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      Consumption of ultra-processed foods and health status: a systematic review and meta-analysis

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          Abstract

          Increasing evidence suggests that high consumption of ultra-processed foods (UPF) is associated with an increase in non-communicable diseases, overweight and obesity. The present study systematically reviewed all observational studies that investigated the association between UPF consumption and health status. A comprehensive search of MEDLINE, Embase, Scopus, Web of Science and Google Scholar was conducted, and reference lists of included articles were checked. Only cross-sectional and prospective cohort studies were included. At the end of the selection process, twenty-three studies (ten cross-sectional and thirteen prospective cohort studies) were included in the systematic review. As regards the cross-sectional studies, the highest UPF consumption was associated with a significant increase in the risk of overweight/obesity (+39 %), high waist circumference (+39 %), low HDL-cholesterol levels (+102 %) and the metabolic syndrome (+79 %), while no significant associations with hypertension, hyperglycaemia or hypertriacylglycerolaemia were observed. For prospective cohort studies evaluating a total population of 183 491 participants followed for a period ranging from 3·5 to 19 years, highest UPF consumption was found to be associated with increased risk of all-cause mortality in five studies (risk ratio (RR) 1·25, 95 % CI 1·14, 1·37; P < 0·00001), increased risk of CVD in three studies (RR 1·29, 95 % CI 1·12, 1·48; P = 0·0003), cerebrovascular disease in two studies (RR 1·34, 95 % CI 1·07, 1·68; P = 0·01) and depression in two studies (RR 1·20, 95 % CI 1·03, 1·40; P = 0·02). In conclusion, increased UPF consumption was associated, although in a limited number of studies, with a worse cardiometabolic risk profile and a higher risk of CVD, cerebrovascular disease, depression and all-cause mortality.

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          Most cited references49

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          Measuring inconsistency in meta-analyses.

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            Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

            David Moher and colleagues introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses
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              Ultra-processed foods: what they are and how to identify them

              The present commentary contains a clear and simple guide designed to identify ultra-processed foods. It responds to the growing interest in ultra-processed foods among policy makers, academic researchers, health professionals, journalists and consumers concerned to devise policies, investigate dietary patterns, advise people, prepare media coverage, and when buying food and checking labels in shops or at home. Ultra-processed foods are defined within the NOVA classification system, which groups foods according to the extent and purpose of industrial processing. Processes enabling the manufacture of ultra-processed foods include the fractioning of whole foods into substances, chemical modifications of these substances, assembly of unmodified and modified food substances, frequent use of cosmetic additives and sophisticated packaging. Processes and ingredients used to manufacture ultra-processed foods are designed to create highly profitable (low-cost ingredients, long shelf-life, emphatic branding), convenient (ready-to-consume), hyper-palatable products liable to displace all other NOVA food groups, notably unprocessed or minimally processed foods. A practical way to identify an ultra-processed product is to check to see if its list of ingredients contains at least one item characteristic of the NOVA ultra-processed food group, which is to say, either food substances never or rarely used in kitchens (such as high-fructose corn syrup, hydrogenated or interesterified oils, and hydrolysed proteins), or classes of additives designed to make the final product palatable or more appealing (such as flavours, flavour enhancers, colours, emulsifiers, emulsifying salts, sweeteners, thickeners, and anti-foaming, bulking, carbonating, foaming, gelling and glazing agents).
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                Author and article information

                Journal
                Br J Nutr
                Br J Nutr
                BJN
                The British Journal of Nutrition
                Cambridge University Press (Cambridge, UK )
                0007-1145
                1475-2662
                14 February 2021
                14 August 2020
                : 125
                : 3
                : 308-318
                Affiliations
                [1 ]Department of Experimental and Clinical Medicine, University of Florence , 50134 Florence, Italy
                [2 ]Unit of Clinical Nutrition, Careggi University Hospital , 50134 Florence, Italy
                [3 ]Department of Epidemiology and Prevention, IRCCS Neuromed , Pozzilli, 86077 Isernia, Italy
                [4 ]Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria , 21100 Varese, Italy
                Author notes
                [* ] Corresponding author: M. Dinu, email monica.dinu@ 123456unifi.it
                Author information
                https://orcid.org/0000-0003-1687-2527
                Article
                S0007114520002688
                10.1017/S0007114520002688
                7844609
                32792031
                72f9759a-c6c5-4ed1-b3a2-f2e2b64bfe6a
                © The Authors 2020

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 27 March 2020
                : 30 June 2020
                : 09 July 2020
                Page count
                Figures: 3, Tables: 2, References: 49, Pages: 11
                Categories
                Systematic Review and Meta-Analysis

                Nutrition & Dietetics
                ultra-processed food,health,cvd,mortality,meta-analysis
                Nutrition & Dietetics
                ultra-processed food, health, cvd, mortality, meta-analysis

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