Ultra-processed foods

Ultra-processed foods linked to heart disease, cancer, and 30 other health conditions

Posted by

0


  • Ultra-processed foods undergo numerous industrial processes and include foods such as instant noodles, ready meals and hot dogs.
  • Researchers say a high intake of ultra-processed foods is associated with 32 adverse health outcomes.
  • Experts note that ultra processed foods are a common part of the diet in the United States with many people unaware of the health dangers associated with them.

High intake of ultra-processed foods is being associated with increased risk of more than 30 damaging health conditions.

ResearchTrusted Source published this week in The BMJ reports that diets high in ultra-processed foods increased the risk of major heart and lung conditions, cancer, mental health disorders, and other negative health outcomes, including early death.

“Greater exposure to ultra-processed food was associated with a higher risk of adverse health outcomes, especially cardiometabolic, common mental disorder, and mortality outcomes,” the study authors wrote.

Details from the ultra-processed foods study

The researchers conducted an umbrella review of 45 meta-analyses from 14 articles that showed an association between ultra-processed foods and adverse health outcomes. In total, the studies involved nearly 10 million participants.

Food frequency questionnaires, dietary history, and 24 hour dietary recalls were used to measure exposure to ultra-processed foods.

The researchers reported that high intake of ultra-processed foods was consistently associated with an increased risk of 32 negative health outcomes.

The researchers said they found an association between ultra processed foods and all causes of mortality, breast cancer, colorectal cancer, pancreatic cancer, adverse sleep outcomes, adverse anxiety outcomes, asthma, hypertension, Crohn’s disease, ulcerative colitis, obesity, metabolic syndrome, non-alcoholic fatty liver disease, and hyperglycemia, among other diseases and conditions.

They reportred a 50% increased risk of deaths related to cardiovascular disease, a 12% higher risk of type 2 diabetes, and a 48% to 53% higher risk of anxiety and mental disorders.

High intake of ultra-processed foods was also found to be associated with a 21% increased risk of death from any cause and a 22% increased risk of depression.

The researchers argue their findings suggest that ultra-processed foods could be harmful to numerous body systems, highlighting the need for urgent action to reduce dietary exposure to ultra-processed foods.

“Coupled with existing population-based strategies, we recommend urgent mechanistic research and the development and evaluation of comprehensive population based and public health strategies, including government led policy frameworks and dietary guidelines, aimed at targeting and reducing dietary exposure to ultra-processed foods for improved human health,” they wrote.

What to know about ultra-processed foods

Ultra-processed foods include items such as instant noodles, chicken nuggets, hot dogs, ready-to-eat meals, sugary cereal, packaged baked goods, snacks, and soft drinks.

These foods often undergo numerous industrial processes and may be made up of chemically modified substances that are extracted from foods.

Additives may be used to enhance the appearance, texture, taste, or durability of the food, along with added colors, flavors and emulsifiers.

Often, ultra-processed foods are high in salt, sugar, and fat, low in vitamins and fiber, and have minimal or no whole foods.

“An ultra-processed food is a food that resembles nothing of its component parts/ingredients. An ultra-processed food has been stripped of its nutritional value (essentially). It also has many ingredients, including food additives (i.e. hydrogenated fats, modified starches) that are not used in home cooking. These foods are mainly of industrial origin and can be stored for long periods of time,” Dana Hunnes, PhD, a senior clinical dietician at the UCLA Medical Center who was not involved in the research, told Medical News Today.

“Unfortunately, ultra-processed foods are inexpensive to purchase [but] expensive in terms of health,” she added. “Individuals need to look at what they can afford in their diet and make incremental changes. Our brains become addicted to these hyperpalatable flavors and ingredients, and like a drug, we need to wean off these ultra-processed foods and exchange them for healthier, whole-food items.”

About 73%Trusted Source of the food supply in the United States is made up of ultra-processed foods.

Research suggests that more than 60%Trusted Source of daily energy intake in the United States comes from ultra-processed foods.

Why we choose ultra-processed foods

Experts say part of the appeal of ultra-processed foods is they are often cheap and convenient.

“There’s a whole category of foods that we eat that are not the most nutritious. Why do we choose them? Because they’re convenient, they’re tasty, they don’t cost very much, they’re accessible 24/7,” Christopher Gardner, PhD, a nutrition researcher at Stanford University in California who wasn’t involved in the research, told Medical News Today.

However, Gardner argues that in some cases, some ultra-processed foods may be a healthier option than other available options.

“Some of the people choosing these foods are because they are maybe healthier and cost less than some other foods that they have access to. So, what if you had gone in and saw the ultra-processed food label on some tomato sauce, or some yogurt, which is quite plausible, because there are some tomato sauces and yogurt that meet the Nova qualification of being ultra-processed. And so instead of that, you went to a fast-food restaurant and got a burger and fries?,” he said.

How to achieve a healthy diet

Experts say there are steps people can take to improve their diets and reduce the risks associated with eating ultra-processed foods.

