Ultra-processed food consumption and indicators of obesity in the United Kingdom population (2008-2016).
ABSTRACT: We examined the association between the consumption of ultra-processed foods and adiposity in a nationally representative sample of the UK adult population. We studied 6,143 participants (19 to 96 years, 51.6% female) sampled by the UK National Diet and Nutrition Survey (2008-16). Food items reported in four-day food diary were classified according to the NOVA system. Multiple linear and logistic regressions were used to evaluate associations between the dietary contribution of ultra-processed foods (sex-specific quartile and continuous) and Body Mass Index (BMI), Waist Circumference (WC) and obesity (BMI>30kg/m2) and abdominal obesity (men: WC?102cm, women: WC?88cm) status. Models were adjusted for sociodemographic and lifestyle characteristics. In multivariable analyses, the highest consumption of ultra-processed food was associated with 1.66 kg/m2 higher BMI (95%CI 0.96-2.36), 3.56 cm greater WC (95%CI 1.79-5.33) and 90% higher odds for being obese (OR = 1.90, 95%CI 1.39-2.61), compared with the lowest consumption. A 10% increase in the consumption of ultra-processed foods was associated with an increase of 0.38 kg/m2 in BMI (95%CI 0.20-0.55), 0.87 cm in WC (95%CI 0.40-1.33) and 18% higher odds of being obese (OR = 1.18, 95%CI 1.08-1.28). The consumption of ultra-processed food was associated with an increase in BMI, WC and prevalence of obesity in both sexes. A dose response relationship was observed in both sexes, with a 10% increase in the consumption of ultra-processed foods being associated with a 18% increase in the prevalence of obesity in men and a 17% increase in women. Higher consumption of ultra-processed food is associated with greater adiposity in the UK adult population. Policy makers should consider actions that promote consumption of unprocessed or minimally processed foods and reduce consumption of ultra-processed foods.
Project description:<h4>Objective</h4>The objective of this study was to examine the associations between ultra-processed food consumption and risk of obesity among UK adults.<h4>Methods</h4>Participants aged 40-69 years at recruitment in the UK Biobank (2006-2019) with dietary intakes collected using 24-h recall and repeated measures of adiposity--body mass index (BMI), waist circumference (WC) and percentage of body fat (% BF)--were included (N = 22,659; median follow-up: 5 years). Ultra-processed foods were identified using the NOVA classification and their consumption was expressed as a percentage of total energy intake. Multivariable Cox proportional hazards regression models were used to estimate hazard ratios (HR) of several indicators of obesity according to ultra-processed food consumption. Models were adjusted for sociodemographic and lifestyle characteristics.<h4>Results</h4>947 incident cases of overall obesity (BMI ≥ 30 kg/m<sup>2</sup>) and 1900 incident cases of abdominal obesity (men: WC ≥ 102 cm, women: WC ≥ 88 cm) were identified during follow-up. Participants in the highest quartile of ultra-processed food consumption had significantly higher risk of developing overall obesity (HR 1.79; 95% CI 1.06─3.03) and abdominal obesity (HR 1.30; 95% CI 1.14─1.48). They had higher risk of experiencing a ≥ 5% increase in BMI (HR 1.31; 95% CI 1.20─1.43), WC (HR 1.35; 95% CI 1.25─1.45) and %BF (HR 1.14; 95% CI 1.03─1.25), than those in the lowest quartile of consumption.<h4>Conclusions</h4>Our findings provide evidence that higher consumption of ultra-processed food is strongly associated with a higher risk of multiple indicators of obesity in the UK adult population. Policy makers should consider actions that promote consumption of fresh or minimally processed foods and reduce consumption of ultra-processed foods.
