[The influence of ultra-processed food on cardiovascular disease: how "why do things the hard way?" makes our brains soft]. / De invloed van sterk bewerkte voeding op hart- en vaatziekten.

Buying and consuming ultra-processed food makes life easy. Nowadays, there is more and more prove that the consumption of this food is associated with morbidity and mortality, e.g. cardiovascular disease, diabetes, neurocognitive diseases and cancer. Recently, Bonaccio et al. strenghtened this in a large prospective cohort for cardiovascular disease. They used among others the 'Nutri-Score' for their analysis. However, the reliability of this score remains under debate, and therefore, it is not the best to use as label for consumers. In short: although consumption of ultra-processed food is a risk factor for cardiovascular and other diseases, for consumers is remains difficult to recognize the healthiest food in the supermarket. What's in this for you, doc? Keep this in mind during your all-day practice and guide your patients to healthier foods during their consultation with you.

Association between Ultra-Processed Food Consumption and Metabolic Syndrome among Adults in China-Results from the China Health and Nutrition Survey.

The prevalence of metabolic syndrome (MetS) is increasing and the relationship between ultra-processed food (UPF) consumption and MetS remains uncertain in Chinese adults. This study aimed to examine the longitudinal association of UPF consumption with the risk of MetS and its components in Chinese adults. Adults aged 18 years and above who participated in at least two waves of the China Health and Nutrition Survey (CHNS) in 2009, 2015, and 2018 were included in this analysis. Dietary intake data were collected by three consecutive 24 h dietary recalls and weighing household foods and condiments. Depending on the purpose and extent of food processing, UPFs were classified using the NOVA food classification system. A multivariate Cox proportional risk model was used to explore the association between UPF consumption (grouped by quartile: quartile 1 (Q1), quartile 2 (Q2), quartile 3 (Q3), and quartile 4 (Q4)) and risk of MetS and its components. A total of 5147 adults were included. During a median (IQR) 6.0 (3.0, 9.0) year follow-up with 31,878 person-years, 1712 MetS cases were identified, with an incidence of 33.26%. After multivariable adjustment, the risk of MetS was increased by 17% in the highest quartile with UPF consumption (HR: 1.17, 95% CI: 1.01-1.35, p trend: 0.047), with the lowest quartile as a reference. For the components of MetS, the risk of central obesity, raised triglycerides (TG), reduced high-density lipoprotein cholesterol (HDL-C), and raised blood pressure (BP) was increased by 33% (HR: 1.33, 95% CI: 1.18-1.51, p trend: <0.001), 26% (HR: 1.26, 95% CI: 1.08-1.48, p trend: 0.003), 25% (HR: 1.25, 95% CI: 1.07-1.46, p trend: 0.007), and 16% (HR: 1.16, 95% CI: 1.03-1.32, p trend: 0.018) in the highest quartile with UPF consumption, respectively. Adults aged 45-59 years and living in urban areas with higher UPF consumption had higher odds of MetS. These results indicate that higher long-term UPF consumption was associated with an increased risk of MetS in Chinese adults. Further studies such as intervention trials are needed to confirm the mechanism of correlation between UPF consumption and health-related outcomes. Nutritional education actions are warranted to promote a balanced diet and improve the overall dietary quality of residents to reduce the risk of MetS effectively.

Ultra-Processed Food Consumption and Depressive Symptoms in a Mediterranean Cohort.

