Processed food

Impact of ultra-processed food consumption on metabolic health.

Type of study: literature review

Number of citations: 28

Year: 2020

Authors: R. Costa de Miranda, F. Rauber, R. Levy

Journal: Current Opinion in Lipidology

Journal ranking: Q1

Key takeaways: High ultra-processed food consumption has an adverse impact on metabolic health, including cardiovascular diseases and mortality, highlighting the need to curb consumption worldwide.

Abstract: PURPOSE OF REVIEW Ultra-processed foods (UPF) have been associated with poor diet quality and adverse health outcomes. Our aim in this review is to summarize recent research assessing the impact of UPF consumption, classified according to the NOVA system, on outcomes related to metabolic health. RECENT FINDINGS Thirty recent studies with different design, quality and target population have investigated the impact of UPF consumption on parameters related to metabolic health, which were organized into: metabolic syndrome; body weight change and obesity indicators; blood pressure and hypertension; glucose profile, insulin resistance and type 2 diabetes; other metabolic risks and cardiovascular diseases and mortality. Most of the studies demonstrated adverse associations between high UPF consumption and metabolic health, mainly those with robust design and involving adults. SUMMARY Most of the latest findings have revealed an adverse impact of high UPF consumption on metabolic health, including cardiovascular diseases and mortality. Scientific evidence is accumulating towards the necessity of curbing UPF consumption worldwide at different life stages. Nevertheless, other studies are needed to confirm the causality between UPF consumption and metabolic health in diverse scenarios and to better elucidate all likely mechanisms involved in this relationship.

A Cross-Sectional Pilot Study on Association of Ready-to-Eat and Processed Food Intakes with Metabolic Factors, Serum Trans Fat and Phospholipid Fatty Acid Compositions in Healthy Japanese Adults

Type of study:

Number of citations: 2

Year: 2024

Authors: Chizuko Maruyama, Miya Uchiyama, A. Umezawa, Aoi Tokunaga, Akari Yasuda, Kanako Chibai, Chieko Fukuda, Rina Ichiki, N. Kameyama, Masakazu Shinohara

Journal: Nutrients

Journal ranking: Q1

Key takeaways: Higher fatty-ready-to-eat food intake is associated with unbalanced nutrient intakes and inversely related to HDL cholesterol in healthy Japanese adults.

Abstract: Frequently consuming processed and ready-to-eat (RTE) foods is regarded as unhealthy, but evidence on the relationships with circulating metabolic parameters is lacking. Japanese residents of a metropolitan area, 20 to 50 years of age, were studied in terms of anthropometric and biochemical parameters, including circulating trans fat and serum phospholipid fatty acid levels. Processed foods, except drinks and dairy items, were categorized according to requirements for additional ingredients and cooking before eating. Processed and RTE foods were divided according to fat and/or oil content into non-fatty or fatty foods. The participants were grouped into tertiles based on the energy percent (En%) derived from fatty-RTE foods. Fatty-RTE En% showed negative associations with fish, soybean and soybean products, dairy, eggs, vegetables, seaweed/mushrooms/konjac, fruit and non-oily seasonings reflecting lower dietary fiber, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and mineral and vitamin intakes, while the associations with fat/oil, confectionaries, and sweet beverages were positive. Fatty-RTE En% consumption was positively associated with alkaline phosphatase, leucine aminopeptidase, direct bilirubin, elaidic acid, and C18:2 but inversely associated with HDL cholesterol, C15:0, C17:0, EPA, and DHA. A higher fatty-RTE food intake was suggested to contribute to unbalanced nutrient intakes, as reflected in lipid metabolic parameters. Further large-scale studies are needed to evaluate the quality and impacts of RTE foods.

Dietary share of ultra-processed foods and metabolic syndrome in the US adult population.

Type of study:

Number of citations: 152

Year: 2019

Authors: Eurídice Martínez Steele, Filippa Juul, D. Neri, F. Rauber, C. Monteiro

Journal: Preventive medicine

Journal ranking: Q1

Key takeaways: Ultra-processed food consumption is significantly associated with a higher prevalence of metabolic syndrome in US adults, with stronger associations in young adults and decreasing with age.

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

Type of study: non-rct observational study

Number of citations: 11

Year: 2023

Authors: L. Barbosa, N. B. R. Vasconcelos, Ewerton Amorim dos Santos, Tamara Rodrigues dos Santos, T. Ataide-Silva, H. S. Ferreira

Journal: International Journal for Equity in Health

Journal ranking: Q1

Key takeaways: Ultra-processed food consumption is associated with an increased prevalence of metabolic syndrome in Quilombola communities in Alagoas, Brazil, due to precarious living conditions and food insecurity.

Abstract: 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.

Is there any putative mediatory role of inflammatory markers on the association between ultra-processed foods and resting metabolic rate?

Type of study: non-rct observational study

Number of citations: 5

Year: 2022

Authors: Niki Bahrampour, Farideh Shiraseb, S. Noori, C. Clark, K. Mirzaei

Journal: Frontiers in Nutrition

Journal ranking: Q1

Key takeaways: Ultra-processed foods intake may negatively affect resting metabolic rate, with inflammatory markers playing a mediatory role.

Abstract: The resting metabolic rate (RMR) represents the largest component of total daily energy expenditure. The sale of ultra-processed foods (UPF) is increasing globally; however, UPF can have many adverse effects, including increasing inflammatory markers and altering RMRs. This cross-sectional study included 285 healthy overweight and obese women. Anthropometric measurements were evaluated using a bioelectrical impedance analyzer InBody 770 scanner. High-sensitivity C-reactive protein (hs-CRP), plasminogen activator-1 (PAI-1), monocyte chemoattractant protein (MCP-1), and interleukin-1 beta (IL-1β) blood levels were measured after a 12-h fasting. Indirect calorimetry was used to evaluate the RMR by using the Weir equation, and RMR deviation (RMR estimated - RMR actual), RMR per body mass index (BMI), and free fat mass (FFM) were estimated. A validated food frequency questionnaire (FFQ) was used, and seven groups of UPFs were extracted based on the NOVA method. A negative association between the RMR [β = −0.159, 95% confidence interval (CI): −0.471, −0.052, P = 0.044], RMR per BMI (β = −0.014, 95% CI: −0.025, −0.006, P = 0.036), and RMR per FFM (β = −0.241, 95% CI: −0.006, −0.000, P = 0.041) using the NOVA score was observed after adjusting for confounders. This association disappeared after inclusion of each inflammatory marker. All the markers may inversely mediate the relationship between the mentioned variables and the NOVA score. hs-CRP and MCP-1 also had a negative effect on the relationship between the NOVA score and RMR deviation. Finally, UPF intake is likely related with the RMR, mediated through changes in the production of hs-CRP, PAI-1, MCP-1, and IL-1β.

Metabolic profiles of ultra-processed food consumption and their role in obesity risk in British children.

Type of study: non-rct observational study

Number of citations: 30

Year: 2022

Authors: E. Handakas, K. Chang, Neha Khandpur, E. Vamos, C. Millett, F. Sassi, P. Vineis, O. Robinson

Journal: Clinical nutrition

Journal ranking: Q1

Key takeaways: Higher consumption of ultra-processed foods in British children is associated with altered metabolic traits, contributing to increased obesity risk.

Abstract: BACKGROUND & AIMS Higher consumption of ultra-processed foods (UPF) has been associated with childhood obesity, but underlying mechanisms remain unclear. We investigated plasma nuclear magnetic resonance metabolic profiles of higher UPF consumption and their role in obesity risk in the British ALSPAC cohort. METHODS We performed cross-sectional and prospective metabolome wide association analyses of UPF, calculated from food diaries using the NOVA classification. In cross-sectional analysis, we tested the association between UPF consumption and metabolic profile at 7 years (N = 4528), and in the prospective analysis we tested the association between UPF consumption at 13 years and metabolic profile at 17 years (N = 3086). Effects of UPF-associated metabolites at 7 years on subsequent fat mass accumulation were assessed using growth curve models. RESULTS At 7 years, UPF was associated with 115 metabolic traits including lower levels of branched-chain and aromatic amino acids and higher levels of citrate, glutamine, and monounsaturated fatty acids, which were also associated with greater fat mass accumulation. Reported intake of nutrients mediated associations with most metabolites, except for citrate. CONCLUSIONS UPF consumption among British children is associated with perturbation of multiple metabolic traits, many of which contribute to child obesity risk.

Ultra-Processed Food Consumption and Its Role in Obesity and Metabolic Syndrome Development

Type of study: systematic review

Number of citations: 1

Year: 2024

Authors: Romyun Alvy Khoiriyah, Bunga Janviera Firnanda, Hilma Nahlah Faradisah, Fitri A

Journal: Proceedings of International Conference on Halal Food and Health Nutrition

Journal ranking: brak

Key takeaways: High ultra-processed food consumption significantly contributes to obesity and metabolic disorders, highlighting the need for better dietary policies to mitigate these adverse impacts.

Abstract: This article examined the relationship between the consumption of ultra-processed foods (UPF) and obesity, as well as metabolic syndrome, through a systematic review approach. UPFs were known to contain salt, sugar, oils, fats, and other additives mimicking natural foods' sensory qualities. Research indicated that diets high in UPF were nutritionally unbalanced and promoted excessive consumption, which was detrimental to health. Data from various studies showed that increased UPF consumption was linked to a higher risk of obesity and related diseases, such as type 2 diabetes. Cross-sectional studies indicated that UPF consumption correlated with a higher risk of overweight in men compared to women. This research utilized diverse data sources that used methods such as semi-quantitative food frequency questionnaires and prospective analysis to evaluate this relationship. Results showed that high UPF consumption significantly contributed to obesity and metabolic disorders, affecting metabolic profiles and overall diet quality, highlighting the need for better dietary policies to mitigate the adverse impacts of ultra-processed foods.

Ultra-processed food consumption and metabolic disease risk: an umbrella review of systematic reviews with meta-analyses of observational studies

Type of study: meta-analysis

Number of citations: 13

Year: 2024

Authors: Jiale Lv, Yi-Fan Wei, Jia-Nan Sun, Yu-Chen Shi, Fang-Hua Liu, Mingshuai Sun, Qing Chang, Qi-Jun Wu, Yuhong Zhao

Journal: Frontiers in Nutrition

Journal ranking: Q1

Key takeaways: Ultra-processed food consumption may be a risk factor for metabolic diseases like obesity and type 2 diabetes mellitus, but well-designed studies are needed to confirm these findings.

Abstract: Background and aims There is an ongoing debate on whether to advocate reducing ultra-processed food (UPF) in dietary guidelines to control metabolic disease (such as obesity and type 2 diabetes mellitus [T2DM]). We aimed to summarize the evidence from systematic reviews with meta-analyses between UPF consumption and metabolic diseases risk, assess the credibility, and verify the robustness of these associations. Methods We systematically searched PubMed, Web of Science, Embase, and Cochrane Library databases from their inception to July 15, 2023, to identify relevant systematic reviews with meta-analyses. We used the random-effects model to evaluate the summary effect size, along with 95% confidence interval and prediction interval. We also assessed heterogeneity, evidence of small-study effects and excess significance bias, and categorized the credibility of each association based on quantitative umbrella review criteria. Additionally, we conducted subgroup and sensitivity analyses to assess the robustness of associations based on continents, study design, dietary assessment methods, definition methods of UPF, population, and units of UPF consumption. Results Overall, 6 systematic reviews with 13 meta-analyses were included. Three (23.08%) meta-analyses were classified as highly suggestive evidence for meeting the criteria that associations were significant at p < 10−6, had more than 1,000 cases, and presented the largest study with significance at p < 0.05. Among them, the highest UPF consumption quantile was associated with an increased risk of obesity (OR = 1.55, 95% CI: 1.36–1.77) when compared with the lowest UPF consumption quantile. The highest UPF consumption quantile was associated with an increased risk of T2DM (RR = 1.40, 95% CI: 1.23–1.59) when compared with the lowest UPF consumption quantile, and a 10% increase in UPF consumption (% g/d) was associated with an increased risk of T2DM (RR = 1.12, 95% CI: 1.10–1.13). Meanwhile, the robustness of these associations was verified by a series of subgroup and sensitivity analyses. Conclusion UPF consumption may be a risk factor for several metabolic diseases. However, well-designed studies are still needed to verify our findings in the future.

Ultra-Processed Food Consumption and Increased Risk of Metabolic Syndrome in Adults: The ELSA-Brasil

Type of study: non-rct observational study

Number of citations: 32

Year: 2022

Authors: S. Canhada, Á. Vigo, V. Luft, R. Levy, S. A. Alvim Matos, Maria del Carmen Molina, L. Giatti, S. Barreto, B. Duncan, M. Schmidt

Journal: Diabetes Care

Journal ranking: Q1

Key takeaways: Greater consumption of ultra-processed foods is associated with an increased risk of metabolic syndrome, impacting diabetes and cardiovascular disease prevention and management.