Project description:<b>Background: </b>Rapid simultaneous increases in ultra-processed food sales and obesity prevalence have been observed worldwide, including in Australia. Consumption of ultra-processed foods by the Australian population was previously shown to be systematically associated with increased risk of intakes of nutrients outside levels recommended for the prevention of obesity. This study aims to explore the association between ultra-processed food consumption and obesity among the Australian adult population and stratifying by age group, sex and physical activity level.<br><br><b>Methods: </b>A cross-sectional analysis of anthropometric and dietary data from 7411 Australians aged ?20 years from the National Nutrition and Physical Activity Survey 2011-2012 was performed. Food consumption was evaluated through 24-h recall. The NOVA system was used to identify ultra-processed foods, i.e. industrial formulations manufactured from substances derived from foods and typically added of flavours, colours and other cosmetic additives, such as soft drinks, confectionery, sweet or savoury packaged snacks, microwaveable frozen meals and fast food dishes. Measured weight, height and waist circumference (WC) data were used to calculate the body mass index (BMI) and diagnosis of obesity and abdominal obesity. Regression models were used to evaluate the association of dietary share of ultra-processed foods (quintiles) and obesity indicators, adjusting for socio-demographic variables, physical activity and smoking.<br><br><b>Results: </b>Significant (P-trend ??0.001) direct dose-response associations between the dietary share of ultra-processed foods and indicators of obesity were found after adjustment. In the multivariable regression analysis, those in the highest quintile of ultra-processed food consumption had significantly higher BMI (0.97?kg/m<sup>2</sup>; 95% CI 0.42, 1.51) and WC (1.92?cm; 95% CI 0.57, 3.27) and higher odds of having obesity (OR?=?1.61; 95% CI 1.27, 2.04) and abdominal obesity (OR?=?1.38; 95% CI 1.10, 1.72) compared with those in the lowest quintile of consumption. Subgroup analyses showed that the trend towards positive associations for all obesity indicators remained in all age groups, sex and physical activity level.<br><br><b>Conclusion: </b>The findings add to the growing evidence that ultra-processed food consumption is associated with obesity and support the potential role of ultra-processed foods in contributing to obesity in Australia.
Project description:<h4>Objective</h4>To assess the association between consumption of ultra-processed foods and obesity, diabetes, hypertension and heart disease in a nationally representative sample of Canadian adults.<h4>Methods</h4>This study used cross-sectional data from 13,608 adults (aged 19+ years) from the 2015 Canadian Community Health Survey-Nutrition. The survey provided data on food consumption (from 24-h recall) and prevalent obesity (BMI ≥ 30 kg/m<sup>2</sup>) and self-reported diabetes, hypertension and heart disease. All foods and drinks consumed were classified according to the extent and purpose of industrial processing using the NOVA classification. Ultra-processed food consumption was estimated as proportion of total daily energy intake. Multivariable logistic regression models assessed the association between ultra-processed food consumption and obesity, diabetes, hypertension and heart disease, adjusting for a range of socio-demographic and lifestyle factors.<h4>Results</h4>In 2015, ultra-processed food contributed, on average, to 24% of total daily energy intake in the lowest tertile of ultra-processed food consumption and 73% in the highest tertile. Compared with those in the lowest tertile, adults in the highest tertile of ultra-processed food consumption had 31% higher odds of obesity (OR = 1.31, 95% CI: 1.06-1.60), 37% higher odds of diabetes (OR = 1.37, 95% CI: 1.01-1.85) and 60% higher odds of hypertension (OR = 1.60, 95% CI: 1.26-2.03), adjusting for a range of covariates.<h4>Conclusion</h4>Higher consumption of ultra-processed foods is associated with higher prevalence of obesity, diabetes and hypertension among Canadian adults. A comprehensive set of strategies and policies is needed to discourage consumption of ultra-processed foods in Canada and to make unprocessed or minimally processed foods more affordable, available and appealing.
Project description:OBJECTIVES:To assess the association between consumption of ultra-processed foods and obesity in the Canadian population. METHODS:Cross-sectional study including 19,363 adults aged 18 years or more from the 2004 Canadian Community Health Survey, cycle 2.2. Ultra-processed food intake was estimated using daily relative energy intake of ultra-processed food (% of total energy intake) from data obtained by 24-h food recalls. Obesity was assessed using body mass index (BMI ? 30 kg/m2). Univariate and multivariate linear regressions were performed to describe ultra-processed food consumption according to socio-economic and demographic variables, and multivariate logistic regression was performed to verify the association between ultra-processed food consumption and obesity, adjusting for potential confounders, including socio-demographic factors, physical activity, smoking, immigrant status, residential location, and measured vs self-reported weight and height. RESULTS:Ultra-processed foods make up almost half (45%) of the daily calories consumed by Canadian adults. Consumption of these foods is higher among men, younger adults, those with fewer years of formal education, smokers, those physically inactive, and Canadian-born individuals. Ultra-processed food consumption is positively associated with obesity. After adjusting for confounding factors, individuals in the highest quintile of ultra-processed food consumption were 32% more likely of having obesity compared to individuals in the first quintile (predicted OR?=?e0.005?×?56?=?1.32; 95% CI?=?1.05-1.57). CONCLUSION:Canadians would benefit from reducing consumption of ultra-processed foods and beverages and increasing consumption of freshly prepared dishes made from unprocessed or minimally processed foods.