Excess consumption of ultra-processed foods (UPFs) is currently under investigation for its potentially detrimental impact on human health. Current evidence demonstrates a substantial association with an increased risk of metabolic disorders, but data on mental health outcomes are just emerging. The aim of this study was to investigate the relationship between the consumption of UPFs and depressive symptoms in a sample of younger Italian adults. A cross-sectional study was conducted on 596 individuals (age 18-35 y) recruited in southern Italy. Food frequency questionnaires and the NOVA classification were used to assess dietary factors; the Center for the Epidemiological Studies of Depression Short Form (CES-D-10) was used to assess presence of depressive symptoms. Individuals in the highest quartile of UPF consumption had higher odds of having depressive symptoms in the energy-adjusted model (odds ratio (OR) = 1.89, 95% confidence interval (CI): 1.06, 3.28); the association remained significant after adjusting for potential confounding factors (OR = 2.04, 95% CI: 1.04, 4.01) and became even stronger after further adjustment for adherence to the Mediterranean diet as a proxy of diet quality (OR = 2.70, 95% CI: 1.32, 5.51). In conclusion, a positive association between UPF consumption and likelihood of having depressive symptoms was found in younger Italian individuals. Given the consistency of the findings after adjustment for diet quality, further studies are needed to understand whether non-nutritional factors may play a role in human neurobiology.

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.

Ultra-processed food consumption and metabolic syndrome: a cross-sectional study in Quilombola communities of Alagoas, Brazil.

BACKGROUND: The processing of food can cause changes that turn them into risk factors for chronic diseases. A higher degree of food processing is associated with the development of chronic non-communicable diseases (NCDs), including the metabolic syndrome (MetS). The objective of this study was to analyze the relationship between ultra-processed food (UPF) consumption and the prevalence of MetS and its risk factors, focusing on a population group especially subjected to precarious living conditions and food insecurity. METHOD: Cross-sectional population-based study with women (19 to 59 years) from Quilombola communities of Alagoas. The socioeconomic, demographic, anthropometric, health status, lifestyle, and food intake (24-h recall) variables were analyzed. The dependent variable was the MetS, defined using the harmonization criteria of the Joint Interim Statement, and its components. The foods consumed were categorized according to the Nova Classification, assuming the highest UPF consumption as risk exposure. The measure of association was the prevalence ratio (PR) and respective 95%CI, calculated by Poisson regression with robust variance. We also analyzed the association with the Nova score of UPF consumption. RESULTS: We investigated 895 women (38.9 ± 11.0 years), of whom 48.3% had MetS. On average, 15.9% of the total energy intake came from UPF. Lower Nova scores were associated with a lower prevalence of diabetes and low HDL. Higher UPF consumption was associated with a 30% higher prevalence of hypertension (PR = 1.30; 95%CI: 1.06-1.61). CONCLUSION: The highest UPF consumption was positively associated with the prevalence of hypertension, while a lower Nova score was a protective factor against diabetes and low HDL. UPF consumption in Quilombola communities is important but lower than that observed in the Brazilian population in general. It is suggested that public health programs be implemented to promote healthy eating while valuing the existing eating habits and traditions among the remaining Brazilian Quilombola people.

RESUMO: INTRODUçãO: O processamento de alimentos pode causar alterações que os transformam em fatores de risco para doenças crônicas. Um maior grau de processamento de alimentos está associado ao desenvolvimento de doenças crônicas não transmissíveis (DCNT), incluindo a síndrome metabólica (SM). O objetivo deste estudo foi analisar a relação entre o consumo de alimentos ultraprocessados (AUP) e a prevalência de SM e seus fatores de risco, com foco em um grupo populacional especialmente submetido a precárias condições de vida e insegurança alimentar. MéTODO: Estudo transversal de base populacional com mulheres (19 a 59 anos) de comunidades Quilombolas de Alagoas. Foram analisadas as variáveis socioeconômicas, demográficas, antropométricas, estado de saúde, estilo de vida e ingestão alimentar (recordatório de 24 horas). A variável dependente foi a SM, definida a partir dos critérios de harmonização do Joint Interim Statement, e seus componentes. Os alimentos consumidos foram categorizados de acordo com a Classificação Nova, assumindo como exposição de risco o maior consumo de AUP. A medida de associação foi a razão de prevalência (RP) e respectivo IC 95%, calculado por regressão de Poisson com variância robusta. Também analisou-se a associação com o Escore Nova de consumo de AUP. RESULTADOS: Foram investigadas 895 mulheres (38,9 ± 11,0 anos), das quais 48,3% tinham SM. Em média, 15,9% da ingestão total de energia provinham de AUP. Escores Nova mais baixos foram associados a uma menor prevalência de diabetes e HDL baixo. O maior consumo de AUP se associou a uma prevalência 30% maior de hipertensão arterial (RP = 1,30; IC95%: 1,06-1,61). CONCLUSãO: O maior consumo de AUP se associou positivamente à prevalência de hipertensão, enquanto o menor escore Nova foi fator de proteção contra diabetes e baixo HDL. O consumo de AUP nas comunidades Quilombolas é relevante, mas inferior ao observado na população brasileira em geral. Sugere-se a implementação de programas de saúde pública que promovam a alimentação saudável, valorizando os hábitos e tradições alimentares existentes entre os remanescentes Quilombolas brasileiros.