Abstract: OBJECTIVE To investigate the association between ultra-processed food (UPF) consumption and the incidence of metabolic syndrome (MetS). RESEARCH DESIGN AND METHODS From 2008 to 2010, we enrolled 15,105 adults, aged 35–74 years, who were employees from six public education and research institutions to assemble the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). We used a food frequency questionnaire to assess UPF consumption (measured in grams per day) at baseline. We then assessed the outcomes of those returning to visits between 2012 and 2014 and between 2017 and 2019. We defined incident MetS by the presence of at least three of the following five abnormalities: high fasting glucose level, high triglyceride level, low HDL cholesterol level, high blood pressure, and abdominal obesity, after excluding those meeting such criteria at baseline. We also excluded those who had missing data or an implausible energy intake, leaving 8,065 participants in the study. RESULTS The median age was 49 years, 59% of participants were women, and the median consumption of UPFs was 366 g/day. After 8 years, there were 2,508 new cases of MetS. In robust Poisson regression, adjusting for sociodemographics, behavioral factors, and energy intake, we found a 7% (relative risk [RR] 1.07; 95% CI 1.05–1.08) higher risk of incident MetS for an increase of 150 g/day in UPF consumption. Similarly, those in the fourth quartile (compared with the first quartile) had a 33% increased risk (RR 1.33; 95% CI 1.20–1.47). Further adjustment for BMI attenuated these associations (for 150 g/day increases in UPF consumption and for the fourth quartile compared to the first one, respectively, RR = 1.04, 95% CI 1.02–1.06; RR = 1.19, 95% CI 1.07–1.32). CONCLUSIONS Greater consumption of UPFs is associated with an increased risk of MetS. These findings have important implications for diabetes and cardiovascular disease prevention and management.

Ultra-processed food intake in relation to metabolic health status in Iranian adolescents with overweight and obesity

Type of study:

Number of citations: 0

Year: 2024

Authors: Sana Farzam, Donya Poursalehi, Saeideh Mirzaei, A. Asadi, M. Akhlaghi, P. Saneei

Journal: Nutrition & Metabolism

Journal ranking: Q1

Key takeaways: Higher ultra-processed food consumption is associated with increased odds of metabolic factors like hyperglycemia, hypertriglyceridemia, hypo-HDL-cholesterolemia, hypertension, and high insulin resistance levels in Iranian adolescents with overweight/obesity.

Abstract: Many studies have explored the association between food intake and metabolic health. However, research on the association of consuming ultra-processed foods (UPFs) and metabolic health in children and adolescents remains unclear. The objective of our study was to investigate the relation between UPFs consumption and metabolic health status in Iranian adolescents with overweight/obesity. For this cross-sectional study, we selected a sample of 203 adolescents (101 boys and 102 girls) with a mean age of 13.98 ± 1.61 who were chosen using a multistage cluster random sampling method. We collected data on their dietary patterns using a validated 147-item semi-quantitative food frequency questionnaire. Additionally, we measured anthropometric indices, blood pressure, fasting glucose, insulin, and lipid profiles. Participants were categorized to either metabolically healthy or unhealthy overweight/obesity (MHO and MUO) based on the International Diabetes Federation (IDF) and IDF/ Homeostasis Model Assessment Insulin Resistance (HOMA-IR) criteria. Our findings revealed that every 10 g/d increase in UPFs consumption was related to an elevated odds of MUO as defined by the IDF (OR = 1.14; 95%CI: 1.08–1.19) and IDF/HOMA-IR (OR = 1.14; 95%CI; 1.08–1.19) criteria, after controlling all confounders. The severity of this association varied among girls and boys and also among those with overweight and obesity according to the applied definitions. Moreover, each 10 g/d increase in daily UPFs intake was associated with increased odds of metabolic factors including hyperglycemia, hypertriglyceridemia, hypo-HDL-cholesterolemia, hypertension, and high insulin resistance levels. These findings highlighted a direct association between higher UPFs consumption and MUO status among adolescents.

Effect of ultra-processed food intake on metabolic syndrome components and body fat in children and adolescents: A systematic review based on cohort studies.

Type of study: systematic review

Number of citations: 8

Year: 2023

Authors: Jesús Ricardo Gómez Frías, L. H. Cadena, A. B. Villarreal, Blanca Gladiana Beltrán Piña, M. Mejía, Luis Alberto Delgado Cerros, Giovanni Barraza Gil, Jorge Octavio Acosta Montes

Journal: Nutrition

Journal ranking: Q2

Key takeaways: High consumption of ultra-processed foods is associated with increased metabolic syndrome components and body fat in children and adolescents, emphasizing the need for early intervention.

Relationship between metabolic syndrome and intake of ultra-processed foods in Korean adults: based on 6th and 7th Korea National Health and Nutrition Examination Survey (2013–2018)

Type of study:

Number of citations: 0

Year: 2023

Authors: Chae-Jong Kim, W. Na, Seunghee Choi, Seohyeon Hwang, C. Sohn

Journal: Nutrition Research and Practice

Journal ranking: Q2

Key takeaways: Ultra-processed food consumption increases the risk of metabolic syndrome, particularly among men.

Abstract: BACKGROUND/OBJECTIVES Metabolic syndrome is closely associated with lifestyle factors, including diet and nutritional intake. Modern trends show a shift in food consumption from healthy home-cooked meals to processed and instant foods. Therefore, this study analyzed the association between ultra-processed food intake and the development of metabolic syndrome in Korean adults based on the data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2013–2018. SUBJECTS/METHODS The subjects of this study were 17,414 adults aged 19–80 years who participated in the 6th–7th KNHANES. Processed food was classified into four categories, NOVA1 to NOVA4, using 24-h recall data. The higher the NOVA category, the more processed the food. Statistical analysis was conducted using logistic regression to investigate the prevalence of metabolic syndrome according to the consumption of ultra-processed foods. RESULTS Among the diagnostic criteria for metabolic syndrome, hypertension (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.62–0.85; Q4 vs. Q1, P-trend < 0.001) and high triglycerides (OR, 0.83; 95% CI, 0.72–0.94; Q4 vs. Q1, P-trend < 0.001) showed a correlation with the percentages of energy consumed from ultra-processed foods. The OR for metabolic syndrome, according to the percentages of energy consumed from ultra-processed foods, is shown only for men. The OR showed that the percentages of energy consumed from ultra-processed foods were associated with increased metabolic syndrome. CONCLUSIONS This study suggests that consumption of ultra-processed foods raises the risk of metabolic syndrome especially among men. To prevent metabolic syndrome, it is necessary to prepare appropriate dietary guidelines for Korean adults.

Increased ultra-processed food consumption is associated with worsening of cardiometabolic risk factors in adults with metabolic syndrome: Longitudinal analysis from a randomized trial.

Type of study: rct

Number of citations: 17

Year: 2023

Authors: S. González-Palacios, A. Oncina-Cánovas, M. García-de-la-Hera, M. Martínez-González, J. Salas‐Salvadó, D. Corella, H. Schröder, J. A. Martínez, Á. Alonso-Gómez, J. Wärnberg, D. Romaguera, J. López-Miranda, R. Estruch, F. Tinahones, J. Lapetra, J. L. Serra-Majem, N. Cano-Ibáñez, J. Tur, V. Martín-Sánchez, X. Pintó, M. Delgado-Rodríguez, P. Matía-Martín, J. Vidal, C. Vázquez, L. Daimiel, E. Ros, M. Bes-Rastrollo, Alessandro Atzeni, J. Sorlí, M. Zomeño, P. Peña-Orihuela, L. Compañ-Gabucio, F. J. Barón-López, M. Zulet, J. Konieczna, R. Casas, E. Garrido-Garrido, L. Tojal-Sierra, A. Gómez-Pérez, M. Ruíz-Canela, A. Palau, C. Saiz, K. Pérez-Vega, A. Garcia-Rios, L. Torres-Collado, Javier Basterra-Gortari, Tany E. Garcidueñas-Fimbres, Mireia Malcampo, J. Vioque

Journal: Atherosclerosis

Journal ranking: Q1

Key takeaways: Higher ultra-processed food consumption is associated with worsening cardiometabolic risk factors after 12 months in adults with metabolic syndrome.

Ultra-processed food consumption and non-alcoholic fatty liver disease, metabolic syndrome and insulin resistance: A systematic review

Type of study: systematic review

Number of citations: 25

Year: 2023

Authors: Laura S Grinshpan, S. Eilat-Adar, Dana Ivancovsky-Wajcman, R. Kariv, M. Gillon-Keren, S. Zelber-Sagi

Journal: JHEP Reports

Journal ranking: Q1

Key takeaways: Ultra-processed food consumption is associated with an increased risk of non-alcoholic fatty liver disease, metabolic syndrome, and insulin resistance.

Ultra-processed food consumption and increased risk of metabolic syndrome: a systematic review and meta-analysis of observational studies

Type of study: meta-analysis

Number of citations: 17

Year: 2023

Authors: L. Shu, Xiaoyan Zhang, Jianying Zhou, Qin Zhu, Caijuan Si

Journal: Frontiers in Nutrition

Journal ranking: Q1

Key takeaways: Higher consumption of ultra-processed food is significantly associated with an increased risk of metabolic syndrome.

Abstract: Background Although higher consumption of ultra-processed food (UPF) has been linked to a higher risk of metabolic syndrome (MetS), the results remain controversial. Herein, we performed a systematic review and meta-analysis of observational studies to clarify the relationship between UPF consumption defined by the NOVA framework and risk of MetS. Methods An extensive literature search on PubMed, ISI Web of Science, EBSCO and China National Knowledge Infrastructure (CNKI) databases was conducted to search for the relevant articles published priori to January 2023, and newly published articles between January 2023 and March 2023 were re-searched. Random-effects or fixed-effects models were adopted to calculate the pooled relative risks (RRs) and 95% confidence intervals (CIs). The between-study heterogeneity was explored using the Cochran's Q test and I-square (I2). Publication bias was investigated using the visual inspection of asymmetry in funnel plots and Begg's and Egger's tests. Results Nine studies (six cross-sectional and three prospective cohort studies) totaling 23,500 participants with 6,192 MetS cases were included in the final analysis. The pooled effect size for the highest vs. lowest categories of UPF consumption indicated a positive association with the risk of MetS (RR: 1.25, 95%CI: 1.09–1.42, P < 0.0001). Subgroup analyses revealed a positive association between consumption of UPF and MetS risk in cross-sectional studies (RR: 1.47, 95%CI: 1.16–1.87, P = 0.002), and no significant association in cohort studies (RR: 1.10, 95%CI: 0.96–1.27, P = 0.104), respectively. In addition, a more significant association between UPF consumption and increased risk of MetS was found in the subgroups of study quality <7 (RR: 2.22; 95%CI: 1.28–3.84, P = 0.004) than study quality ≥7 (RR: 1.20; 95%CI: 1.06–1.36, P = 0.005). Similarly, when we performed analyses separately by sample size, there was a significant association between UPF consumption and MetS risk in sample size ≥5,000 (RR: 1.19; 95%CI: 1.11–1.27, P < 0.0001), and in sample size <5,000 (RR: 1.43; 95%CI: 1.08–1.90, P = 0.013), respectively. Conclusions Our findings suggest that higher consumption of UPF is significantly associated with an increased risk of MetS. Further longitudinal studies are needed to confirm the effect of UPF consumption on MetS.

The effect of ultra-processed very low-energy diets on gut microbiota and metabolic outcomes in individuals with obesity: A systematic literature review.

Type of study: systematic review

Number of citations: 36

Year: 2020

Authors: M. Lane, Gina Howland, Madeline L. West, Meghan Hockey, W. Marx, A. Loughman, Martin O’Hely, F. Jacka, Tetyana Rocks

Journal: Obesity research & clinical practice

Journal ranking: Q1

Key takeaways: Ultra-processed very low-energy diets may alter gut microbiota, potentially reducing beneficial bacteria and increasing pathogenic bacteria, but overall metabolic changes are mostly beneficial or not significantly altered in obese individuals.

Association between ultra-processed food consumption and gut microbiota in senior subjects with overweight/obesity and metabolic syndrome

Type of study: non-rct observational study

Number of citations: 41

Year: 2022

Authors: Alessandro Atzeni, Miguel Ángel Martínez, N. Babio, Prokopis Konstanti, F. Tinahones, J. Vioque, D. Corella, M. Fitó, J. Vidal, I. Moreno-Indias, S. Pertusa-Martínez, Andrea Álvarez-Sala, O. Castañer, A. Goday, M. Damas-Fuentes, C. Belzer, M. Martínez-González, F. Hu, J. Salas‐Salvadó

Journal: Frontiers in Nutrition

Journal ranking: Q1

Key takeaways: Ultra-processed food consumption is associated with lower adherence to a healthy diet, higher total energy intake, and increased gut microbiota related to inflammatory diseases and low fruit and vegetable consumption in senior subjects with overweight/obesity and metabolic syndrome.

