: We introduce the E value to obesity researchers. The E value is defined as the minimum hypothetical strength of association that one or more unaccounted for confounding variables would need to have with an exposure (UPF consumption) and outcome (weight gain) to explain the association between the exposure and outcome of interest. We meta-analysed prospective studies on the association between UPF consumption and weight gain in adults to provide an effect estimation. Next, we applied the E value approach to this effect estimate and illustrated the potential role that unmeasured or hypothetical residual confounding variables could theoretically have in explaining associations. RESULTS: Higher consumption of UPFs was associated with increased weight gain in meta-analysis (RR = 1.14). The corresponding E value = 1.55, indicating that unaccounted for confounding variables with small-to-moderate sized associations with UPF consumption and weight gain (e.g., depressive symptoms, trait overeating tendencies, access to healthy and nutritious food) could individually or collectively hypothetically account for observed associations between UPF consumption and weight gain. CONCLUSIONS: Unaccounted for confounding could plausibly explain the prospective association between UPF consumption and weight gain in adults. High quality observational research controlling for potential confounders and evidence from study types devoid of confounding are now needed.

Food-Related Online Media (Mukbang and Cookbang) Exposure and Dietary Risk Behaviors in Korean Adolescents.

BACKGROUND: Studies have shown that prolonged smartphone use is associated with dietary risk behaviors among adolescents. However, little is known about whether the exposure to food-related online media contents, such as mukbang (eating broadcast) and cookbang (cooking broadcast), is associated with unhealthy dietary behaviors, independent of overall duration of smartphone use. OBJECTIVES: This study investigated the associations between the frequency of mukbang/cookbang watching and dietary risk behaviors among Korean adolescents, using nationally representative survey data. METHODS: In this cross-sectional study, we examined the data from 50,044 middle and high school students in the Korea Youth Risk Behavior Web-based Survey 2022. Participants reported their frequency of mukbang/cookbang watching, mean duration of smartphone use, frequency of breakfast eating, frequency of nighttime eating, and intakes of fast foods, sugar-sweetened beverages (SSBs), and high-caffeine drinks. We performed multivariable logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between mukbang/cookbang watching and dietary risk behaviors, accounting for complex survey sampling and adjusting for potential confounders. RESULTS: Frequent mukbang/cookbang watching (≥5 times/wk compared with never) was positively associated with dietary risk behaviors, including frequent breakfast skipping (OR: 1.20; 95% CI: 1.13, 1.28), frequent nighttime eating (OR: 1.43; 95% CI: 1.33, 1.54), and frequent intakes of fast foods (OR: 1.69; 95% CI: 1.58, 1.80), SSBs (OR: 1.47; 95% CI: 1.30, 1.66), and high-caffeine drinks (OR: 1.41; 95% CI: 1.33, 1.50), adjusting for duration of smartphone use. All mukbang/cookbang viewers, including those who perceived that mukbang/cookbang videos had "no influence" on their dietary behavior, had higher prevalence of dietary risk behaviors than nonviewers (perceived "no influence" compared with nonviewers-OR: 1.18; 95% CI: 1.10, 1.26, breakfast skipping; OR: 1.15; 95% CI: 1.06, 1.24, nighttime eating; OR: 1.40; 95% CI: 1.30, 1.50, fast foods; OR: 1.22; 95% CI: 1.07, 1.38, SSBs; OR: 1.28; 95% CI: 1.20, 1.37, high-caffeine drinks). CONCLUSIONS: Our findings suggest that frequent mukbang/cookbang watching may be associated with unhealthy dietary behaviors among Korean adolescents.

Association Between Ultra-Processed Food Consumption and Leucocyte Telomere Length: A cross-sectional study of UK Biobank.