Ultra-Processed Food Consumption Is Related to Higher Trans Fatty Acids, Sugar Intake, and Micronutrient-Impaired Status in Schoolchildren of Bahia, Brazil.

Ultra-processed food (UPF) consumption impacts nutrient intake and plays an important role in non-communicable diseases (NCD), even among schoolchildren. This cross-sectional study aimed to characterize the food consumption of this population and its relationship with laboratory and anthropometric aspects. A sample of 190 subjects aged 5 to 19 y was randomly selected for dietary, laboratory, and anthropometric assessment. Statistical inference was calculated using Spearman's correlation. Excess weight was observed in 34%, a high Waist-to-Height Ratio in 9%, and hypertriglyceridemia in 17% of the subjects, higher among those from urban schools (45%, p = 0.011; 15%, p = 0.015; 24%, p = 0.026, respectively). UPF consumption represented 21% of caloric intake and showed a positive correlation with trans fatty acids (r = 0.70) and sugar (r = 0.59) intake. Unprocessed food consumption showed a weak, but significant, correlation with Body Mass Index (r = 0.22) and Waist Circumference (r = 0.23), while processed meat showed a negative correlation with serum ferritin (r = -0.16) and vitamins D (r = -0.20) and B12 (r = -0.15). These findings highlight the need for public policies to promote Food and Nutritional Security for schoolchildren to prevent NCD and nutritional deficiencies.

Ultra-Processed Food Consumption Associated with Incident Hypertension among Chinese Adults-Results from China Health and Nutrition Survey 1997-2015.

OBJECTIVE: Ultra-processed food (UPF) has been shown to increase the cardiometabolic health risks. We aimed to determine the association between UPF intake based on the NOVA classification and the risk of hypertension incidence during 1997-2015. METHODS: Data from 15,054 adults aged ≥ 20 years (47.4% males) attending the China Nutrition and Health Survey (CNHS) were used. Food intake at each survey was assessed by a 3-day 24 h dietary recall and weighed food record method between 1997-2011. Cox regression was used to assess the association between UPF intake and incident hypertension. RESULTS: During a mean average of 9.5 years (SD 5.5) of follow up, 4329 hypertension incident cases were identified. The incident rates (per 1000) for non-consumers and 1-49, 50-99, and ≥100 g/day of UPF intake were 29.5 and 29.5, 33.4, and 36.3, respectively. Compared with non-consumers, the hazard ratios (95% CI) for UPF intake of 1-49, 50-99, and >100 g/day were 1.00 (0.90-1.12), 1.17 (1.04-1.33), and 1.20 (1.06-1.35), respectively, (p = 0.001) after adjusting for potential confounding factors. There was a significant interaction between UPF intake and age with a higher risk in the younger group (<40 years) than in the older one. CONCLUSION: UPF consumption was dose-responsively associated with increased risk of hypertension among Chinese adults, especially in younger groups.

Ultra-Processed Foods and Drinks Consumption Is Associated with Psychosocial Functioning in Adolescents.