Project description:The processed food sector in low- and middle-income countries has grown rapidly. Little is understood about its effect on obesity. Using data from 14,976 participants aged two and older in the 2011 China Health and Nutrition Survey, this paper examines patterns of processed food consumption and their impacts on obesity while considering the endogeneity of those who purchase processed foods. A major assumption of our analysis of the impact of processed foods on overweight and obesity was that the consumption of processed foods is endogenous due to their accessibility and urbanicity levels. The results show that 74.5% of participants consumed processed foods, excluding edible oils and other condiments; 28.5% of participants' total daily energy intake (EI) was from processed foods. Children and teenagers in megacities had the highest proportion of EI (40.2%) from processed foods. People who lived in megacities or highly urbanized neighborhoods with higher incomes and educational achievement consumed more processed foods. When controlling for endogeneity, only the body mass index (BMI) and risk of being overweight of children ages two to eighteen are adversely associated with processed foods (+4.97 BMI units, 95% confidence interval (CI): 1.66-8.28; odds ratio (OR) = 3.63, 95% CI: 1.45-9.13). Processed food purchases represent less than a third of current Chinese food purchases. However, processed food purchases are growing at the rate of 50% per year, and we must begin to understand the implications for the future.
Project description:<h4>Background</h4>Ultra-processed foods are highly processed foods which are manufactured with industrial substances to increase convenience and palatability. Some organophosphate esters (OPEs) are used as flame retardants and plasticizers and have been detected in food samples, particularly processed foods. However, little is known about dietary sources of OPEs or whether higher consumption of ultra-processed foods increases exposures.<h4>Objectives</h4>We evaluated whether higher consumption of ultra-processed food is associated with urinary OPE metabolite concentrations in a nationally representative sample of US children and adults.<h4>Methods</h4>Among 2242 participants (?6 years) in the National Health and Nutrition Examination Survey (NHANES) 2013-2014, we used the NOVA classification system to calculate percent of total energy from ultra-processed food using a 24 h dietary recall. Concentrations of 7 OPE metabolites, including diphenyl phosphate (DPHP), bis(1,3-dichloro-2-propyl) phosphate (BDCPP), bis(2-chloroethyl) phosphate (BCEP), dibutyl phosphate (DBUP), di-p-cresyl phosphate (DPCP), 2,3,4,5-tetrabromobenzoic acid (TBBA), and bis(1-chloro-2-propyl) phosphate (BCPP) were measured in urine. We used multivariable linear or logistic regressions to examine associations per 10% higher total energy from ultra-processed foods with percent changes or prevalence of detectable levels of creatinine-standardized OPEs.<h4>Results</h4>In a model adjusting for only urinary creatinine, each 10% higher total energy from ultra-processed food was associated with 3.5% (95% CI: 0.7%, 6.3%) higher DPHP and 8.2% (95% CI: 4.6, 11.9%) higher BDCPP concentrations. However, none of the OPE metabolites was associated with ultra-processed food consumption in models adjusted for sociodemographic characteristics, health behaviors, and BMI (all p-values >0.05). Ultra-processed breads and tortillas; sauces, dressing, and gravies; and milk-based drinks were associated with higher concentrations of BDCPP while frozen and shelf-stable plate meals were associated with lower concentrations. Reconstituted meat or fish products and ultra-processed milk-based desserts were associated with greater odds of detectable levels of BCPP.<h4>Conclusion</h4>While some food groups were associated with urinary OPE metabolite concentrations, ultra-processed foods do not appear to be a major source of current OPE exposure in the US.
Project description:<b>Background:</b> Little is known about the potential impact of climate change on food systems and diet. We aimed to estimate the association of changes in rainfall and temperatures with consumption of unprocessed and processed foods among residents of Mexican cities by climate region. <b>Methods:</b> We analyzed 3,312 participants of the 2012 Mexican National Health and Nutrition Survey with dietary intake and sociodemographic information linked to historical rainfall and temperature data collected by the Mexican National Weather Service. We classified foods as unprocessed, processed, or ultra-processed. We performed multilevel linear regression to estimate the association of annual change in rainfalls (for each 0.5 mm decrease) and temperatures (for each 0.1°C increase) at municipality level over the past 5 years with consumption of processed and unprocessed foods measured as the contribution to total energy intake. We investigated whether associations differed by climate region (tropical, temperate, and arid). <b>Results:</b> Each 0.5 mm annual decrease in precipitation was associated with lower consumption of unprocessed foods and higher consumption of ultra-processed foods [mean differences in percent contribution to total energy intake -0.009% (95% CI: -0.019, < -0.001) and 0.011% (95% CI: 0.001, 0.021), respectively]. Each 0.1 degree Celsius annual increase in temperature was also associated with lower consumption of unprocessed and higher consumption of ultra-processed foods [mean differences in percent contribution to total energy intake was -0.03 (95% CI: -0.05, -0.01) and 0.03% (95% CI: <0.01, 0.05)]. When stratified by climate region these associations were only observed in tropical regions. <b>Conclusions:</b> Decreases in rainfalls and increases in temperature were associated with lower consumption of unprocessed foods but higher consumption of ultra-processed foods, especially in tropical regions. Previous studies have established how food production affects the climate, our study suggests that climate change could, in turn, reinforce modern food production, closing a vicious circle with clear negative implications for planetary health.