Abstract: The production and consumption of ultra-processed foods (UPF) has increased considerably during the last years worldwide. Collective evidence shows the association between UPF consumption and adverse health outcomes, including inflammatory gastro-intestinal disorders and obesity. The gut microbiota has been suggested as potential mediator of the effects of UPF consumption on metabolism and health. However, few studies have been conducted in order to elucidate these aspects. Therefore, the aim of the present study was to assess the cross-sectional associations between UPF consumption and gut microbiota in a population of senior subjects (n = 645) within the frame of the PREDIMED-Plus trial. Eligible participants were men and women (aged 55–75 years), without documented history of cardiovascular disease at enrollment, with overweight/obesity (body mass index ≤ 27 and <40 kg/m2) and metabolic syndrome. Using the information of food frequency questionnaires, the consumption of UPF, expressed as a percentage of total dietary energy intake in kcal/day, was calculated considering those food items classified in group 4 of NOVA system. Population was categorized according to tertiles of UPF consumption. Taxonomic fecal microbiota information, along with blood biochemical parameters, anthropometric measurements and clinical data were obtained. Bioinformatics analysis was performed to study the association between fecal microbiota composition and UPF consumption. We observed that subjects allocated in the highest tertile of UPF consumption (21.4 ± 5.0 % kcal/day) presented lower adherence to MedDiet (p < 0.001) and higher total energy intake (p < 0.001). The taxonomic analysis of the fecal microbiota revealed a significant (Benjamini-Hochberg adjusted p < 0.2) positive association between specific taxa and tertiles (T) of UPF consumption: Alloprevotella (p = 0.041 vs. T2; p = 0.065 vs. T3), Negativibacillus (p = 0.096 vs. T3), Prevotella (p = 0.116 vs. T3), and Sutterella (p = 0.116 vs. T2). UPF consumption was positively associated with lower adherence to MedDiet and higher total energy intake in senior subjects with overweight obesity and metabolic syndrome. In addition, positive association with specific fecal microbiota taxa related to inflammatory gastro-intestinal diseases and low consumption of fruits and vegetables, was observed.

Ultra-processed foods consumption and the risk of metabolically unhealthy phenotype in normal-weight and overweight/obese adults: a prospective investigation

Type of study:

Number of citations: 8

Year: 2023

Authors: P. Mirmiran, N. Moslehi, M. Golzarand, Fereidoun Azizi

Journal: International Journal of Food Sciences and Nutrition

Journal ranking: Q1

Key takeaways: Ultra-processed food consumption is positively related to the risk of metabolically unhealthy normal weight and overweight/obese adults, with a 54% higher risk for normal weight individuals and a 2% higher risk for overweight/obese individuals.

Abstract: Abstract This study investigated the association between ultra-processed foods (UPF) and the risk of metabolically unhealthy normal weight (MUNW) and metabolically unhealthy overweight/obese (MUO). We included 512 normal-weight and 787 overweight/obese adults with a metabolically healthy phenotype from the Tehran and Lipid Glucose Study, who were followed from the third (baseline) to the sixth study examinations. Each 10% increase in energy intake from UPF was related to a 54% (95% CI = 21–96%) and 2% (95% CI = 1–3%) higher risk of MUNW and MUO, respectively. The risk of MUNW was significantly higher in quartile 4 compared to quartile 1. The restricted cubic splines suggested that the risk of MUNW increases monotonically when UPF accounts for at least 20% of energy intake. No non-linear association was observed between UPF and the risk of MUO. Energy intake from UPF was positively related to the risk of MUNW and MUO.

Fruit and vegetable intake modifies the association between ultra-processed food and metabolic syndrome

Type of study:

Number of citations: 2

Year: 2024

Authors: S. Hosseinpour-Niazi, H. Malmir, P. Mirmiran, Maryam Shabani, M. Hasheminia, Fereidoun Azizi

Journal: Nutrition & Metabolism

Journal ranking: Q1

Key takeaways: Consuming more fruits and vegetables mitigates the adverse effect of ultra-processed food on the risk of developing metabolic syndrome.

Abstract: Abstract Background This prospective cohort study aimed to investigate the association between ultra-processed food (UPF) and the risk of metabolic syndrome (MetS), as well as to assess whether fruit and vegetable intake and weight change modify this association. Methods We included 1915 healthy participants who participated in the Tehran Lipid and Glucose Study (TLGS), all of whom had complete demographic, anthropometric, and dietary measurements. A validated food frequency questionnaire was used to assess UPF consumption based on the NOVA classification system. MetS was defined according to the Joint Interim Statement. Multivariable adjusted Cox regression was used to estimate hazard ratios (HRs) for MetS events across tertiles of UPF. The effect of fruit and vegetable consumption and weight change on this association was assessed using joint classification by Cox regression. Results UFP consumption showed no association with MetS risk after adjusting for confounders. However, after adjustment for dietary fiber, fruits, and vegetables, the highest tertile of UPF consumption was positively linked to MetS risk, compared to the lowest tertile. There was a significant interaction between fruit, vegetable, and dietary fiber intake and UPF consumption concerning the risk of MetS (All P values &lt; 0.05). Among individuals consuming less than 248 g/day of fruit, the risk of MetS increased by 54% (confidence interval: 1.13–2.10) in the highest UPF tertile. Consuming vegetables and dietary fiber below the median (258 g/day and 42.2 g/day, respectively) increased the risk of MetS in the third tertile of UPF. However, consuming vegetables and fiber ≥ median intake, reduced the risk of MetS among those with the lowest UPF consumption. Furthermore, the risk of MetS was observed in the third tertile of UPF consumption among individuals with fruit and vegetable consumption &lt; 537 g/day. UPF consumption was not associated with the risk of MetS in different weight change statuses. Conclusions Consuming more fruits and vegetables mitigated the adverse effect of UPF on the risk of developing MetS.

Lifestyle improvement reduces the consumption of ultra-processed foods in adults with metabolic syndrome.

Type of study: rct

Number of citations: 5

Year: 2022

Authors: M. Walker, F. S. Tarasiuk, A. Gustavo, M. S. Oliveira, M. Donadio, A. P. Feoli

Journal: Nutrition, metabolism, and cardiovascular diseases : NMCD

Journal ranking: Q1

Key takeaways: Lifestyle interventions significantly reduced the consumption of ultra-processed foods in adults with metabolic syndrome, potentially impacting the prevention and treatment of metabolic syndrome.

Ultra-Processed Food Consumption and Mental Health: A Systematic Review and Meta-Analysis of Observational Studies

Type of study: meta-analysis

Number of citations: 123

Year: 2022

Authors: M. Lane, E. Gamage, N. Travica, T. Dissanayaka, D. N. Ashtree, Sarah Gauci, M. Lotfaliany, A. O’Neil, F. Jacka, W. Marx

Journal: Nutrients

Journal ranking: Q1

Key takeaways: Greater ultra-processed food consumption is associated with increased odds of depressive and anxiety symptoms, and an increased risk of depression.

Abstract: Since previous meta-analyses, which were limited only to depression and by a small number of studies available for inclusion at the time of publication, several additional studies have been published assessing the link between ultra-processed food consumption and depression as well as other mental disorders. We aimed to build on previously conducted reviews to synthesise and meta-analyse the contemporary evidence base and clarify the associations between the consumption of ultra-processed food and mental disorders. A total of 17 observational studies were included (n = 385,541); 15 cross-sectional and 2 prospective. Greater ultra-processed food consumption was cross-sectionally associated with increased odds of depressive and anxiety symptoms, both when these outcomes were assessed together (common mental disorder symptoms odds ratio: 1.53, 95%CI 1.43 to 1.63) as well as separately (depressive symptoms odds ratio: 1.44, 95%CI 1.14 to 1.82; and, anxiety symptoms odds ratio: 1.48, 95%CI 1.37 to 1.59). Furthermore, a meta-analysis of prospective studies demonstrated that greater ultra-processed food intake was associated with increased risk of subsequent depression (hazard ratio: 1.22, 95%CI 1.16 to 1.28). While we found evidence for associations between ultra-processed food consumption and adverse mental health, further rigorously designed prospective and experimental studies are needed to better understand causal pathways.

The risk associated with ultra-processed food intake on depressive symptoms and mental health in older adults: a target trial emulation

Type of study: rct

Number of citations: 1

Year: 2025

Authors: Belayneh Mengist, M. Lotfaliany, Julie A. Pasco, Bruno Agustini, Michael Berk, Malcolm Forbes, M. M. Lane, S. Orchard, Joanne Ryan, Alice J. Owen, Robyn L. Woods, John J. McNeil, M. Mohebbi

Journal: BMC Medicine

Journal ranking: Q1

Key takeaways: Higher ultra-processed food consumption is associated with an increased risk of depressive symptoms and negatively affects mental health in older adults.

Abstract: Abstract Background Longitudinal cohort studies across the lifespan suggest an association between ultra-processed food (UPF) and depression. However, the effect of UPF on depression and mental health in older adults has not been determined. Therefore, this study investigated the effect of UPF on depressive symptoms and mental health in community-dwelling older adults. Methods A pragmatic target trial was designed and emulated using the ASPirin in Reducing Events in the Elderly longitudinal data. Participants were community-dwelling older adults (≥ 70 years) in Australia. We specified and emulated the protocol of a two-arm randomised pragmatic clinical trial using the level of UPF consumption as the intervention. Greater than or equal to 4 servings of UPF per day was considered the intervention, with less than 4 servings per day the control. Dietary consumption was assessed using a mail-based diet screening questionnaire, and the level of food processing was classified based on the NOVA classification. The study outcomes were depressive symptoms, defined as a score of ≥ 8 on the Center for Epidemiological Studies Depression 10-item scale, and general mental health, defined by the mental component summary score of the Short Form-12. We applied inverse probability treatment weighting to balance confounders. Marginal structural models were employed to estimate the population-level average effect of intervention using generalised estimated equations. Results A total of 11,192 participants (3415 intervention and 7777 control) were eligible for the emulation. High UPF consumption at time zero was associated with an increased risk of depressive symptoms at follow-ups (RR: 1.10; CI: 1.04–1.18). The finding was consistent with sensitivity analyses; after excluding participants on antidepressants at time zero, the risk of depressive symptoms in the intervention group was increased by 11% compared to the control (RR: 1.11; 95% CI: (1.04–1.20)). Consumption of UPF adversely affected the mental component quality of life ( β : − 0.40; CI: − 0.65 to − 0.15). Conclusions A higher level of UPF consumption was associated with a higher risk of depressive symptoms and adversely affected mental health among older adults.

Ultra-Processed Foods and Mental Health: Where Do Eating Disorders Fit into the Puzzle?

Type of study: literature review

Number of citations: 8

Year: 2024

Authors: D. Wiss, Erica M. LaFata

Journal: Nutrients

Journal ranking: Q1

Key takeaways: Ultra-processed foods may contribute to poorer mental health, particularly depression, and ultra-processed food addiction (UPFA) may be a new clinical phenotype.

Abstract: Ultra-processed foods (UPFs) like pastries, packaged snacks, fast foods, and sweetened beverages have become dominant in the modern food supply and are strongly associated with numerous public health concerns. While the physical health consequences of UPF intake have been well documented (e.g., increased risks of cardiometabolic conditions), less empirical discussion has emphasized the mental health consequences of chronic UPF consumption. Notably, the unique characteristics of UPFs (e.g., artificially high levels of reinforcing ingredients) influence biological processes (e.g., dopamine signaling) in a manner that may contribute to poorer psychological functioning for some individuals. Importantly, gold-standard behavioral lifestyle interventions and treatments specifically for disordered eating do not acknowledge the direct role that UPFs may play in sensitizing reward-related neural functioning, disrupting metabolic responses, and motivating subsequent UPF cravings and intake. The lack of consideration for the influences of UPFs on mental health is particularly problematic given the growing scientific support for the addictive properties of these foods and the utility of ultra-processed food addiction (UPFA) as a novel clinical phenotype endorsed by 14–20% of individuals across international samples. The overarching aim of the present review is to summarize the science of how UPFs may affect mental health, emphasizing contributing biological mechanisms. Specifically, the authors will (1) describe how corporate-sponsored research and financial agendas have contributed to contention and debate about the role of UPFs in health; (2) define UPFs and their nutritional characteristics; (3) review observed associations between UPF intake and mental health conditions, especially with depression; (4) outline the evidence for UPFA; and (5) describe nuanced treatment considerations for comorbid UPFA and eating disorders.

Fast Foods, and Processed Foods May Worsen Perceived Stress and Mental Health

Type of study: non-rct observational study

Number of citations: 1

Year: 2022

Authors: Lexis Rosenberg, Megan Welch, Gerard Dempsey, Michael Colabelli, Tharsana Kumarasivam, Lindsey Moser, L. Begdache

Journal: The FASEB Journal

Journal ranking: Q1

Key takeaways: High consumption of fast food and processed foods is positively correlated with increased perceived stress and mental distress, leading to decreased mental health status.