Adolescents show one of the highest rates of ultra-processed foods and drinks (UPF) consumption, and studies indicate an association between their consumption and internalizing problems. We aim to investigate whether UPF consumption associates with dysfunctions in other psychosocial domains, as well as sex effects. In 560 Spanish adolescents (14-17 years old), we assessed the UPF products consumed in the previous day, fruits and vegetables consumption (servings/day), and physical activity (days/week). Psychosocial functioning (total and subscales) was assessed through the Pediatric Symptom Checklist-Youth self-report. Associations between UPF and psychosocial functioning were assessed using linear regression models, adjusting for sex, age, fruits and vegetables consumption, and physical activity. Sex-specific associations were also explored. Participants reported a daily consumption of 7.72 UPF servings per day, with male adolescents showing higher consumption than female adolescents. Consumption of fruits and vegetables and physical activity levels were lower than recommended. Psychosocial impairment was present in 26.2% of the participants. Higher UPF consumption was associated with higher presence of depressive symptoms and internalizing and externalizing problems in the whole sample and in male adolescents. The present study supports previous studies suggesting that UPF consumption may interact with mental health problems and indicates that these effects may go beyond internalizing problems.

Joint association of food nutritional profile by Nutri-Score front-of-pack label and ultra-processed food intake with mortality: Moli-sani prospective cohort study.

OBJECTIVE: To jointly analyse two food dimensions, the Food Standards Agency Nutrient Profiling System (FSAm-NPS), used to derive the Nutri-Score front-of-pack label, and the NOVA classification in relation to mortality. DESIGN: Prospective cohort study. SETTING: Moli-sani Study, Italy 2005-10. PARTICIPANTS: 22 895 participants (mean age 55 (SD 12) years; 48% men). MAIN OUTCOMES MEASURES: Associations between dietary exposures and mortality risk, assessed using multivariable cause specific Cox proportional hazard models controlled for known risk factors. RESULTS: A total of 2205 deaths occurred during 272 960 person years of follow-up. In the highest quarter of the FSAm-NPS index compared with the lowest quarter, multivariable adjusted hazard ratios for all cause and cardiovascular mortality were 1.19 (95% confidence interval 1.04 to 1.35; absolute risk difference 4.3%, 95% confidence interval 1.4% to 7.2%) and 1.32 (1.06 to 1.64; 2.6%, 0.3% to 4.9%), respectively. The hazard ratios were 1.19 (1.05 to 1.36; absolute risk difference 9.7%, 5.0% to 14.3%) and 1.27 (1.02 to 1.58; 5.0%, 1.2% to 8.8%), respectively, for all cause and cardiovascular mortality when the two extreme categories of ultra-processed food intake were compared. When these two indices were analysed jointly, the magnitude of the association of the FSAm-NPS dietary index with all cause and cardiovascular mortality was attenuated by 22.3% and 15.4%, respectively, whereas mortality risks associated with high ultra-processed food intake were not altered. CONCLUSIONS: Adults with the lowest quality diet, as measured using the FSAm-NPS dietary index (underpinning the Nutri-Score), and the highest ultra-processed food consumption (NOVA classification) were at the highest risk for all cause and cardiovascular mortality. A significant proportion of the higher mortality risk associated with an elevated intake of nutrient poor foods was explained by a high degree of food processing. In contrast, the relation between a high ultra-processed food intake and mortality was not explained by the poor quality of these foods.

Association between Ultra-Processed Food Consumption and Diabetes in Chinese Adults-Results from the China Health and Nutrition Survey.