OBJECTIVE: This study aimed to investigate the association between consumption of ultra-processed foods (UPFs) and leucocyte telomere length (LTL). METHODS: This cross-sectional study utilized data from the UK Biobank, including a total of 64,690 participants. LTL was measured using Q-PCR with natural logarithmic conversion and Z-score normalization. Dietary data were collected through a 24-hour recall questionnaire from 2009 to 2010. UPFs were identified using the Nova food classification and analyzed as either a continuous or categorical variable respectively. Multiple linear regression models were employed to analyze the association between UPF consumption and LTL. RESULTS: The included participants had an average age of 56.26 years, of whom 55.2% were female. After adjusting for sociodemographic, lifestyle-related and anthropometric variables, LTL exhibited a decrease of 0.005 (95% CI: -0.007, -0.002) with one UPF serving/day increase. Compared to participants consuming ≤ 3.5 servings/day, those consuming 3.5 to < 6, 6 to ≤ 8 and > 8 servings/day showed a shortening of LTL by 0.025 (95% CI: -0.047, -0.004), 0.034 (95% CI: -0.055, -0.012) and 0.038 (95% CI: -0.062, -0.015), respectively (P for trend = 0.001). Subgroup analyses by UPF subclasses revealed that consumption of ready-to-eat/heated food (ß = -0.008, 95% CI: -0.014, -0.002), beans and potatoes (ß = -0.024, 95% CI: -0.039, -0.009), animal-based products (ß = -0.011, 95% CI: -0.019, -0.004), artificial sugar (ß = -0.014, 95% CI: -0.025, -0.004), and beverages (ß = -0.005, 95% CI: -0.009, -0.001) showed negative associations with LTL. Conversely, breakfast cereals (ß = 0.020, 95% CI: 0.004, 0.036) and vegetarian alternatives (ß = 0.057, 95% CI: 0.027, 0.086) showed positive correlations with LTL. CONCLUSIONS: Our study found that a higher consumption of total UPFs was associated with a shorter LTL. However, some subclass UPFs may be associated with longer LTL, depending on their nutritional composition.

Socioeconomic Inequalities in Intakes of Ultraprocessed and Minimally Processed Foods in Nationally Representative Samples of Adults in Canada: An Analysis of Trends between 2004 and 2015.

BACKGROUND: Individuals with a lower socioeconomic position (SEP) often have higher intakes of ultraprocessed food (UPF) and lower intakes of minimally processed food (MPF); however, studies have not examined trends in absolute and relative gaps and gradients in UPF and MPF intake using multiple indicators of SEP. OBJECTIVES: We examined within-year absolute and relative gaps and gradients in UPF and MPF intake and trends between 2004 and 2015 according to 6 indicators of SEP among nationally representative samples of adults in Canada. METHODS: Adults (≥18 y) in the Canadian Community Health Survey-Nutrition 2004 (n = 20,880) or 2015 (n = 13,970) reported SEP (individual and household education, household income adequacy, household food insecurity, neighborhood material and social deprivation) and completed a 24-h dietary recall. Multivariable linear regression assessed within-year absolute and relative gaps and gradients in the proportion of energy from UPF and MPF and trends between 2004 and 2015. RESULTS: The largest and most consistent within-year inequities in UPF and MPF intake were for individual and household educational attainment. Overall and among males, higher SEP groups had more favorable intakes over time based on trends in absolute and relative gaps and gradients in UPF and MPF intake by household food insecurity [for example, the absolute gap in UPF intake declined from -1.2% (95% confidence interval: -5.3%, 2.9%) to -7.9% of energy (95% confidence interval: -11.2%, -4.5%) in the overall population]. Overall and among males, lower SEP groups had more favorable intakes over time based on trends in absolute and relative gaps in UPF and MPF intake by neighborhood material deprivation. CONCLUSIONS: Socioeconomic inequalities in UPF and MPF intake were most pronounced for individual and household education. Between 2004 and 2015, several inequalities in UPF and MPF intake emerged according to household food insecurity (favoring higher SEP groups) and neighborhood material deprivation (favoring lower SEP groups).

Ultraprocessed Food Intake during the Transition to Adulthood Varies According to Sociodemographic Characteristics and Maternal Intake in Cebu, Philippines.

BACKGROUND: Ultraprocessed foods (UPFs) are associated with elevated risk of noncommunicable disease, but little is known about UPF intake and the individual-, household-, and community-level factors associated with it among adolescents in low- or middle-income countries. OBJECTIVES: We estimated the association of UPF intake across adolescence with sociodemographic characteristics and maternal UPF intake in a Filipino cohort. METHODS: Data were from 4 waves (1994-2005) of the Cebu Longitudinal Health and Nutrition Survey (n = 2068); participants were aged 11, 15, 18, and 21 y. Foods from 24-h recalls were classified using NOVA. We used two-part multilevel models to estimate time-varying associations of the odds and amount (percentage daily kilocalories) of UPF intake with sociodemographic characteristics and maternal UPF intake (none, below median among UPF-consuming mothers ["low"], at or above median ["high"]). RESULTS: Median UPF intake (interquartile range [IQR]) among adolescents was 7.3% (IQR: 0, 17.2%) of daily kilocalories at age 11 y and 10.6% (IQR: 3.6, 19.6%) at 21 y. The odds and amount of adolescent UPF intake were positively associated with female sex, years of schooling, and household wealth and inversely associated with household size. The odds-but not amount-of adolescent UPF intake was positively associated with maternal education and urbanicity and inversely associated with the distance from a household's primary store/market. The association between odds of adolescent UPF intake and school enrollment was positive in adolescence but disappeared in early adulthood. Compared with offspring whose mothers did not consume UPFs, the odds of UPF intake among those whose mothers had low or high UPF intake was greater in adolescence, but there was no association once offspring became adults. At all ages, maternal UPF intake was positively associated with the amount of offspring intake. CONCLUSIONS: Adolescent UPF intake varied across sociodemographic characteristics and was positively associated with maternal UPF intake, but not after adolescents entered adulthood.