Abstract: The connection between dietary factors and mental health has been addressed in the literature. However, the association between dietary factors and perceived stress combined with mental distress is still in need of further research. In particular, fast food and processed food are typically devoid of high‐quality nutrients and tend to be energy‐dense containing high levels of simple sugars, saturated fats, and trans fats. These dietary factors promote inflammation, alter brain chemicals, and initiate a stress response. Therefore, the aim of this study was to assess the impact of fast food and processed food consumption on perceived stress and mental distress. It was hypothesized that high amounts of fast foods will have a positive correlation with symptoms of mental distress and perceived stress. An anonymous survey was administered through social media platforms targeting adults 18 years or older. The survey consisted of validated scales: the Food Mood Questionnaire, Kessler‐6 and Perceived Stress Scale, A total of 1591 individuals completed the survey. Data was analyzed using Spearman’s Rho correlation and Principal Component Analysis in IBM SPSS Version 25.0. The results reveal that there is a positive correlation between consumption of high amounts of fast food and processed foods and feelings of anxiety (p <0.01), nervousness (p <0.01), restlessness (p <0.01), lack of motivation (p <0.01), and depressive symptoms (p <0.01). Our results suggest that a diet high in fast food and processed foods is positively correlated with higher perceived stress and mental distress levels; hence, a decreased mental health status.

Higher Ultra-Processed Food Consumption is Associated with Increased Risk of Mental Health Issues in Undergraduates

Type of study:

Number of citations: 0

Year: 2025

Authors: Azira Sazali, Nur Atikah Yusoff, Nadya Insyirah Azmawi, Ng Ming Li, H. M. Yahya, Norhasniza Yaacob, Nurul Fatin Malek Rivan

Journal: Jurnal Gizi dan Pangan

Journal ranking: brak

Key takeaways: Higher ultra-processed food consumption is strongly associated with an increased risk of mental health problems in undergraduate students.

Abstract: This cross-sectional study, involving 250 healthy undergraduate students, aimed to examine the association between Ultra-Processed Food (UPF) consumption and mental health status. Mental health was assessed using the 12-Item General Health Questionnaire (GHQ-12), where participants were classified as either normal or high-risk based on their scores. Subsequently, dietary intake was assessed using the Dietary History Questionnaire (DHQ), examining meals throughout the day. Additionally, the degree of food processing was classified using the NOVA food classification. Univariate and multivariate logistic regression analyses were used to evaluate the relationship between mental health status, ultra-processed food consumption, and the contributing factors. The average daily energy intake was 1,216±488 kcal, with 25.7% coming from ultra-processed foods. Those at higher risk for mental health issues typically had a slightly lower fat percentage (26.5±8.5%) but a higher total body water percentage (50.6±4.7%) compared to those with normal mental health. Even after adjustment for confounding factors, high consumption of ultra-processed foods remained strongly associated with an increased risk of mental health problems (OR=2.196, 95% CI:1.056–4.566, p=0.035). Further research is needed to fully understand the effects of ultra-processed foods on mental health and enhance awareness of their risks while promoting fresh, minimally processed alternatives.

Increased Consumption of Ultra-Processed Food Is Associated with Poor Mental Health in a Nationally Representative Sample of Adolescent Students in Brazil

Type of study: non-rct observational study

Number of citations: 13

Year: 2022

Authors: A. Mesas, A. D. González, S. M. de Andrade, V. Martínez-Vizcaíno, J. F. López-Gil, E. Jiménez-López

Journal: Nutrients

Journal ranking: Q1

Key takeaways: Higher consumption of ultra-processed food is associated with increased frequency of poor mental health symptoms in Brazilian adolescent students, regardless of various factors.

Abstract: The objective of this study was to analyze the association between ultra-processed food (UPF) consumption and mental health symptoms in a nationally representative sample of the Brazilian adolescent student population. Cross-sectional analyses with data from the National School-Based Health Survey (PeNSE 2019) were performed. Self-reported information was obtained for the frequency of five mental health symptoms in the last month and the consumption of thirteen UPFs in the last 24 h. Generalized linear models adjusting for the main confounders were performed for each sex. Of the 94,767 adolescent students (52.4% girls) included, 8.1% of the boys and 27.2% of the girls reported “almost always” or “always” having at least four of the five mental health symptoms. In the fully adjusted models, compared to the boys who consumed ≤3 UPF, those consuming ≥6 UPF reported more frequent symptoms of poor mental health (ß-coefficient = 0.27 [0.03, 0.51]; p-for-trend = 0.005). A similar association was observed in girls (ß-coefficient = 0.31 [0.13, 0.50]; p-for-trend = 0.001). In conclusion, in this large sample of adolescent students from an entire country, the higher the consumption of UPF was, the higher the frequency of reported symptoms of poor mental health. These findings remained significant regardless of sociodemographic and lifestyle factors, self-perceived body image, and bullying victimization.

Association between junk food consumption and mental health problems in adults: a systematic review and meta-analysis

Type of study: meta-analysis

Number of citations: 15

Year: 2024

Authors: H. Ejtahed, Parham Mardi, Bahram Hejrani, Fatemeh Sadat Mahdavi, Behnaz Ghoreshi, Kimia Gohari, M. Heidari-Beni, Mostafa Qorbani

Journal: BMC Psychiatry

Journal ranking: Q1

Key takeaways: Junk food consumption is associated with an increased risk of developing depression and psychological stress in adults.

Abstract: Abstract Background Anxiety and depression can seriously undermine mental health and quality of life globally. The consumption of junk foods, including ultra-processed foods, fast foods, unhealthy snacks, and sugar-sweetened beverages, has been linked to mental health. The aim of this study is to use the published literature to evaluate how junk food consumption may be associated with mental health disorders in adults. Methods A systematic search was conducted up to July 2023 across international databases including PubMed/Medline, ISI Web of Science, Scopus, Cochrane, Google Scholar, and EMBASE. Data extraction and quality assessment were performed by two independent reviewers. Heterogeneity across studies was assessed using the I 2 statistic and chi-square-based Q-test. A random/fixed effect meta-analysis was conducted to pool odds ratios (ORs) and hazard ratios (HRs). Results Of the 1745 retrieved articles, 17 studies with 159,885 participants were suitable for inclusion in the systematic review and meta-analysis (seven longitudinal, nine cross-sectional and one case-control studies). Quantitative synthesis based on cross-sectional studies showed that junk food consumption increases the odds of having stress and depression (OR = 1.15, 95% CI: 1.06 to 1.23). Moreover, pooling results of cohort studies showed that junk food consumption is associated with a 16% increment in the odds of developing mental health problems (OR = 1.16, 95% CI: 1.07 to 1.24). Conclusion Meta-analysis revealed that consumption of junk foods was associated with an increased hazard of developing depression. Increased consumption of junk food has heightened the odds of depression and psychological stress being experienced in adult populations.

The association of ultra-processed food consumption with adult mental health disorders: a systematic review and dose-response meta-analysis of 260,385 participants

Type of study: meta-analysis

Number of citations: 25

Year: 2022

Authors: Seyadeh Narges Mazloomi, S. Talebi, S. Mehrabani, R. Bagheri, Abed Ghavami, M. Zarpoosh, H. Mohammadi, A. Wong, M. Nordvall, M. Kermani, S. Moradi

Journal: Nutritional Neuroscience

Journal ranking: Q1

Key takeaways: Ultra-processed food consumption is associated with an increased risk of depression, but not anxiety, in adults.

Abstract: ABSTRACT Objective We aimed to conduct a systematic review and meta-analysis of observational studies examining the relationship between ultra-processed food (UPF) consumption and the risk of mental health disorders. Methods The ISI Web of Science, PubMed/MEDLINE, and Scopus databases were searched without date restriction until 28 December 2021. Data were extracted from 26 studies, including 260,385 participants from twelve countries. Risk ratios for mental health disorders were pooled by a random-effects model. Results Meta-analyses suggested that UPF consumption was associated with an increased risk of depression (RR = 1.28; 95% CI: 1.19, 1.38; I2 = 61.8%; p = 0.022) but not anxiety (RR = 1.35; 95% CI: 0.86, 2.11; I2 =  77.8%; p = 0.198). However, when analyzed for the dietary assessment method, UPF consumption was significantly associated with an enhanced risk of depression among studies utilizing food frequency questionnaires (RR = 1.31; 95% CI: 1.21, 1.41; I2 = 60.0%; p < 0.001) as opposed to other forms of dietary recall approaches. Additionally, for every 10% increase in UPF consumption per daily calorie intake, 11% higher risk of depression (RR = 1.11; 95% CI: 1.01, 1.17; I2 = 88.9%; p < 0.001) was observed among adults. Dose-response analysis further emphasized a positive linear association between UPF consumption with depression risk (p-nonlinearity = 0.819, p-dose-response = p < 0.001). Conclusion Our findings indicate that UPF consumption is related to an enhanced depressive mental health status risk. There may be different causes for this increased risk, and further studies are needed to investigate if there is a causal relationship between consumption of UPF and mental health.

Factors Affecting Ultra‐Processed Food Consumption: Hedonic Hunger, Food Addiction, and Mood

Type of study: non-rct observational study

Number of citations: 0

Year: 2025

Authors: Özge Mengi Çelik, Ümmügülsüm Güler, E. Ekici

Journal: Food Science & Nutrition

Journal ranking: Q1

Key takeaways: Ultra-processed food consumption is positively correlated with food addiction and mood, suggesting policies targeting psychosocial processes should be developed to limit consumption and promote healthy eating habits.

Abstract: ABSTRACT Ultra‐processed foods (UPF) play a central role in modern diets but pose a serious threat to public health. The aim of this study was to investigate the relationship between UPF consumption and hedonic hunger, food addiction, and mood and to explain the impact of these factors on dietary habits. This cross‐sectional study included 3997 adults (2517 female, 1480 male), aged 18–65 years, recruited through snowball sampling in Ankara, Turkey. Data were collected via a web‐based survey that included demographic information, self‐reported anthropometric measurements, and validated scales: Screening Questionnaire of Highly Processed Food Consumption, The Power of Food Scale, Yale Food Addiction Scale, and Depression Anxiety Stress Scale‐21. The mean age of the participants was 31.7 ± 12.82 years. The Screening Questionnaire of Highly Processed Food Consumption was positively correlated with the Yale Food Addiction Scale score and the subdimension scores of the Depression Anxiety Stress Scale‐21 (p < 0.05). According to linear regression analysis, it was determined that gender, age, Yale Food Addiction Scale score, and the scores of depression, anxiety, and stress affected the Screening Questionnaire of Highly Processed Food Consumption score (p < 0.05). There was a difference between the groups with low and high levels of UPF consumption in terms of age, gender, marital and working status, Yale Food Addiction Scale score, and the subdimension scores of the Depression Anxiety Stress Scale‐21 (p < 0.05). In conclusion, considering the influence of food addiction and mood on UPF consumption, policies and interventions targeting the psychosocial processes of individuals should be developed and further research conducted in this area to limit the UPF consumption and promote healthy eating habits along with conscious eating behaviors.

Cross-sectional examination of ultra-processed food consumption and adverse mental health symptoms

Type of study: non-rct observational study

Number of citations: 17

Year: 2022

Authors: E. Hecht, Anna M. Rabil, Eurídice Martínez Steele, G. Abrams, Deanna Ware, D. Landy, C. Hennekens

Journal: Public Health Nutrition

Journal ranking: Q2

Key takeaways: Higher consumption of ultra-processed foods is associated with increased likelihood of mild depression, more mentally unhealthy and anxious days, and decreased chances of reporting zero mentally unhealthy or anxious days.

Abstract: Abstract Objective: To explore whether individuals who consume higher amounts of ultra-processed food (UPF) have more adverse mental health symptoms. Design: Using a cross-sectional design, we measured the consumption of UPF as a percentage of total energy intake in kilo-calories using the NOVA food classification system. We explored whether individuals who consume higher amounts of UPF were more likely to report mild depression, more mentally unhealthy days and more anxious days per month using multivariable analyses adjusting for potential confounding variables. Setting: Representative sample from the United States National Health and Nutrition Examination Survey between 2007 and 2012. Participants: 10 359 adults aged 18+ without a history of cocaine, methamphetamine or heroin use. Results: After adjusting for covariates, individuals with the highest level of UPF consumption were significantly more likely to report at least mild depression (OR: 1·81; 95 % CI1·09, 3·02), more mentally unhealthy (risk ratio (RR): 1·22; 95 % CI 1·18, 1·25) and more anxious days per month (RR: 1·19; 95 % CI 1·16, 1·23). They were also significantly less likely to report zero mentally unhealthy (OR: 0·60; 95 % CI 0·41, 0·88) or anxious days (OR: 0·65; 95 % CI 0·47, 0·90). Conclusions: Individuals reporting higher intakes of UPF were significantly more likely to report mild depression, more mentally unhealthy and more anxious days and less likely to report zero mentally unhealthy or anxious days. These data add important information to a growing body of evidence concerning the potential adverse effects of UPF consumption on mental health.

Multiple health risk behaviors, including high consumption of ultra-processed foods and their implications for mental health during the COVID-19 pandemic

Type of study: non-rct observational study

Number of citations: 7

Year: 2022

Authors: H. Coletro, R. Mendonça, A. Meireles, G. Machado-Coelho, M. C. de Menezes

Journal: Frontiers in Nutrition

Journal ranking: Q1

Key takeaways: A combination of two or three health risk behaviors, such as sedentary lifestyles, high ultra-processed food consumption, and non-daily fruit and vegetable consumption, is associated with a higher prevalence of mental health symptoms.