Project description:<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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<sub>quintile 5 vs. 1</sub>, 1.50; 95% CI, 1.36-1.64) and heart disease (HR<sub>quintile 5 vs. 1</sub>, 1.68; 95% CI, 1.50-1.87) but not cerebrovascular disease (HR<sub>quintile 5 vs. 1</sub>, 0.94; 95% CI, 0.76-1.17). A nonlinear dose-response pattern was observed for overall cardiovascular and heart disease mortality (all P<sub>nonlinearity</sub>?<?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<sub>interaction</sub>?<?0.05).<h4>Conclusions</h4>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.
Project description:The association between the consumption of ultra-processed food (UPF) with overweight/obesity in Chinese adults has not been investigated. This study included a cohort of 12,451 adults aged >20 years who participated at least twice in the China Nutrition and Health Survey (CNHS) during 1997-2011. Food intake at each survey was assessed using a 3-day 24-h dietary recall. Body weight (kg), height (m), and waist circumference (WC) were measured during the survey. UPF was defined by the NOVA classification. Mixed effect logistic regression analyses were used. The mean UPF consumption of the study population (baseline mean age 43.7 years) increased from 12.0 g in 1997 to 41.5 g in 2011 with the corresponding proportion of UPF in daily diet from 1.0% to 3.6%. The adjusted odds ratios (95% CI) for BMI ≥ 25 kg/m<sup>2</sup> for those with mean UPF consumption of 1-19 g/d, 20-49 g/d, and ≥50 g/d were 1.45 (1.26-1.65), 1.34 (1.15-1.57), and 1.45 (1.21-1.74), respectively (<i>p</i>-trend = 0.015), compared with the non-consumers. Similarly, the corresponding adjusted ORs (95% CI) for central obesity were 1.54 (1.38-1.72), 1.35 (1.19-1.54), and 1.50 (1.29-1.74). Higher long-term UPF consumption was associated with increased risk of overweight/obesity among Chinese adults.
Project description:BACKGROUND:Consumption of certain foods is associated with long-term weight gains and abdominal fat accumulation in healthy, middle-aged and young, non-obese participants. Whether the same foods might be associated with changes in adiposity in elderly population at high cardiovascular risk is less known. OBJECTIVE:Using yearly repeated measurements of both food habits and adiposity parameters, we aimed to investigate how changes in the consumption of specific foods were associated with concurrent changes in weight or waist circumference (WC) in the PREDIMED trial. DESIGN:We followed-up 7009 participants aged 55-70?years at high cardiovascular risk for a median time of 4.8?years. A validated 137-item semi-quantitative Food Frequency Questionnaire was used for dietary assessment with yearly repeated measurements. We longitudinally assessed associations between yearly changes in food consumption (serving/d) and concurrent changes in weight (kg) or WC (cm). RESULTS:Yearly increments in weight were observed with increased consumption (kg per each additional increase in 1 serving/d) for refined grains (0.32?kg/serving/d), red meat (0.24), potatoes (0.23), alcoholic beverages (0.18), processed meat (0.15), white bread (0.07) and sweets (0.04); whereas inverse associations were detected for increased consumption of low-fat yogurt (-?0.18), and low-fat milk (-?0.06). Annual WC gain (cm per each additional increase in 1 serving/d) occurred with increased consumption of snacks, fast-foods and pre-prepared dishes (0.28), processed meat (0.18), alcoholic beverages (0.13), and sweets (0.08); whereas increased consumption of vegetables (-?0.23), and nuts (-?0.17), were associated with reductions in WC. CONCLUSIONS:In this assessment conducted in high-risk subjects using yearly repeated measurements of food habits and adiposity, some ultra-processed foods, refined carbohydrates (including white bread), potatoes, red meats and alcohol were associated with higher weight and WC gain, whereas increases in consumption of low-fat dairy products and plant foods were associated with less gain in weight and WC. TRIAL REGISTRATION:This study was registered at controlled-trials.com with International Standard Randomized Controlled Trial Number (ISRCTN): 35739639. Registration date: 5 October 2005.