Association between processed and ultra-processed food intake and the risk of breast cancer: a case-control study.

BACKGROUND: Results from studies investigating the association between ultra-processed foods (UPFs) and breast cancer are scarce and, in some cases, contradictory. Therefore, we aimed to evaluate the association between the intake of processed foods (PFs) and UPFs with the risk of breast cancer in Iranian women. METHODS: The present case (n = 133) - control (n = 266) study was carried out at two general hospitals in Tehran, Iran. A 168-item semi-quantitative food frequency questionnaire was used to assess the participants' dietary intake. Also, the NOVA classification was used to identify PFs and UPFs. The association between PFs and UPFs with the odds of breast cancer was analyzed using logistic regression models. RESULTS: According to Model 1 of conditional logistic regression, the odds of breast cancer were higher in the last tertile of UPFs than in the first tertile (odds ratio (OR) = 1.930; 95% confidence interval (CI): 1.080-3.449). In Model 2, no significant association was observed between the second and last tertiles of PFs and UPFs with the odds of breast cancer compared to the reference tertile. Also based on menopause status, the odds of breast cancer increased in the last tertile only among premenopausal women in Model 2 (OR = 3.656; 95% CI: 1.326-10.079). CONCLUSIONS: This study demonstrated that higher consumption of UPFs is associated with higher odds of breast cancer in premenopausal women.

Ultra-processed Food Intake and Risk of Type 2 Diabetes in Korean Adults.

BACKGROUND: Several studies from the United States and European countries reported a positive association between ultra-processed food intake and diabetes risk. However, little is known about the association in Asian populations. It is also unknown about the individual ultra-processed food items that are most unfavorably associated with diabetes risk. OBJECTIVE: We examined the associations of ultra-processed food intake (combined, as well as individual ultra-processed food items) with the risk of type 2 diabetes. METHODS: This prospective analysis included 7438 participants aged 40-69 y from the Korean Genome and Epidemiology Study Ansan-Ansung cohort. Dietary intake was assessed at baseline using a 103-item semiquantitative food-frequency questionnaire. Ultra-processed foods were classified using the Nova definition. Incident type 2 diabetes cases were identified via follow-up interviews and health examination. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for potential confounders. RESULTS: During the follow-up (2001-2019; median: 15 y), a total of 1187 type 2 diabetes cases were identified. Compared with the lowest quartile of ultra-processed food intake, the highest quartile was positively associated with diabetes risk [HR (95% CI) = 1.34 (1.13, 1.59), P-trend = 0.002]. The association did not change after additional adjustment for diet quality or BMI. Among individual ultra-processed food items, a higher consumption of ham/sausage [per 1% increase in the weight ratio: HR (95% CI) = 1.40 (1.05, 1.86)], instant noodles [1.07 (1.02, 1.11)], ice cream [1.08 (1.03, 1.13)], and carbonated beverages [1.02 (1.00, 1.04)] were associated with an increased risk of type 2 diabetes, whereas a higher intake of candy/chocolate was associated with a decreased risk [0.78 (0.62, 0.99)]. CONCLUSIONS: Our data suggest that the high intake of ultra-processed foods, particularly ham/sausage, instant noodles, ice cream, and carbonated beverages, is associated with an increased risk of type 2 diabetes in Korean adults.

Ultra-processed foods, allergy outcomes and underlying mechanisms in children: An EAACI task force report.