Abstract: Background and aim The growing increase in diet- and behavior-related illnesses has drawn the attention of many epidemiologists who attribute such changes to the epidemiological and nutritional transition. Thus, this study aims to evaluate the association between the combined occurrence of health risk behaviors, such as sedentary lifestyles, high weekly consumption of ultra-processed foods (UPFs), and non-daily consumption of fruits and vegetables, and symptoms of anxiety or depression in adults. Methods This is a cross-sectional study based on an epidemiological survey in two Brazilian cities. The outcome, anxiety, and depression symptoms were assessed using the Generalized Anxiety Disorder 7-item (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). Food consumption was assessed using a qualitative food frequency questionnaire (FFQ) with reference to consumption in the last 3 months and categorized into the consumption of fruits and vegetables and the consumption of UPFs according to the NOVA classification. Sedentary behavior was assessed by considering the amount of sitting or reclining time per day reported by participants and categorized as less than 9 h of sitting or reclining and 9 h or more. For the analysis, adjusted Poisson regression (PR) was used to estimate the prevalence ratio and the 95% confidence interval (CI). Results Those with the health risk behaviors, non-daily consumption of fruits and vegetables, and high consumption of UPFs had a 2.6 higher prevalence ratio for symptoms of mental disorder (PR: 2.6 and 95%CI: 1.1–6.5), as well as those with all three health risk behaviors, had a 2.8 higher prevalence ratio for symptoms of mental disorder (PR: 2.8 and 95%CI: 1.3–6.1). Conclusion This study revealed that the existence of a combination of two and three health risk behaviors led to a higher prevalence of symptoms of anxiety or depression.

Food consumption associated with depression, anxiety and stress in students entering a public university

Type of study: non-rct observational study

Number of citations: 0

Year: 2025

Authors: Maria Eduarda Ribeiro José, I.E.C. Ramos, Taciana Maia de Sousa, D. Canella

Journal: Journal of Nutritional Science

Journal ranking: Q2

Key takeaways: High consumption of fresh or minimally processed foods is associated with a lower likelihood of depression, anxiety, and stress in university students, while ultra-processed foods show no association with mental health outcomes.

Abstract: Abstract Cross-sectional study investigated the association of fresh or minimally processed foods and ultra-processed food consumption with symptoms of depression, anxiety and stress in students from a Brazilian public university. Undergraduate students admitted in 2022 answered an online questionnaire during their first semester. Consumption of 12 subgroups of fresh or minimally processed foods and 13 of ultra-processed foods on the previous day were investigated (affirmative answer for ≥ 5 subgroups was classified as high consumption). Depression, anxiety and stress were investigated using the DASS-21 and mild to extremely severe symptoms were grouped to be compared with individuals without symptoms. Adjusted logistic regression models estimated the Odds Ratio (OR) of the association between symptoms of depression, anxiety and stress (outcomes) and food consumption (exposures), with a significance level of 5%. A total of 924 students were evaluated, of whom 57.7% presented symptoms of depression, 51.9% of anxiety and 59.4% of stress. A high consumption of fresh or minimally processed foods was observed in 80.3% of the students, with a higher frequency among those without symptoms of depression, anxiety, and stress, while 38.9% showed a high consumption of ultra-processed foods, without differences according to symptoms. High consumption of fresh or minimally processed foods was associated with a lower likelihood of symptoms of depression (OR: 0.62; p=0.011), anxiety (OR: 0.58; p=0.003) and stress (OR: 0.69; p=0.043). No association was found between ultra-processed and mental health outcomes. Actions that support and encourage the consumption of healthy food in the university environment can contribute to mental health outcomes.

Processed and ultra-processed foods are associated with depression and anxiety symptoms in a cross-sectional sample of urban Lebanese adults.

Type of study:

Number of citations: 1

Year: 2024

Authors: Lamia Ghernati, Hani Tamim, F. A. Z. Chokor, Mandy Taktouk, Batoul Assi, Lara Nasreddine, Martine Elbejjani

Journal: Nutrition research

Journal ranking: Q2

Key takeaways: Higher intakes of ultra-processed foods are associated with higher odds of depression and anxiety symptoms, while higher intakes of processed or minimally processed foods are associated with lower odds of these symptoms.

Associations of Ultra-Processed Food Intake with the Incidence of Cardiometabolic and Mental Health Outcomes Go Beyond Specific Subgroups—The Brazilian Longitudinal Study of Adult Health

Type of study: non-rct observational study

Number of citations: 2

Year: 2024

Authors: S. Canhada, Álvaro Vigo, Luana Giatti, M. J. Fonseca, L. J. Lopes, L. D. O. Cardoso, C. Monteiro, Maria Schmidt, B. B. Duncan

Journal: Nutrients

Journal ranking: Q1

Key takeaways: Ultra-processed food intake, including processed meat and sweetened beverages, predicts increased risk of cardiometabolic and mental health disorders.

Abstract: Background/Objectives: Avoidance of ultra-processed foods (UPFs) has been recommended to achieve a healthy diet, but whether it applies equally to all UPFs is uncertain. We evaluated individual UPF subgroups in the prediction of cardiometabolic and mental health outcomes. Methods: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is an occupational cohort study of 15,105 adults (35–74 years) recruited in 2008–2010. We followed participants up to 2018 to ascertain elevated weight and waist gains and the onset of metabolic syndrome, hypertension, metabolic dysfunction-associated steatotic liver disease, diabetes, common mental disorders, depressive episodes, and anxiety disorders. Results: In adjusted robust Poisson regression, greater overall UPF intake at the baseline predicted all studied outcomes. Various subgroups of UPF, most frequently processed meat and sweetened beverages, individually conferred a greater risk, and nearly all predicted at least one studied outcome. Considering all subgroups and outcomes, a broad pattern of overall risk was present. When subgroups not individually predictive of these outcomes were aggregated, increased risk (for a one-standard deviation change) was observed for elevated weight (RR = 1.05; 95% CI 1.01–1.11) and waist (RR = 1.05; 95% CI 1.00–1.10) gains, and for the incidence of common mental (RR = 1.06; 95% CI 1.01–1.12), and anxiety (RR = 1.09; 95% CI 1.02–1.16) disorders. Conclusions: UPFs overall and their subgroups predicted future cardiometabolic and mental health outcomes. The pattern of individual UPF subgroup associations varied across outcomes, and the aggregate of subgroups not individually predicting risk also predicted large gains in overall and central adiposity and the incidence of mental health disorders. While additional studies investigating other outcomes are needed, these findings justify avoidance of overall UPF intake in health promotion and disease prevention.

Consumption of ultra-processed foods and mental health of pregnant women from the South of Brazil

Type of study: non-rct observational study

Number of citations: 0

Year: 2024

Authors: Fernanda de Oliveira Meller, C. S. Costa, M. R. Quadra, Vanessa Iribarrem Avena Miranda, Fernanda Daminelli Eugenio, Tamara Justin da Silva, Maria Vitória Rodrigues Teixeira, A. A. Schäfer

Journal: British Journal of Nutrition

Journal ranking: Q1

Key takeaways: High consumption of ultra-processed foods is associated with increased anxiety, stress, and depressive symptoms in pregnant women from the South of Brazil.

Abstract: Abstract The objective of this study is to evaluate the association between the consumption of ultra-processed foods (UPF) and the mental health of pregnant women from the South of Brazil. This is a cross-sectional study carried out in Criciúma, Brazil, through face-to-face interviews, from April to December 2022. Pregnant women aged 18 or older who underwent prenatal care in the forty-eight basic health care units of the municipality and who were in their third trimester of pregnancy were included. High consumption of UPF was considered as six or more items or subgroups of UPF consumed on the day before the interview, using the Nova-UPF screener. The mental health variables were depressive symptoms, stress, sadness and anxiety. Crude and adjusted analyses were conducted using the Fisher’s exact test and the Poisson regression with robust variance. In total, 428 pregnant women were studied; most of them were aged between 20 and 25 years and were white. Pregnant women who presented high consumption of UPF were 1·42-fold (95 % CI 1·06, 1·92) more likely to experience anxiety and presented a prevalence 56 % (95 % CI 1·18, 2·07) higher of stress when compared with those who did not present high consumption of UPF. The prevalence of depressive symptoms and feelings of sadness was 1·31-fold (95 % CI 1·08, 1·60) and 3·41-fold (95 % CI 1·77, 6·58) higher among those with high consumption of UPF, respectively. The results suggest that diet quality is associated with the mental health of pregnant women. Promoting joint actions focused on food and nutritional education, and mental health, for pregnant women, is necessary.

Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses

Type of study: meta-analysis

Number of citations: 306

Year: 2024

Authors: M. M. Lane, E. Gamage, Shutong Du, D. N. Ashtree, A. McGuinness, Sarah Gauci, Phillip Baker, M. Lawrence, C. Rebholz, B. Srour, M. Touvier, F. Jacka, Adrienne O’Neil, Toby Segasby, Wolfgang Marx

Journal: The BMJ

Journal ranking: Q1

Key takeaways: Greater exposure to ultra-processed foods is associated with increased risks of cardiometabolic, common mental disorder, and mortality outcomes.

Abstract: Abstract Objective To evaluate the existing meta-analytic evidence of associations between exposure to ultra-processed foods, as defined by the Nova food classification system, and adverse health outcomes. Design Systematic umbrella review of existing meta-analyses. Data sources MEDLINE, PsycINFO, Embase, and the Cochrane Database of Systematic Reviews, as well as manual searches of reference lists from 2009 to June 2023. Eligibility criteria for selecting studies Systematic reviews and meta-analyses of cohort, case-control, and/or cross sectional study designs. To evaluate the credibility of evidence, pre-specified evidence classification criteria were applied, graded as convincing (“class I”), highly suggestive (“class II”), suggestive (“class III”), weak (“class IV”), or no evidence (“class V”). The quality of evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework, categorised as “high,” “moderate,” “low,” or “very low” quality. Results The search identified 45 unique pooled analyses, including 13 dose-response associations and 32 non-dose-response associations (n=9 888 373). Overall, direct associations were found between exposure to ultra-processed foods and 32 (71%) health parameters spanning mortality, cancer, and mental, respiratory, cardiovascular, gastrointestinal, and metabolic health outcomes. Based on the pre-specified evidence classification criteria, convincing evidence (class I) supported direct associations between greater ultra-processed food exposure and higher risks of incident cardiovascular disease related mortality (risk ratio 1.50, 95% confidence interval 1.37 to 1.63; GRADE=very low) and type 2 diabetes (dose-response risk ratio 1.12, 1.11 to 1.13; moderate), as well as higher risks of prevalent anxiety outcomes (odds ratio 1.48, 1.37 to 1.59; low) and combined common mental disorder outcomes (odds ratio 1.53, 1.43 to 1.63; low). Highly suggestive (class II) evidence indicated that greater exposure to ultra-processed foods was directly associated with higher risks of incident all cause mortality (risk ratio 1.21, 1.15 to 1.27; low), heart disease related mortality (hazard ratio 1.66, 1.51 to 1.84; low), type 2 diabetes (odds ratio 1.40, 1.23 to 1.59; very low), and depressive outcomes (hazard ratio 1.22, 1.16 to 1.28; low), together with higher risks of prevalent adverse sleep related outcomes (odds ratio 1.41, 1.24 to 1.61; low), wheezing (risk ratio 1.40, 1.27 to 1.55; low), and obesity (odds ratio 1.55, 1.36 to 1.77; low). Of the remaining 34 pooled analyses, 21 were graded as suggestive or weak strength (class III-IV) and 13 were graded as no evidence (class V). Overall, using the GRADE framework, 22 pooled analyses were rated as low quality, with 19 rated as very low quality and four rated as moderate quality. Conclusions Greater exposure to ultra-processed food was associated with a higher risk of adverse health outcomes, especially cardiometabolic, common mental disorder, and mortality outcomes. These findings provide a rationale to develop and evaluate the effectiveness of using population based and public health measures to target and reduce dietary exposure to ultra-processed foods for improved human health. They also inform and provide support for urgent mechanistic research. Systematic review registration PROSPERO CRD42023412732.

Dissecting ultra-processed foods and drinks: Do they have a potential to impact the brain?

Type of study:

Number of citations: 31

Year: 2022

Authors: O. Contreras-Rodríguez, M. Solanas, R. M. Escorihuela

Journal: Reviews in Endocrine and Metabolic Disorders

Journal ranking: Q1

Key takeaways: Ultra-processed foods and drinks may negatively impact brain health and eating behavior, with potential effects on serotonergic and dopaminergic neurotransmission, brain integrity, and function.