AIMS: We aimed to assess the association between ultra-processed food (UPF) consumption with diabetes in Chinese adults. METHODS: This study included 12,849 eligible adults aged 20 years and over attending at least two surveys in the China Nutrition and Health Survey during 1997-2011. Food intake at each survey was assessed by a 3-day 24-h dietary recall method. UPF was defined based on the NOVA classification. Diabetes was obtained from questionnaires and/or ascertained by fasting blood tests. The association of diabetes with UPF was examined using mix effect logistic regression adjusting for potential confounding factors. RESULTS: The mean age of the participants was 43.3 (SD 14.8) years. The age and gender adjusted mean UPF intake increased four times and the prevalence of diabetes increased eight times in 1997-2011. Compared with non-consumers, the odds ratios (95% CI) of diabetes for those with mean UPF consumption of 1-19 g/day, 20-49 g/day, and ≥50 g/day were 1.21 (0.98, 1.48), 1.49 (1.19, 1.86), and 1.40 (1.08, 1.80), respectively (p trend < 0.001) after adjusted for the measured covariates including lifestyle factors (smoking, alcohol drinking, and physical activity), BMI and hypertension. CONCLUSIONS: both UPF consumption and prevalence of diabetes increased among adults in China during 1997-2011. Higher UPF consumption was positively associated with diabetes.

The Origins of the Obesity Epidemic in the USA-Lessons for Today.

The obesity epidemic appeared in the USA in 1976-1980 and then spread across Westernized countries. This paper examines the most likely causes of the epidemic in the USA. An explanation must be consistent with the emergence of the epidemic in both genders and in all age groups and ethnicities at about the same time, and with a steady rise in the prevalence of obesity until at least 2016. The cause is closely related to changes in the American diet. There is little association with changes in the intake of fat and carbohydrate. This paper presents the opinion that the factor most closely linked to the epidemic is ultra-processed foods (UPFs) (i.e., foods with a high content of calories, salt, sugar, and fat but with very little whole foods). Of particular importance is sugar intake, especially sugar-sweetened beverages (SSBs). There is strong evidence that consumption of SSBs leads to higher energy intake and more weight gain. A similar pattern is also seen with other UPFs. Factors that probably contributed to the increased intake of UPFs include their relatively low price and the increased popularity of fast-food restaurants. Other related topics discussed include: (1) the possible importance of Farm Bills implemented by the US Department of Agriculture; (2) areas where further research is needed; (3) health hazards linked to UPFs; and (4) the need for public health measures to reduce intake of UPFs.

Association of Ultraprocessed Food Consumption With Risk of Dementia: A Prospective Cohort Study.

BACKGROUND AND OBJECTIVES: There has been a growing body of evidence associating consumption of ultraprocessed foods (UPF) with adverse health outcomes including depression, cardiovascular disease, and all-cause mortality. However, whether UPF are associated with dementia is unknown. The authors investigated the associations between UPF and dementia incidence in the UK Biobank. METHODS: We included 72,083 participants (55 years or older) who were free from dementia at baseline and provided at least 2 times 24-hour dietary assessments from the UK Biobank study. Follow-up occurred through March 2021. UPF were defined according to the NOVA classification. Incident all-cause dementia comprising Alzheimer disease (AD) and vascular dementia was ascertained through electronic linkages to hospital and mortality records. Cox proportional hazards were used to estimate the association between the proportion (%) of UPF in the diet and the subsequent risk of dementia. In addition, substitution analysis was used to estimate the risk of dementia when substituting UPF with an equivalent proportion of unprocessed or minimally processed foods. RESULTS: During a total of 717,333 person-years of follow-up (median 10.0 years), 518 participants developed dementia, of whom 287 developed AD and 119 developed vascular dementia. In the fully adjusted model, consumption of UPF was associated with higher risk of dementia (hazard ratio [HR] for 10% increase in UPF 1.25; 95% CI 1.14-1.37), AD (HR 1.14; 95% CI 1.00-1.30), and vascular dementia (HR 1.28; 95% CI 1.06-1.55), respectively. In addition, replacing 10% of UPF weight in diet with an equivalent proportion of unprocessed or minimally processed foods was estimated to be associated with a 19% lower risk of dementia (HR 0.81; 95% CI 0.74-0.89). DISCUSSION: In this prospective cohort study, higher consumption of UPF was associated with higher risk of dementia, whereas substituting unprocessed or minimally processed foods for UPF was associated with lower risk of dementia.

