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Influence of Food Processing on Blood Lipids in Children

*,

Nutrients

MDPI

4772059

10.3390/nu8020097

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      Abstract

      With reference to a recent study published in this journal “Processed Food Contributions to Energy and Nutrient Intake Differ among US Children by Race/Ethnicity”, by Eicher-Miller et al. [1], we would like to make some comments, as our study [2] was mentioned and there are some misunderstandings regarding our conclusions. Our longitudinal study investigated the effect of processed and ultra-processed food intake between 4 and 8 years old children on blood lipid profile. We used NOVA—a food classification system that categorizes foods according to the extent and purpose of food processing [3]—which “is now recognized as a valid tool for nutrition and public health research, policy and action, in reports from the Food and Agriculture Organization of the United Nations and the Pan American Health Organization” [4]. Our study provided evidence that ultra-processed food expressed as a percentage of total energy intake was associated with worse lipid profiles in children [2]. In the study by Eicher-Miller and colleagues, food intake was assessed using a different food classification proposed by the International Food Information Council Foundation [5]. This system aims to provide information about modern food production, food processing and processed foods to guide consumers and clients, rather than assess the impact of these foods on health. Based on their findings that “minimally processed foods” provided high quantities of cholesterol (according to their methodology) the authors suggested a possible bias in our study since we did not consider the energy provided by minimally processed foods, only from processed and ultra-processed foods. Therefore, according to them, we have lost a potential strong association between “minimally processed foods” and blood lipid concentrations. First of all, the main question of our research was to verify the effect of processed food consumption on children’s lipid profile, adjusting for relevant variables. Second, the author’s interpretation of our study was superficial because our analysis was done using the percentage of total energy from processed and ultra-processed foods and not simply energy. This detail makes a huge difference, since children consuming high percentages of energy provided by processed and ultra-processed food will have a low intake of energy provided from minimally processed foods, and vice versa. Third, the Eicher-Miller conclusions must be reviewed going back to their classification of food groups. For instance, in their study the cholesterol content was shown separately in three food categories (mixtures of combined ingredients, ready-to-eat processed foods, prepared foods/meals, and foods from restaurants/cafeterias) that are all ultra-processed foods according to NOVA classification. Taking their Table 1 as an example and summing the cholesterol content of all ultra-processed foods together will result in 64.4 mg of cholesterol, while minimally processed foods contributed 29.2 mg of cholesterol. The same fact can be observed in Tables 2 and 3 (63.5 vs. 30.9 and 56.7 vs. 40.8, respectively). Fourth, our results show that we did not observe any association between the “processed food category” and blood lipids, which suggests that among children, in our study only ultra-processed foods were associated with cardiovascular risk factors. Finally, as they stated about our results “Energy of minimally processed foods was not included and may represent a potentially stronger association with blood lipid”, we would like to add that, so far, there is not enough evidence of a relation between diet cholesterol and blood lipids as concluded by a recent systematic review with adults [6]: “the effect of dietary cholesterol on incident CAD and serum cholesterol outcomes remains unclear”.

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      Most cited references 6

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      Consumption of ultra-processed food products and its effects on children's lipid profiles: a longitudinal study.

      Cardiovascular disease development is related to known risk factors (such as diet and blood lipids) that begin in childhood. Among dietary factors, the consumption of ultra-processing products has received attention. This study investigated whether children's consumption of processed and ultra-processing products at preschool age predicted an increase in lipid concentrations from preschool to school age.
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        Food Classification Systems Based on Food Processing: Significance and Implications for Policies and Actions: A Systematic Literature Review and Assessment.

        This paper is the first to make a systematic review and assessment of the literature that attempts methodically to incorporate food processing into classification of diets. The review identified 1276 papers, of which 110 were screened and 21 studied, derived from five classification systems. This paper analyses and assesses the five systems, one of which has been devised and developed by a research team that includes co-authors of this paper. The quality of the five systems is assessed and scored according to how specific, coherent, clear, comprehensive and workable they are. Their relevance to food, nutrition and health, and their use in various settings, is described. The paper shows that the significance of industrial food processing in shaping global food systems and supplies and thus dietary patterns worldwide, and its role in the pandemic of overweight and obesity, remains overlooked and underestimated. Once food processing is systematically incorporated into food classifications, they will be more useful in assessing and monitoring dietary patterns. Food classification systems that emphasize industrial food processing, and that define and distinguish relevant different types of processing, will improve understanding of how to prevent and control overweight, obesity and related chronic non-communicable diseases, and also malnutrition. They will also be a firmer basis for rational policies and effective actions designed to protect and improve public health at all levels from global to local.
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          • Record: found
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          • Article: not found

          Dietary cholesterol and cardiovascular disease: a systematic review and meta-analysis.

          Dietary cholesterol has been suggested to increase the risk of cardiovascular disease (CVD), which has led to US recommendations to reduce cholesterol intake.
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            Author and article information

            Affiliations
            Federal University of Health Sciences of Porto Alegre (UFCSPA), Rua Sarmento Leite 245, Porto Alegre 90050-170, Brazil; rauber.fernanda@123456gmail.com
            Author notes
            [*]Correspondence: marciavitolo@123456hotmail.com; Tel.: +55-51-33038798
            Journal
            Nutrients
            Nutrients
            nutrients
            Nutrients
            MDPI
            2072-6643
            18 February 2016
            February 2016
            : 8
            : 2
            © 2016 by the authors; licensee MDPI, Basel, Switzerland.

            This article is an open access article distributed under the terms and conditions of the Creative Commons by Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/).

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            Letter
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