Abstract: Ultra-processed foods and drinks (UPF) are formulation of ingredients, mostly of exclusive industrial use, that result from a series of industrial processes. They usually have a low nutrient but high energy density, with a high content of saturated and trans fats, and added sugars. In addition, they have characteristic organoleptic properties, and usually contain sophisticated additives, including artificial sweeteners, to intensify their sensory qualities and imitate the appearance of minimally processed foods. In addition, recent research has warned about the presence of chemicals (e.g., bisphenol) and neo-formed contaminants in these products. UPF production and consumption growth have been spectacular in the last decades, being specially consumed in children and adolescents. UPF features have been associated with a range of adverse health effects such as overeating, the promotion of inflammatory and oxidative stress processes, gut dysbiosis, and metabolic dysfunction including problems in glucose regulation. The evidence that these UPF-related adverse health effects may have on the neural network implicated in eating behavior are discussed, including the potential impact on serotonergic and dopaminergic neurotransmission, brain integrity and function. We end this review by placing UPF in the context of current food environments, by suggesting that an increased exposure to these products through different channels, such as marketing, may contribute to the automatic recruitment of the brain regions associated with food consumption and choice, with a detrimental effect on inhibitory-related prefrontal cortices. While further research is essential, preliminary evidence point to UPF consumption as a potential detrimental factor for brain health and eating behavior.

Food and mood: how do diet and nutrition affect mental wellbeing?

Type of study:

Number of citations: 177

Year: 2020

Authors:

Journal: The BMJ

Journal ranking: Q1

Key takeaways: Adherence to healthy dietary patterns, high in fruits, vegetables, nuts, and legumes, is associated with reduced risk of depression, but the relationship is complex and may involve reverse causality.

Abstract: Depression and anxiety are the most common mental health conditions worldwide, mak­ ing them a leading cause of disability. Even beyond diag­ nosed conditions, subclinical symptoms of depression and anxiety affect the wellbeing and functioning of a large proportion of the population. Therefore, new approaches to managing both clinically diagnosed and subclinical depression and anxiety are needed. In recent years, the relationships bet­ ween nutrition and mental health have gained considerable interest. Indeed, epidemiological research has observed that adherence to healthy or Mediterranean dietary patterns—high consumption of fruits, vegetables, nuts, and legumes; moderate consumption of poultry, eggs, and dairy products; and only occasional consumption of red meat—is associated with a reduced risk of depression. However, the nature of these relations is complicated by the clear potential for reverse causality between diet and mental health (fig 1). For example, alterations in food choices or preferences in response to our temporary psychological state—such as “comfort foods” in times of low mood, or changes in appetite from stress—are common human experiences. In addition, relationships between nutrition and longstanding mental illness are compounded by barriers to maintaining a healthy diet. These barriers disproportionality affect people with mental illness and include the financial and environmental determinants of health, and even the appetite inducing effects of psychiatric medications. While acknowledging the complex, multidirectional nature of the relationships between diet and mental health (fig 1), in this article we focus on the ways in which certain foods and dietary patterns could affect mental health.

Intake of Raw Fruits and Vegetables Is Associated With Better Mental Health Than Intake of Processed Fruits and Vegetables

Type of study: non-rct observational study

Number of citations: 119

Year: 2018

Authors: Kate L Brookie, Georgia I. Best, Tamlin S. Conner

Journal: Frontiers in Psychology

Journal ranking: Q2

Key takeaways: Raw fruit and vegetable intake is associated with better mental health outcomes in young adults compared to processed fruit and vegetable intake.

Abstract: Background: Higher intakes of fruits and vegetables, rich in micronutrients, have been associated with better mental health. However, cooking or processing may reduce the availability of these important micronutrients. This study investigated the differential associations between intake of raw fruits and vegetables, compared to processed (cooked or canned) fruits and vegetables, and mental health in young adults. Methods: In a cross-sectional survey design, 422 young adults ages 18–25 (66.1% female) living in New Zealand and the United States completed an online survey that assessed typical consumption of raw vs. cooked/canned/processed fruits and vegetables, negative and positive mental health (depressive symptoms, anxiety, negative mood, positive mood, life satisfaction, and flourishing), and covariates (including socio-economic status, body mass index, sleep, physical activity, smoking, and alcohol use). Results: Controlling for covariates, raw fruit and vegetable intake (FVI) predicted reduced depressive symptoms and higher positive mood, life satisfaction, and flourishing; processed FVI only predicted higher positive mood. The top 10 raw foods related to better mental health were carrots, bananas, apples, dark leafy greens like spinach, grapefruit, lettuce, citrus fruits, fresh berries, cucumber, and kiwifruit. Conclusions: Raw FVI, but not processed FVI, significantly predicted higher mental health outcomes when controlling for the covariates. Applications include recommending the consumption of raw fruits and vegetables to maximize mental health benefits.

Influence of Nutrition on Mental Health: Scoping Review

Type of study: systematic review

Number of citations: 14

Year: 2023

Authors: Lara María Suárez-López, L. M. Bru-Luna, Manuel Martí-Vilar

Journal: Healthcare

Journal ranking: brak

Key takeaways: Healthy nutrition, such as the Mediterranean diet, improves mental health, with levels of magnesium, vitamin D, and vitamin B6 also playing a role.

Abstract: The aim of this article was to carry out a scoping review of existing research on the influence of food on mental health: (1) Background: nutrition, nutrient levels or an adequate body weight seem to influence the mental health status of individuals. The consumption of psychotropic drugs also seems to contribute to overweight; (2) Methods: fifteen previous research articles were used in the review, which were read in their entirety, following PRISMA methodology and using SPIDER and GRADE tools; (3) Results: there is a relationship between diet and mental health status. Low levels of magnesium, together with high levels of calcium, provoke anxious states, and supplementation with Melissa Officinalis attenuates them. Healthy nutritional habits generally reduce depressive symptoms; while vitamin D supplementation improves mental health status; (4) Conclusion: in general, healthy and appropriate nutrition, such as the Mediterranean diet, improves mental health status. Levels of magnesium, vitamin D, and vitamin B6 also seem to have an influence. As limitations of the present review, “food” was considered any form of nutrient administered as an independent variable, and it may include linguistic and publication bias.

Ultra-processed Foods and Cardiovascular Diseases: Potential Mechanisms of Action.

Type of study: literature review

Number of citations: 184

Year: 2021

Authors: Filippa Juul, G. Vaidean, N. Parekh

Journal: Advances in nutrition

Journal ranking: Q1

Key takeaways: Ultra-processed foods may increase cardiovascular disease risk through altered lipid concentrations, gut microbiota composition, obesity, inflammation, and oxidative stress, beyond traditional nutrients.

Abstract: Ultra-processed foods are industrially manufactured ready-to-eat or ready-to-heat formulations containing food additives and little or no whole foods, in contrast to processed foods, which are whole foods preserved by traditional techniques such as canning or pickling. Recent epidemiological studies suggest that higher consumption of ultra-processed food is associated with increased risk of cardiovascular disease (CVD). However, epidemiological evidence needs to be corroborated with criteria of biological plausibility. This review summarizes the current evidence on the putative biological mechanisms underlying the associations between ultra-processed foods and CVD. Research ranging from laboratory-based to prospective epidemiological studies and experimental evidence suggest that ultra-processed foods may affect cardiometabolic health through a myriad of mechanisms, beyond the traditionally recognized individual nutrients. Processing induces significant changes to the food matrix, for which ultra-processed foods may affect health outcomes differently than unrefined whole foods with similar nutritional composition. Notably, the highly degraded physical structure of ultra-processed foods may affect cardiometabolic health by influencing absorption kinetics, satiety, glycemic response, and the gut microbiota composition and function. Food additives and neo-formed contaminants produced during processing may also play a role in CVD risk. Key biological pathways include altered serum lipid concentrations, modified gut microbiota and host-microbiota interactions, obesity, inflammation, oxidative stress, dysglycemia, insulin resistance, and hypertension. Further research is warranted to clarify the proportional harm associated with the nutritional composition, food additives, physical structure, and other attributes of ultra-processed foods. Understanding how ultra-processing changes whole foods and through which pathways these foods affect health is a prerequisite for eliminating harmful processing techniques and ingredients.

Ultra-processed food intake and risk of cardiovascular disease: prospective cohort study (NutriNet-Santé)

Type of study: non-rct observational study

Number of citations: 643

Year: 2019

Authors: B. Srour, L. Fezeu, E. Kesse‐Guyot, B. Allès, C. Méjean, R. M. Andrianasolo, E. Chazelas, M. Deschasaux, S. Hercberg, P. Galan, C. Monteiro, C. Julia, M. Touvier

Journal: The BMJ

Journal ranking: Q1

Key takeaways: Higher consumption of ultra-processed foods is associated with increased risks of cardiovascular, coronary heart, and cerebrovascular diseases.

Abstract: Abstract Objective To assess the prospective associations between consumption of ultra-processed foods and risk of cardiovascular diseases. Design Population based cohort study. Setting NutriNet-Santé cohort, France 2009-18. Participants 105 159 participants aged at least 18 years. Dietary intakes were collected using repeated 24 hour dietary records (5.7 for each participant on average), designed to register participants’ usual consumption of 3300 food items. These foods were categorised using the NOVA classification according to degree of processing. Main outcome measures Associations between intake of ultra-processed food and overall risk of cardiovascular, coronary heart, and cerebrovascular diseases assessed by multivariable Cox proportional hazard models adjusted for known risk factors. Results During a median follow-up of 5.2 years, intake of ultra-processed food was associated with a higher risk of overall cardiovascular disease (1409 cases; hazard ratio for an absolute increment of 10 in the percentage of ultra-processed foods in the diet 1.12 (95% confidence interval 1.05 to 1.20); P<0.001, 518 208 person years, incidence rates in high consumers of ultra-processed foods (fourth quarter) 277 per 100 000 person years, and in low consumers (first quarter) 242 per 100 000 person years), coronary heart disease risk (665 cases; hazard ratio 1.13 (1.02 to 1.24); P=0.02, 520 319 person years, incidence rates 124 and 109 per 100 000 person years, in the high and low consumers, respectively), and cerebrovascular disease risk (829 cases; hazard ratio 1.11 (1.01 to 1.21); P=0.02, 520 023 person years, incidence rates 163 and 144 per 100 000 person years, in high and low consumers, respectively). These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet (saturated fatty acids, sodium and sugar intakes, dietary fibre, or a healthy dietary pattern derived by principal component analysis) and after a large range of sensitivity analyses. Conclusions In this large observational prospective study, higher consumption of ultra-processed foods was associated with higher risks of cardiovascular, coronary heart, and cerebrovascular diseases. These results need to be confirmed in other populations and settings, and causality remains to be established. Various factors in processing, such as nutritional composition of the final product, additives, contact materials, and neoformed contaminants might play a role in these associations, and further studies are needed to understand better the relative contributions. Meanwhile, public health authorities in several countries have recently started to promote unprocessed or minimally processed foods and to recommend limiting the consumption of ultra-processed foods. Study registration ClinicalTrials.gov NCT03335644.

Ultra-Processed Foods and Incident Cardiovascular Disease in the Framingham Offspring Study.

Type of study:

Number of citations: 129

Year: 2021

Authors: Filippa Juul, G. Vaidean, Yong Lin, A. Deierlein, N. Parekh

Journal: Journal of the American College of Cardiology

Journal ranking: Q1

Key takeaways: Higher consumption of ultra-processed foods is associated with increased risk of cardiovascular disease incidence and mortality.

Association of ultra-processed food consumption with cardiovascular mortality in the US population: long-term results from a large prospective multicenter study

Type of study: non-rct observational study

Number of citations: 61

Year: 2020

Authors: Guochao Zhong, H. Gu, Yang Peng, Kang-Tao Wang, Youqile Wu, Tian-Yang Hu, F. Jing, Fa-Bao Hao

Journal: International Journal of Behavioral Nutrition and Physical Activity

Journal ranking: Q1

Key takeaways: High consumption of ultra-processed foods is associated with increased risks of cardiovascular and heart disease mortality, with more pronounced effects in women.

Abstract: Abstract Background Ultra-processed foods have now become dominant in the global food system. Whether their consumption is associated with cardiovascular mortality remains controversial. Moreover, data on ultra-processed foods and cardiovascular outcomes are scarce in the US population. We aimed to examine the association of ultra-processed food consumption with cardiovascular mortality in a US population. Methods A population-based cohort of 91,891 participants was identified from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Dietary data were collected through a validated 137-item food frequency questionnaire. Ultra-processed foods were defined by the NOVA classification. Cox regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for cardiovascular mortality. Restricted cubic spline regression was used to test nonlinearity. Subgroup analyses were conducted to identify the potential effect modifiers. Results After an average follow-up of 13.5 years (1,236,049.2 person-years), 5490 cardiovascular deaths were documented, including 3985 heart disease deaths and 1126 cerebrovascular deaths. In the fully adjusted model, participants in the highest vs. the lowest quintiles of ultra-processed food consumption had higher risks of death from cardiovascular disease (HR quintile 5 vs. 1 , 1.50; 95% CI, 1.36–1.64) and heart disease (HR quintile 5 vs. 1 , 1.68; 95% CI, 1.50–1.87) but not cerebrovascular disease (HR quintile 5 vs. 1 , 0.94; 95% CI, 0.76–1.17). A nonlinear dose–response pattern was observed for overall cardiovascular and heart disease mortality (all P nonlinearity &lt; 0.05), with a threshold effect observed at ultra-processed food consumption of 2.4 servings/day and 2.3 servings/day, respectively; below the thresholds, no significant associations were observed for these two outcomes. Subgroup analyses showed that the increased risks of mortality from ultra-processed foods were significantly higher in women than in men (all P interaction &lt; 0.05). Conclusions High consumption of ultra-processed foods is associated with increased risks of overall cardiovascular and heart disease mortality. These harmful associations may be more pronounced in women. Our findings need to be confirmed in other populations and settings.