Does Consumption of Ultra-Processed Foods Matter for Liver Health? Prospective Analysis among Older Adults with Metabolic Syndrome.

Non-alcoholic fatty liver disease (NAFLD) includes a spectrum of liver alterations that can result in severe disease and even death. Consumption of ultra-processed foods (UPF) has been associated with obesity and related comorbidities. However, the link between UPF and NAFLD has not been sufficiently assessed. We aimed to investigate the prospective association between UPF consumption and liver health biomarkers. Methods: We followed for 1 year 5867 older participants with overweight/obesity and metabolic syndrome (MetS) from the PREDIMED-Plus trial. A validated 143-item semi-quantitative food frequency questionnaire was used to evaluate consumption of UPF at baseline, 6, and 12 months. The degree of processing for foods and beverages (g/day) was established according to the NOVA classification system. The non-invasive fatty liver index (FLI) and hepatic steatosis index (HSI) were used to evaluate liver health at three points in time. The associations between changes in UPF consumption (percentage of total daily dietary intake (g)) and liver biomarkers were assessed using mixed-effects linear models with repeated measurements. Results: In this cohort, UPF consumption at baseline was 8.19% (SD 6.95%) of total daily dietary intake in grams. In multivariable models, each 10% daily increment in UPF consumption in 1 year was associated with significantly greater FLI (ß 1.60 points, 95% CI 1.24;1.96 points) and HSI (0.43, 0.29; 0.57) scores (all p-values < 0.001). These associations persisted statistically significant after adjusting for potential dietary confounders and NAFLD risk factors. Conclusions: A higher UPF consumption was associated with higher levels of NAFLD-related biomarkers in older adults with overweight/obesity and MetS.

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

OBJECTIVE: To assess whether maternal ultra-processed food intake during peripregnancy and during the child rearing period is associated with offspring risk of overweight or obesity during childhood and adolescence. DESIGN: Population based prospective cohort study. SETTING: The Nurses' Health Study II (NHSII) and the Growing Up Today Study (GUTS I and II) in the United States. PARTICIPANTS: 19 958 mother-child (45% boys, aged 7-17 years at study enrollment) pairs with a median follow-up of 4 years (interquartile range 2-5 years) until age 18 or the onset of overweight or obesity, including a subsample of 2925 mother-child pairs with information on peripregnancy diet. MAIN OUTCOME MEASURES: Multivariable adjusted, log binomial models with generalized estimating equations and an exchangeable correlation structure were used to account for correlations between siblings and to estimate the relative risk of offspring overweight or obesity defined by the International Obesity Task Force. RESULTS: 2471 (12.4%) offspring developed overweight or obesity in the full analytic cohort. After adjusting for established maternal risk factors and offspring's ultra-processed food intake, physical activity, and sedentary time, maternal consumption of ultra-processed foods during the child rearing period was associated with overweight or obesity in offspring, with a 26% higher risk in the group with the highest maternal ultra-processed food consumption (group 5) versus the lowest consumption group (group 1; relative risk 1.26, 95% confidence interval 1.08 to 1.47, P for trend<0.001). In the subsample with information on peripregnancy diet, while rates were higher, peripregnancy ultra-processed food intake was not significantly associated with an increased risk of offspring overweight or obesity (n=845 (28.9%); group 5 v group 1: relative risk 1.17, 95% confidence interval 0.89 to 1.53, P fortrend=0.07). These associations were not modified by age, sex, birth weight, and gestational age of offspring or maternal body weight. CONCLUSIONS: Maternal consumption of ultra-processed food during the child rearing period was associated with an increased risk of overweight or obesity in offspring, independent of maternal and offspring lifestyle risk factors. Further study is needed to confirm these findings and to understand the underlying biological mechanisms and environmental determinants. These data support the importance of refining dietary recommendations and the development of programs to improve nutrition for women of reproductive age to promote offspring health.