BACKGROUND: Consumption of ultra-processed foods [UPFs] may be associated with negative health outcomes. Limited data exist regarding the potential role of UPFs in the occurrence of allergic diseases. The underlying mechanisms underpinning any such associations are also poorly elucidated. METHODS: We performed a systematic review and narrative evidence synthesis of the available literature to assess associations between UPF consumption and pediatric allergy outcomes (n = 26 papers), including data on the association seen with the gut microbiome (n = 16 papers) or immune system (n = 3 papers) structure and function following PRISMA guidelines. RESULTS: Dietary exposure to fructose, carbonated soft drinks, and sugar intake was associated with an increased risk of asthma, allergic rhinitis, and food allergies in children. Commercial baby food intake was associated with childhood food allergy. Childhood intake of fructose, fruit juices, sugar-sweetened beverages, high carbohydrate UPFs, monosodium glutamate, UPFs, and advanced glycated end-products (AGEs) was associated with the occurrence of allergic diseases. Exposure to UPFs and common ingredients in UPFs seem to be associated with increased occurrence of allergic diseases such as asthma, wheezing, food allergies, atopic dermatitis, and allergic rhinitis, in many, but not all studies. CONCLUSION: More preclinical and clinical studies are required to better define the link between UPF consumption and the risk of allergies and asthma. These observational studies ideally require supporting data with clearly defined UPF consumption, validated dietary measures, and mechanistic assessments to definitively link UPFs with the risk of allergies and asthma.

Ultra-processed foods cause weight gain and increased energy intake associated with reduced chewing frequency: A randomized, open-label, crossover study.

AIM: To elucidate the effects of ultra-processed foods (UPFs) on body weight and ad libitum energy intake compared with non-UPFs. MATERIALS AND METHODS: In this randomized, open-label crossover study conducted at the University of Tokyo Hospital, overweight/obese Japanese male participants were randomly assigned (1:1) to start the study with consumption of either UPFs or non-UPFs for 1 week, followed by a 2-week washout period, before crossing over to the alternate food diet for 1 week. Individuals with diabetes, hypertension or any other medical conditions who visited a hospital regularly were excluded. The meals were designed to be matched for the total energy and macronutrient levels. The primary outcome was the difference in the body weight change between the UPF and non-UPF periods. The differences in the average daily energy intake and chewing frequency were assessed as one of the prespecified secondary outcomes. RESULTS: Nine eligible participants were randomly assigned to start the study with either UPFs or non-UPFs. All participants completed the study. During the UPF period, participants gained 1.1 kg more weight (95% confidence interval 0.2 to 2.0; P = .021) and consumed 813.5 kcal more per day (342.4 to 1284.7; P = .0041) compared with during the non-UPF period. Regarding the chewing frequency, the number of chews per calorie was significantly lower during the UPF period (P = .016). CONCLUSIONS: Consumption of UPFs causes significant weight gain. Medical nutritional therapy focused on reducing the consumption of UPFs could be an effective strategy for preventing obesity.

Effects of changes in residential fast-food outlet exposure on Body Mass Index change: longitudinal evidence from 92,211 Lifelines participants.

BACKGROUND: Evidence on the association between fast-food outlet exposure and Body Mass Index (BMI) remains inconsistent and is primarily based on cross-sectional studies. We investigated the associations between changes in fast-food outlet exposure and BMI changes, and to what extent these associations are moderated by age and fast-food outlet exposure at baseline. METHODS: We used 4-year longitudinal data of the Lifelines adult cohort (N = 92,211). Participant residential addresses at baseline and follow-up were linked to a register containing fast-food outlet locations using geocoding. Change in fast-food outlet exposure was defined as the number of fast-food outlets within 1 km of the residential address at follow-up minus the number of fast-food outlets within 1 km of the residential address at baseline. BMI was calculated based on objectively measured weight and height. Fixed effects analyses were performed adjusting for changes in covariates and potential confounders. Exposure-moderator interactions were tested and stratified analyses were performed if p < 0.10. RESULTS: Participants who had an increase in the number of fast-food outlets within 1 km had a greater BMI increase (B(95% CI): 0.003 (0.001,0.006)). Decreases in fast-food outlet exposure were not associated with BMI change (B(95% CI): 0.001 (-0.001,0.004)). No clear moderation pattern by age or fast-food outlet exposure at baseline was found. CONCLUSIONS: Increases in residential fast-food outlet exposure are associated with BMI gain, whereas decreases in fast-food outlet exposure are not associated with BMI loss. Effect sizes of increases in fast-food outlet exposure on BMI change were small at individual level. However, a longer follow-up period may have been needed to fully capture the impact of increases in fast-food outlet exposure on BMI change. Furthermore, these effect sizes could still be important at population level considering the rapid rise of fast-food outlets across society. Future studies should investigate the mechanisms and changes in consumer behaviours underlying associations between changes in fast-food outlet exposure and BMI change.