Ultra-processed food consumption and risk of cardiovascular events: a systematic review and dose-response meta-analysis

Type of study: meta-analysis

Number of citations: 13

Year: 2024

Authors: Wei Hu, Changyang Xing, Fenghui Ma, Y. Qu, L. Yuan, Jing Huang, Bijun Tan

Journal: eClinicalMedicine

Journal ranking: Q1

Key takeaways: Ultra-processed food consumption is associated with a higher risk of cardiovascular events, emphasizing the importance of minimizing consumption for cardiovascular health.

Ultra-processed food consumption is associated with increased risk of all-cause and cardiovascular mortality in the Moli-sani Study.

Type of study: non-rct observational study

Number of citations: 115

Year: 2020

Authors: M. Bonaccio, Augusto Di Castelnuovo, S. Costanzo, Amalia De Curtis, M. Persichillo, F. Sofi, C. Cerletti, M. Donati, Giovanni de Gaetano, L. Iacoviello

Journal: The American journal of clinical nutrition

Journal ranking: Q1

Key takeaways: High consumption of ultra-processed foods is linked to increased risks of cardiovascular and all-cause mortality, partly due to their high sugar content.

Abstract: BACKGROUND Consumption of ultra-processed food (UPF) is gaining growing attention in relation to disease/mortality risk, but less is known on the main nutritional factors or biological mechanisms potentially underlying such associations. OBJECTIVES We aimed to assess the association between UPF and mortality risk in a large sample of the Italian adult population and test which nutritional factors were on the pathway of this relation. Established risk factors for cardiovascular disease (CVD) were analyzed as potential biological mechanisms linking UPF to mortality. METHODS Longitudinal analysis was conducted on 22,475 men and women (mean ± SD age: 55 ± 12 y) recruited in the Moli-sani Study (2005-2010, Italy) and followed for 8.2 y. Food intake was assessed using a semiquantitative FFQ. UPF was defined using the NOVA classification according to degree of processing, and UPF intakes were categorized as quartiles of the ratio (%) of UPF (g/d) to total food consumed (g/d). RESULTS Individuals reporting the highest intake of UPF (Q4, >14.6% of total food), as opposed to the lowest (Q1, UPF < 6.6%), experienced increased risks of CVD mortality (HR: 1.58; 95% CI: 1.23, 2.03), death from ischemic heart disease (IHD)/cerebrovascular disease (HR: 1.52; 95% CI: 1.10, 2.09), and all-cause mortality (HR: 1.26; 95% CI: 1.09, 1.46). High sugar content explained 36.3% of the relation of UPF with IHD/cerebrovascular mortality, whereas other nutritional factors (e.g., saturated fats) were unlikely to be on the pathway. Biomarkers of renal function accounted for 20.1% of the association of UPF with all-cause mortality, and 12.0% for that of UPF with CVD mortality. CONCLUSIONS A high proportion of UPF in the diet was associated with increased risk of CVD and all-cause mortality, partly through its high dietary content of sugar. Some established biomarkers of CVD risk were likely to be on the pathway of such associations. These findings should serve as an incentive for limiting consumption of UPF, and encouraging natural or minimally processed foods, as several national nutritional policies recommend.

Associations of ultra-processed food consumption, circulating protein biomarkers, and risk of cardiovascular disease

Type of study:

Number of citations: 12

Year: 2023

Authors: Huiping Li, Yaogang Wang, E. Sonestedt, Y. Borné

Journal: BMC Medicine

Journal ranking: Q1

Key takeaways: High ultra-processed food intake increases the risk of cardiovascular disease and is associated with several protein biomarkers.

Abstract: We aim to examine the association between ultra-processed foods (UPF) consumption and cardiovascular disease (CVD) risk and to identify plasma proteins associated with UPF.This prospective cohort study included 26,369 participants from the Swedish Malmö Diet and Cancer Study, established in 1991-1996. Dietary intake was assessed using a modified diet history method, and UPF consumption was estimated using the NOVA classification system. A total of 88 selected CVD-related proteins were measured among 4475 subjects. Incident CVD (coronary heart disease and ischemic stroke) was defined as a hospital admission or death through registers. Cox proportional hazards regression models were performed to analyze the associations of UPF intake with risks of CVD. Linear regression models were used to identify the plasma proteins associated with UPF intake.During 24.6 years of median follow-up, 6236 participants developed CVD, of whom 3566 developed coronary heart disease and 3272 developed ischemic stroke. The adjusted hazard ratio (95% confidence interval) in the 4th versus 1st quartile of UPF was 1.18 (1.08, 1.29) for CVD, 1.20 (1.07, 1.35) for coronary heart disease, and 1.17 (1.03, 1.32) for ischemic stroke. Plasma proteins interleukin 18, tumor necrosis factor receptor 2, macrophage colony-stimulating factor 1, thrombomodulin, tumor necrosis factor receptor 1, hepatocyte growth factor, stem cell factor, resistin, C-C motif chemokine 3, and endothelial cell-specific molecule 1 were positively associated with UPF after correcting for multiple testing.Our study showed that high UPF intake increased the risk of CVD and was associated with several protein biomarkers. Future studies are warranted to validate these findings and assess the potential pathways between UPF intake and CVD.

Associations of ultra-processed food consumption with cardiovascular disease and all-cause mortality: UK Biobank

Type of study: non-rct observational study

Number of citations: 42

Year: 2022

Authors: Xuan Chen, Jiadong Chu, Wei Hu, Na Sun, Qida He, Siyuan Liu, Zhaolong Feng, Tongxing Li, Qiang Han, Yueping Shen

Journal: The European Journal of Public Health

Journal ranking: Q1

Key takeaways: Higher intake of ultra-processed food is associated with a higher risk of cardiovascular disease and all-cause mortality, suggesting that limiting this consumption should be part of prevention recommendations.

Abstract: Abstract Background This study aimed to investigate the associations between ultra-processed food (UPF) consumption and the risk of cardiovascular disease and all-cause mortality in the UK Biobank Cohort. Methods This observational prospective study evaluated 60 298 participants aged 40 years or older. We used the NOVA classification system to identify and categorize UPF. The associations among UPF consumption, cardiovascular disease (CVD) incidence and all-cause mortality were estimated using multivariable Cox proportional hazards models. Dose–response analysis of UPF consumption and CVD incidence and mortality was performed using a restricted cubic spline. Results After a median follow-up of 10.9 years, 6048 participants (10.0%) experienced CVD events, and 5327 (8.8%) and 1503 (2.5%) experienced coronary heart and cerebrovascular diseases, respectively. There were 2590 (4.3%) deaths, of which 384 (0.6%) deaths were caused by CVD. A higher intake of UPF was associated with a higher risk of CVD and all-cause mortality (all P < 0.001). A higher intake of UPF was associated with a higher risk of CVD [hazard ratio (HR) = 1.17, 95% confidence interval (CI): 1.09–1.26], coronary heart disease (HR = 1.16, 95% CI: 1.07–1.25), cerebrovascular disease (HR = 1.30, 95% CI: 1.13–1.50) and all-cause mortality (HR = 1.22, 95% CI: 1.09–1.36). The association of UPF consumption with a range of CVD incidents and all-cause mortality was monotonic (all P for non-linearity > 0.30). Conclusions A higher proportion of UPF consumption was associated with CVD and all-cause mortality. Thus, actions to limit UPF consumption should be incorporated into the CVD and all-cause mortality prevention recommendations.

Higher ultra-processed food intake is associated with an increased incidence risk of cardiovascular disease: the Tehran lipid and glucose study

Type of study:

Number of citations: 6

Year: 2024

Authors: Mohammad Jalali, Z. Bahadoran, P. Mirmiran, D. Khalili, Michael E. Symonds, Fereidoun Azizi, S. Faghih

Journal: Nutrition & Metabolism

Journal ranking: Q1

Key takeaways: Higher ultra-processed food intake is associated with an increased risk of cardiovascular disease.

Abstract: Cardiovascular disease (CVD) is a major cause of death worldwide, although limited data are currently available regarding the impact of consuming ultra-processed food (UPF) on its incidence. Given the increased consumption of UPF in Iran, we aimed to investigate the association between UPF intake and CVD risk.

Association of ultra-processed food consumption with cardiovascular risk factors among patients with type-2 diabetes mellitus

Type of study: non-rct observational study

Number of citations: 3

Year: 2024

Authors: Mohammad Heidari Seyedmahalleh, E. Nasli-Esfahani, Mobina Zeinalabedini, Leila Azadbakht

Journal: Nutrition & Diabetes

Journal ranking: Q1

Key takeaways: Higher consumption of ultra-processed foods is associated with increased chances of developing cardiovascular diseases in type-2 diabetes mellitus patients.

Associations of Processed Meat, Unprocessed Red Meat, Poultry, or Fish Intake With Incident Cardiovascular Disease and All-Cause Mortality.

Type of study:

Number of citations: 246

Year: 2020

Authors: Victor W. Zhong, L. V. Van Horn, P. Greenland, M. Carnethon, Hongyan Ning, J. Wilkins, D. Lloyd‐Jones, N. Allen

Journal: JAMA internal medicine

Journal ranking: Q1

Key takeaways: Processed meat, unprocessed red meat, poultry, and fish intake are significantly associated with increased risk of developing cardiovascular disease and all-cause mortality.

Abstract: Importance Although the associations between processed meat intake and cardiovascular disease (CVD) and all-cause mortality have been established, the associations of unprocessed red meat, poultry, or fish consumption with CVD and all-cause mortality are still uncertain. Objective To identify the associations of processed meat, unprocessed red meat, poultry, or fish intake with incident CVD and all-cause mortality. Design, Setting, and Participants This cohort study analyzed individual-level data of adult participants in 6 prospective cohort studies in the United States. Baseline diet data from 1985 to 2002 were collected. Participants were followed up until August 31, 2016. Data analyses were performed from March 25, 2019, to November 17, 2019. Exposures Processed meat, unprocessed red meat, poultry, or fish intake as continuous variables. Main Outcomes and Measures Hazard ratio (HR) and 30-year absolute risk difference (ARD) for incident CVD (composite end point of coronary heart disease, stroke, heart failure, and CVD deaths) and all-cause mortality, based on each additional intake of 2 servings per week for monotonic associations or 2 vs 0 servings per week for nonmonotonic associations. Results Among the 29 682 participants (mean [SD] age at baseline, 53.7 [15.7] years; 13 168 [44.4%] men; and 9101 [30.7%] self-identified as non-white), 6963 incident CVD events and 8875 all-cause deaths were adjudicated during a median (interquartile range) follow-up of 19.0 (14.1-23.7) years. The associations of processed meat, unprocessed red meat, poultry, or fish intake with incident CVD and all-cause mortality were monotonic (P for nonlinearity ≥ .25), except for the nonmonotonic association between processed meat intake and incident CVD (P for nonlinearity = .006). Intake of processed meat (adjusted HR, 1.07 [95% CI, 1.04-1.11]; adjusted ARD, 1.74% [95% CI, 0.85%-2.63%]), unprocessed red meat (adjusted HR, 1.03 [95% CI, 1.01-1.06]; adjusted ARD, 0.62% [95% CI, 0.07%-1.16%]), or poultry (adjusted HR, 1.04 [95% CI, 1.01-1.06]; adjusted ARD, 1.03% [95% CI, 0.36%-1.70%]) was significantly associated with incident CVD. Fish intake was not significantly associated with incident CVD (adjusted HR, 1.00 [95% CI, 0.98-1.02]; adjusted ARD, 0.12% [95% CI, -0.40% to 0.65%]). Intake of processed meat (adjusted HR, 1.03 [95% CI, 1.02-1.05]; adjusted ARD, 0.90% [95% CI, 0.43%-1.38%]) or unprocessed red meat (adjusted HR, 1.03 [95% CI, 1.01-1.05]; adjusted ARD, 0.76% [95% CI, 0.19%-1.33%]) was significantly associated with all-cause mortality. Intake of poultry (adjusted HR, 0.99 [95% CI, 0.97-1.02]; adjusted ARD, -0.28% [95% CI, -1.00% to 0.44%]) or fish (adjusted HR, 0.99 [95% CI, 0.97-1.01]; adjusted ARD, -0.34% [95% CI, -0.88% to 0.20%]) was not significantly associated with all-cause mortality. Conclusions and Relevance These findings suggest that, among US adults, higher intake of processed meat, unprocessed red meat, or poultry, but not fish, was significantly associated with a small increased risk of incident CVD, whereas higher intake of processed meat or unprocessed red meat, but not poultry or fish, was significantly associated with a small increased risk of all-cause mortality. These findings have important public health implications and should warrant further investigations.

Ultra-processed food consumption and cardiovascular events rate: An analysis from Isfahan Cohort Study (ICS).