The Intake of Ultra-Processed Foods and Prevalence of Chronic Kidney Disease: The Health Examinees Study.

Emerging evidence links several health outcomes to the consumption of ultra-processed food (UPF), but few studies have investigated the association between UPF intake and kidney function. This cross-sectional study investigated the prevalence of chronic kidney disease (CKD) in relation to UPF intake in Korea. Data were obtained from the 2004-2013 Health Examinees (HEXA) study. The intake of UPF was assessed using a 106-item food frequency questionnaire and evaluated using the NOVA classification. The prevalence of CKD was defined as an estimated glomerular filtration rate (eGFR) of <60 mL/min/m2. Poisson regression models were used to compute the prevalence ratios (PR) of CKD according to quartiles of the proportion of UPF intake (% food weight). A total of 134,544 (66.4% women) with a mean age of 52.0 years and an eGFR of 92.7 mL/min/m2 were analysed. The median proportion of UPF in the diet was 5.6%. After adjusting for potential confounders, the highest quartile of UPF intake was associated with the highest prevalence of CKD (PR 1.16, 95% CI 1.07-1.25), and every IQR (6.6%) increase in the proportion of UPF in the diet was associated with a 6% higher prevalence of CKD (PR 1.06, 95% CI 1.03-1.09). Furthermore, the highest consumption of UPF was inversely associated with eGFR (Q4 vs. Q1: ß -1.07, 95% CI -1.35, -0.79; per IQR increment: (ß -0.45, 95% CI -0.58, -0.32). The intake of UPF was associated with a high prevalence of CKD and a reduced eGFR. Longitudinal studies in the Korean population are needed to corroborate existing findings in other populations.

The inflammatory potential of the diet as a link between food processing and low-grade inflammation: An analysis on 21,315 participants to the Moli-sani study.

BACKGROUND & AIMS: Food processing may adversely affect human health through a variety of mechanisms, including the development of a chronic pro-inflammatory state. In this study we aimed to test the hypothesis that an increasing degree of food processing is directly associated with low-grade inflammation, and evaluate to what extent this association is mediated by the inflammatory potential of highly processed foods. METHODS: Cross-sectional analysis on 21,315 subjects (mean age 55 ± 3 y) from the Moli-sani Study with complete dietary data collected by a validated 188-item food frequency questionnaire. The NOVA classification was used to categorize foods on the basis of industrial processing as: 1) unprocessed/minimally processed foods; 2) processed culinary ingredients; 3) processed foods; 4) ultra-processed foods (UPF). The inflammatory potential of the diet was evaluated through the Energy-adjusted Dietary Inflammatory Index (E-DII™). Low-grade inflammation was assessed by a composite INFLA-score including C-reactive protein, leukocyte and platelet counts and the granulocyte to lymphocyte ratio. RESULTS: In multivariable-adjusted linear regression models, the INFLA-score was positively associated with E-DII (ß = 0.15; 0.10, 0.19), processed foods (ß = 0.04; 0.01, 0.08) and UPF (ß = 0.13; 0.07, 0.19), but inversely associated with minimally processed foods (ß = -0.09; -0.13, -0.06). The E-DII score was inversely associated with minimally processed food (ß = -0.40; 95%CI -0.41, -0.39 for 5% increment in the weight ratio) but directly with either processed culinary ingredients (ß = 0.18; 0.15, 0.21 for 1% increment), processed food (ß = 0.28; 0.27, 0.29 for 5% increment) or UPF (ß = 0.34; 0.32, 0.36 for 5% increment). The inclusion of the E-DII into the multivariable model explained 88.5% of the association of processed food with the INFLA-score (p < 0.0001) and mitigated by 32.6% (p < 0.0001) the association with UPF. CONCLUSIONS: The association of UPF with low-grade inflammation is only partially explained by the high pro-inflammatory potential of these foods. Further studies are warranted to test whether the observed adverse relationship of UPF with low-grade inflammation could be triggered by mechanisms that are not directly related to the pro-inflammatory potential of highly processed food products.