#junkfluenced: the marketing of unhealthy food and beverages by social media influencers popular with Canadian children on YouTube, Instagram and TikTok.

BACKGROUND: Marketing of unhealthy foods to children on digital media significantly impacts their dietary preferences and contributes to diet-related noncommunicable diseases. Canadian children spend a significant amount of time on digital devices and are frequently exposed to unhealthy food marketing on social media, including by influencers with celebrity status who endorse products. This study aimed to examine the frequency, healthfulness, and power of unhealthy food marketing in posts by influencers popular with Canadian children on YouTube, Instagram and TikTok. METHODS: The top 9 influencers popular amongst Canadian children aged 10-12 years were identified from the 2021 International Food Policy Study Youth Survey. A total of 2,232 Instagram, YouTube and TikTok posts made by these influencers between June 1st 2021 and May 31st 2022 were examined for instances of food marketing. Food products/brands were identified and frequencies were calculated for the number of posts promoting food products/brands, posts promoting products/brands classified as less healthy according to Health Canada's Nutrient Profile Model (2018) and marketing techniques utilized. RESULTS: YouTube had the highest average rate of food marketing instances per post, at a rate of 1 food marketing instance every 0.7 posts, while TikTok and Instagram had instances every 10.2 posts and 19.3 posts, respectively. Overall, fast food restaurants was the most promoted food category (21%), followed by regular soft drinks (13%), snacks (11%), candy and chocolate (11%) and water (8%). The most frequently used marketing techniques were appeals to fun/cool (37%), the use of songs or music (28%) and the product being consumed (25%). In terms of healthfulness, 83% of the products/brands (87% of brands and 82% of products) promoted were classified as less healthy. CONCLUSIONS: Social media influencers play a substantial role in promoting unhealthy food products to children, primarily fast food items. Given the significant impact of such marketing on children, there is a need for ongoing government-led monitoring, and it is crucial to include social media and influencer marketing in marketing restrictions targeting children in Canada to safeguard this vulnerable demographic.

Evaluating the impact of the universal infant free school meal policy on the ultra-processed food content of children's lunches in England and Scotland: a natural experiment.

BACKGROUND: The Universal Infant Free School Meal (UIFSM) policy was introduced in 2014/15 in England and Scotland for schoolchildren aged 4-7 years, leading to an increase in school meal uptake. UK school meals are known to be healthier and less industrially processed than food brought from home (packed lunches). However, the impact of the UIFSM policy on the quantity of ultra-processed food (UPF) consumed at school during lunchtime is unknown. This study aimed to evaluate the impact of the UIFSM policy on lunchtime intakes of UPF in English and Scottish schoolchildren. METHODS: Data from the UK National Diet and Nutrition Survey (2008-2019) were used to conduct a difference-in-difference (DID) natural experiment. Outcomes included school meal uptake and the average intake of UPF (% of total lunch in grams (%g) and % total lunch in Kcal (%Kcal)) during school lunchtime. The change in the outcomes before and after the introduction of UIFSM (September 2014 in England, January 2015 in Scotland) in the intervention group (4-7 years, n = 835) was compared to the change in an unexposed control group (8-11 years, n = 783), using linear regression. Inverse probability weights were used to balance characteristics between intervention and control groups. RESULTS: Before UIFSM, school meal uptake and consumption of UPFs were similar in the intervention and control groups. The DID model showed that after UIFSM, school meal uptake rose by 25%-points (pp) (95% CI 14.2, 35.9) and consumption of UPFs (%g) decreased by 6.8pp (95% CI -12.5,-1.0). Analyses indicated this was driven by increases in minimally processed dairy and eggs, and starchy foods, and decreases in ultra-processed salty snacks, bread and drinks. The differences were larger in the lowest-income children (-19.3 UPF(%g); 95% CI -30.4,-8.2) compared to middle- and high-income children. Analyses using UPF %Kcal had similar conclusions. CONCLUSIONS: This study builds on previous evidence suggesting that UIFSM had a positive impact on dietary patterns, showing that it reduced consumption of UPFs at school lunchtime, with the greatest impact for children from the lowest-income households. Universal free school meals could be an important policy for long term equitable improvements in children's diet.