Type of study:

Number of citations: 3

Year: 2024

Authors: M. Kermani-Alghoraishi, Amin Behrouzi, R. Hassannejad, N. Sarrafzadegan, Fatemeh Nouri, Mansoureh Boshatam, H. Roohafza, F. Haghighatdoost, Masoumeh Sadeghi

Journal: Nutrition, metabolism, and cardiovascular diseases : NMCD

Journal ranking: Q1

Key takeaways: Ultra-processed food consumption does not show a significant association with cardiovascular events risk in this mid-term study.

Associations of minimally processed and ultra-processed food intakes with cardiovascular health in Korean adults: the Korea National Health and Nutrition Examination Survey (KNHANES VI), 2013-2015.

Type of study:

Number of citations: 3

Year: 2024

Authors: Lita Kim, Y. Choi, D. Huh, K. Moon

Journal: Journal of exposure science & environmental epidemiology

Journal ranking: Q1

Key takeaways: High intake of minimally processed foods is associated with improved cardiovascular health, while high intake of ultra-processed foods is associated with poorer cardiovascular health in Korean adults.

OUP accepted manuscript

Type of study:

Number of citations: 49

Year: 2021

Authors:

Journal: European Heart Journal

Journal ranking: Q1

Key takeaways: Higher intake of ultra-processed food (UPF) is associated with increased mortality risks in individuals with prior cardiovascular events, potentially due to altered renal function.

Abstract: Abstract Aims To evaluate the association of ultra-processed food (UPF) intake and mortality among individuals with history of cardiovascular disease (CVD) and analyse some biological pathways possibly relating UPF intake to death. Methods and results Longitudinal analysis on 1171 men and women (mean age: 67 ± 10 years) with history of CVD, recruited in the Moli-sani Study (2005–10, Italy) and followed for 10.6 years (median). Food intake was assessed using a food frequency questionnaire. UPF was defined using the NOVA classification according to degree of processing and categorized as quartiles of the ratio (%) between UPF (g/day) and total food consumed (g/day). The mediating effects of 18 inflammatory, metabolic, cardiovascular, and renal biomarkers were evaluated using a logistic regression model within a counterfactual framework. In multivariable-adjusted Cox analyses, higher intake of UPF (Q4, ≥11.3% of total food), as opposed to the lowest (Q1, UPF &amp;lt;4.7%), was associated with higher hazards of all-cause (hazard ratio [HR]: 1.38; 95% confidence interval (CI): 1.00–1.91) and CVD mortality (HR: 1.65; 95% CI: 1.07–2.55). A linear dose–response relationship of 1% increment in UPF intake with all-cause and CVD mortality was also observed. Altered levels of cystatin C explained 18.3% and 16.6% of the relation between UPF (1% increment in the diet) with all-cause and CVD mortality, respectively. Conclusion A diet rich in UPF is associated with increased hazards of all-cause and CVD mortality among individuals with prior cardiovascular events, possibly through an altered renal function. Elevated UPF intake represents a major public health concern in secondary CVD prevention.

Ultra-processed foods and cardiovascular disease: analysis of three large US prospective cohorts and a systematic review and meta-analysis of prospective cohort studies

Type of study: meta-analysis

Number of citations: 28

Year: 2024

Authors: Kenny Mendoza, S. Smith-Warner, S. Rossato, Neha Khandpur, J. Manson, Lu Qi, E. Rimm, K. Mukamal, W. C. Willett, Molin Wang, Frank B. Hu, J. Mattei, Qi Sun

Journal: Lancet Regional Health - Americas

Journal ranking: brak

Key takeaways: Total ultra-processed food intake is associated with increased cardiovascular disease and coronary heart disease risk, with a small excess stroke risk in US adults.

Ultra-processed food consumption and cardiovascular events risk

Type of study: meta-analysis

Number of citations: 0

Year: 2023

Authors: Y. Qu, W. Hu, C. Xing, L. Yuan, J. Huang

Journal: European Heart Journal

Journal ranking: Q1

Key takeaways: Moderate intake of ultra-processed foods is associated with a lower risk of cardiovascular events, while heavy consumption significantly increases the risk.

Abstract: The consumption of ultra-processed food (UPF) has been suggested to be associated with cardiovascular events risk, but their dose-response relationship have not reached a consensus. We searched PubMed, EMBASE, Cochrane Library, and Web of Science databases for manuscripts published from inception to November 17, 2021, which reported the relationship between UPF consumption and cardiovascular events risk. A total of ten studies were included with 325,403 participants and 38,720 cardiovascular events cases. Using the fixed/random-effects models, hazard ratios of pooled outcomes were estimated. A non-linear relationship of UPF consumption with cardiovascular events risk was identified (P for heterogeneity = 0.013, P for dose-response < 0.001, P for non-linearity = 0.013). Compared with the lowest UPF consumption category, the third highest pooled HR for cardiovascular events risk was 1.02 (95% CI, 0.98 to 1.05), the second highest was 1.08 (95% CI, 1.04 to 1.12) and the highest was 1.24 (95% CI, 1.16 to 1.32). A linear association between UPF consumption and coronary heart disease (CHD) risk was identified (P for heterogeneity = 0.110, P for dose-response < 0.001, P for non-linearity = 0.202). A 10% increase in UPF consumption in daily calorie intake was associated with a 6% increase in CHD risk. UPF consumption was non-linearly associated with cerebrovascular disease (CeVD) risk (P for heterogeneity = 0.001, P for dose-response < 0.001, P for non-linearity = 0.026). There was a nonlinear relationship between UPF consumption and cardiovascular events. Moderate intake of UPF was associated with a lower risk of cardiovascular events, with the lowest risk at <15%/day of UPF consumption out of total calorie intake. Heavy UPF consumption was significantly and positively associated with increased risk of cardiovascular events.

Consumption of ultra-processed foods raises the possibility of cardiovascular disease - A meta-analysis.

Type of study: meta-analysis

Number of citations: 0

Year: 2024

Authors: Jiaxin You, Jinjie Hou, Xiaoran Xie, Rong Xu

Journal: Nutricion hospitalaria

Journal ranking: Q3

Key takeaways: Consuming a significant quantity of ultra-processed foods increases the likelihood of developing cardiovascular disease or experiencing mortality associated with cardiovascular disease.

Abstract: AIM the purpose of this study was to assess the connection among ultra-processed food consumption and the likelihood of cardiovascular disease, with the intention of establishing a basis for future research. METHODS this meta-analysis adheres to the reporting principles recommended in the PRISMA framework. PubMed, Embase, and Web of Science bibliographic databases were searched in January 2023. RESULTS ten observational studies were identified from 1,079 records retrieved by searching various relevant electronic bibliographic databases, and two additional observational studies were identified from references within one of the retrieved records; leading to the inclusion of a total of twelve observational studies. The data were combined, utilizing random effects models as well as relative risk ratios. Consuming a higher quantity of ultra-processed foods was found to be correlated with a 31 % elevated likelihood of mortality due to cardiovascular disease, in comparison to individuals who abstained from consuming any ultra-processed foods. Furthermore, an association has been seen between increased consumption of ultra-processed food and an elevated likelihood of acquiring hypertension, coronary heart disease, and cerebrovascular disorders. CONCLUSION consuming a significant quantity of ultra-processed meals increases the likelihood of developing cardiovascular disease or experiencing mortality associated with cardiovascular disease.

Ultra-processed food intake and all-cause and cause-specific mortality in individuals with cardiovascular disease: the Moli-sani Study.

Type of study: non-rct observational study

Number of citations: 18

Year: 2021

Authors: M. Bonaccio, S. Costanzo, A. Di Castelnuovo, M. Persichillo, S. Magnacca, A. De Curtis, C. Cerletti, M. Donati, G. de Gaetano, L. Iacoviello

Journal: European heart journal

Journal ranking: Q1

Key takeaways: A diet rich in ultra-processed food is associated with increased hazards of all-cause and cardiovascular disease mortality in individuals with prior cardiovascular events, possibly through altered renal function.

Abstract: AIMS To evaluate the association of ultra-processed food (UPF) intake and mortality among individuals with history of cardiovascular disease (CVD) and analyse some biological pathways possibly relating UPF intake to death. METHODS AND RESULTS  Longitudinal analysis on 1171 men and women (mean age: 67 ± 10 years) with history of CVD, recruited in the Moli-sani Study (2005-10, Italy) and followed for 10.6 years (median). Food intake was assessed using a food frequency questionnaire. UPF was defined using the NOVA classification according to degree of processing and categorized as quartiles of the ratio (%) between UPF (g/day) and total food consumed (g/day). The mediating effects of 18 inflammatory, metabolic, cardiovascular, and renal biomarkers were evaluated using a logistic regression model within a counterfactual framework. In multivariable-adjusted Cox analyses, higher intake of UPF (Q4, ≥11.3% of total food), as opposed to the lowest (Q1, UPF <4.7%), was associated with higher hazards of all-cause (hazard ratio [HR]: 1.38; 95% confidence interval (CI): 1.00-1.91) and CVD mortality (HR: 1.65; 95% CI: 1.07-2.55). A linear dose-response relationship of 1% increment in UPF intake with all-cause and CVD mortality was also observed. Altered levels of cystatin C explained 18.3% and 16.6% of the relation between UPF (1% increment in the diet) with all-cause and CVD mortality, respectively. CONCLUSION A diet rich in UPF is associated with increased hazards of all-cause and CVD mortality among individuals with prior cardiovascular events, possibly through an altered renal function. Elevated UPF intake represents a major public health concern in secondary CVD prevention.

Association of Ultra-Processed Food Intake with Cardiovascular And Respiratory Disease Multimorbidity: A Prospective Cohort Study.

Type of study: non-rct observational study

Number of citations: 18

Year: 2023

Authors: Huiping Li, Shu Li, Hongxi Yang, Yuan Zhang, Yue Ma, Yabing Hou, Xinyu Zhang, Li Sun, Y. Borné, Yaogang Wang

Journal: Molecular nutrition & food research

Journal ranking: Q1

Key takeaways: Higher consumption of ultra-processed food is associated with higher risks of cardiovascular disease and respiratory disease multimorbidity.

Abstract: SCOPE Evidence suggests a positive association between ultra-processed food (UPF) consumption and the incidence of cardiovascular disease (CVD). We aimed to investigate associations between UPF intake and respiratory disease, CVD, and their multimorbidity in a large prospective cohort. METHODS AND RESULTS Within the UK Biobank, participants who were free from respiratory disease or CVD at baseline and completed at least two times 24-h dietary records were included in this study. After adjusting for socioeconomic status and lifestyle factors, the hazard ratios (95% confidence interval) for each ten percent increase in UPF were 1.06 (1.04, 1.09) for CVD, 1.04 (1.02, 1.06) for respiratory disease, 1.15 (1.08, 1.22) for CVD mortality, and 1.06 (1.01, 1.12) for their multimorbidity, respectively. In addition, replacing 20% of UPF weight in diet with an equivalent proportion of unprocessed or minimally processed foods was estimated to be associated with 11% lower risk of CVD, 7% lower risk of respiratory disease, 25% lower risk of CVD mortality and 11% lower risk of CVD and respiratory disease multimorbidity. CONCLUSION In this prospective cohort study, higher consumption of UPF was associated with higher risks of CVD and respiratory disease multimorbidity. Further longitudinal studies are needed to confirm our findings. This article is protected by copyright. All rights reserved.

Ultra-processed food consumption and human health: an umbrella review of systematic reviews with meta-analyses

Type of study: meta-analysis

Number of citations: 14

Year: 2024

Authors: J. Barbaresko, Janine Bröder, Johanna Conrad, E. Szczerba, Alexander Lang, S. Schlesinger

Journal: Critical Reviews in Food Science and Nutrition

Journal ranking: Q1

Key takeaways: Ultra-processed food consumption may increase the risk of certain diseases, but the exact link remains unclear.

Abstract: Abstract Recently, ultra-processed foods received a lot of attention, but also criticism. Our aim was to provide an overview of the existing evidence of ultra-processed food consumption on human health. We conducted a systematic search in four databases until January 5th, 2024. Systematic reviews with meta-analyses on ultra-processed food consumption as defined by the NOVA classification system were included. The certainty of evidence was evaluated by the GRADE approach. We identified 16 publications. Moderate certainty of evidence was found for all-cause mortality (Summary Risk Ratio per 50 g: 1.02; 95% confidence Interval (CI): 1.01, 1.03), cardiovascular disease incidence and mortality (per 50 g/d: 1.04; 95% CI: 1.02, 1.06, and 1.05; 95% CI: 1.01, 1.08), type 2 diabetes incidence (per 10%: 1.12; 95% CI: 1.10, 1.13) and colorectal cancer (per 10%: 1.04; 95% CI: 1.01, 1.07). For several outcomes such as inflammatory bowel diseases, obesity, metabolic syndrome, nonalcoholic fatty liver disease, mental health as well as nutrient quality, similar estimates were observed, but certainty of evidence was limited. Discussing the NOVA concept, it remains unclear whether the processing of foods leads to increased health risks or if ultra-processed food consumption is only a measure for poor diet quality.