Effect of the food processing degree on cardiometabolic health outcomes: A prospective approach in childhood.

BACKGROUND & AIMS: Ultra-processed foods (UPF) consumption has increased greatly over the last decades but its impact on health remains unclear. This study aimed to evaluate the prospective effect of different degrees of food processing on children's cardiometabolic profile. METHODS: Children from the Portuguese population-based birth cohort Generation XXI evaluated at 7 and 10 years of age (y), with dietary information at 7 y and anthropometric measurements at 10 y, were included in the present study (n = 3034). Dietary data were collected by 3-day food diaries and all reported food items were classified according to the degree of processing using the NOVA classification system. The daily consumption of the NOVA classification groups was calculated (in grams, as a proportion of total grams and total energy intake). The cardiometabolic outcomes included were serum markers [fasting glucose, insulin, blood lipids], anthropometric measurements [body mass index (BMI) and waist circumference (WC)], body composition [fat-free mass (FFM) and fat mass (FM)] and blood pressure (BP). Age- and sex-specific sample z-scores were obtained for all outcomes. Principal Component Analysis was used to identify a potential cluster of cardiovascular risk factors. Generalized linear models were fitted to evaluate the association between the consumption according to the processing degree (as absolute gram intake) and the individual cardiometabolic risk factors and cluster, adjusted for child's sex, maternal age and education and remaining NOVA groups. A mediation role of children's BMI in the previous analysis were tested. RESULTS: At 7 y, the daily median consumption of un/minimally processed, processed and UPF was 1210 g, 113 g and 433 g (68%, 6% and 25% of the total grams, as well as 51%, 15% and 31% of the total energy intake, respectively). After adjustment, an increase of 100 g in the consumption of un/minimally processed at 7 y was associated with a lower BMI (߈ = -0.028; 95%CI: -0.043; -0.014), WC (߈ = -0.020; 95%CI: -0.032; -0.008), FM (߈ = -0.023; 95%CI: -0.035; -0.011), insulin (߈ = -0.022; 95%CI: -0.036; -0.008) and BP (systolic BP: ߈ = -0.014; 95%CI: -0.025;-0.004; diastolic BP: ߈ = -0.013; 95%CI: -0.020;-0.005), at 10 y. BMI was a mediator between the consumption of un/minimally processed foods and BP. Positive associations were found between consumption of processed foods and the cluster 'higher blood pressure', while an inverse association was described between un/minimally processed and the cluster 'higher blood pressure'. No significant associations were found between the UPF consumption and any cardiometabolic outcomes. CONCLUSIONS: High consumption of unprocessed or minimally processed foods has a favourable effect on later children's cardiometabolic health, namely lower body weight and body fat, lower waist circumference, blood pressure insulin serum levels.

Ultra-processed Foods and Cardiometabolic Health Outcomes: from Evidence to Practice.

PURPOSE OF REVIEW: Poor diet quality is the leading risk factor related to the overall cardiometabolic disease burden in the USA and globally. We review the current evidence linking ultra-processed foods and cardiometabolic health risk and provide recommendations for action at the clinical and public health levels. RECENT FINDINGS: A growing body of evidence conducted in a variety of study populations supports an association between ultra-processed food intake and increased risk of metabolic syndrome, hypertension, type 2 diabetes, overweight and obesity trajectories, and cardiovascular disease. The strongest evidence is observed in relation to weight gain and obesity among adults, as this association is supported by high-quality epidemiological and experimental evidence. Accumulating epidemiologic evidence and putative biological mechanisms link ultra-processed foods to cardiometabolic health outcomes. The high intake of ultra-processed foods in all population groups and its associated risks make ultra-processed foods an ideal target for intensive health promotion messaging and interventions.