“Ultra-processed foods have been such a staple of the American diet that many do not know the potential harm they are doing to their health. People often turn to ultra-processed foods because of lack of time, but convenience can be unhealthy,” Lauri Wright, PhD, the president of the Academy of Nutrition and Dietetics who was not involved in the research, told Medical News Today.

“Try switching out minimally processed foods rather than ultra-processed foods,” she suggested. “Eat out less and make healthier choices when you do. For example, a grilled chicken sandwich, fruit cup and water or low-fat milk instead of a burger, fries and soda.”

“Finally, make more foods at home,” Wright added. “This requires advance planning, some batch cooking, and taking advantage of some convenience methods such as an instapot or slow cooker. Try making your own kale chips, roasting chickpeas or snacking on nuts as an alternative to chips. For a sweet tooth, sprinkle berries on Greek yogurt, freeze grapes for a flavor blast, or make your own trail mix.”

Posted by

0


The Hidden Dangers of Ultra-Processed Foods: The New Silent Killer and What You Need to Know

In an era where convenience often trumps quality, the standard American diet is under scrutiny for its heavy reliance on ultra-processed foods. A recent study by physicians from Florida Atlantic University’s Schmidt College of Medicine reveals a concerning trend: nearly 60% of the average adult’s diet and almost 70% of children’s diets in the U.S. consist of foods packed with novel ingredients unknown to human physiology. This unprecedented consumption could be heralding a new era of ‘silent’ killers, akin to the unacknowledged dangers of high blood pressure in decades past.

What Are Ultra-Processed Foods?

Ultra-processed foods are not just prevalent; they are pervasive in modern diets. From fizzy drinks to cereals, packaged snacks, and processed meats, these food items are loaded with additives like oil, fat, sugar, starch, sodium, and a range of emulsifiers including carrageenan, mono- and diglycerides, carboxymethylcellulose, polysorbate, and soy lecithin. These additives deplete the food’s nutritional value while introducing potentially harmful ingredients.

The Silent Epidemic

The research highlights a grim reality: “Those of us practicing medicine in the U.S. today find ourselves in an ignominious and unique position — we are the first cohort of health care professionals to have presided over a decline in life expectancy in 100 years,” notes Dawn H. Sherling, M.D., a leading voice in the study. The U.S. faces a lower life expectancy compared to other economically comparable countries, a trend that correlates with the rising consumption of ultra-processed foods and an increase in non-communicable diseases globally.

The Underlying Dangers

These foods are not just empty calories; they represent a deeper threat to our health. According to Allison H. Ferris, M.D., another author of the study, even without the harmful additives, ultra-processed foods could still lead to obesity, diabetes, and heart disease due to their efficient digestion and high glycemic loads. The NOVA classification system, endorsed by public health organizations, categorizes foods based on their level of processing, spotlighting ultra-processed foods as a distinct category due to their industrial production and synthetic ingredients.

A Disrupted Microbiome

One of the most alarming findings is the potential impact of these foods on our gut health. Additives like maltodextrin may alter the mucous layer in the gut, favoring harmful bacteria and contributing to diseases like inflammatory bowel disease. This disruption could lead to a compromised gut lining and trigger immune responses, possibly explaining the marked increase in colorectal cancer and other gastrointestinal diseases in the U.S.

A Call to Action

The study draws parallels between the slow recognition of tobacco’s dangers and the current situation with ultra-processed foods. Despite the power of multinational food corporations, the authors stress the importance of healthcare professionals discussing the benefits of whole foods with their patients. They advocate for a broader public health response to make healthier options more accessible and affordable.

Practical Tips for Reducing Ultra-Processed Foods in Your Diet

  1. Prioritize Whole Foods: Focus on incorporating more fruits, vegetables, whole grains, and lean proteins into your meals.
  2. Read Labels Carefully: Look for products with a short list of recognizable ingredients.
  3. Cook at Home More Often: Preparing meals at home allows you to control the ingredients and avoid unnecessary additives.
  4. Plan Your Meals: Planning helps reduce the temptation to reach for convenient, processed options.
  5. Educate Yourself: Stay informed about the ingredients in your food and their impact on your health.

In conclusion, the silent epidemic of ultra-processed foods is a pressing concern for our health and longevity. By understanding the dangers these foods pose and taking proactive steps to minimize their presence in our diets, we can protect our health and ensure a brighter, healthier future.

How Ultra-Processed Foods Impact Depression

Posted by

0


Research continues to show how ultra-processed foods, like frozen meals and packaged snacks, can be harmful to your health. 

And now another study has discovered a possible link to depression. 
 
“This is no surprise. There is a connection between our mood and the foods that we eat,” said Susan Albers, PsyD, psychologist for Cleveland Clinic. “What we eat every day is a daily investment in how we feel.”  
 
Dr. Albers was not a part of the study but said ultra-processed foods trigger the release of dopamine into the brain, which makes you feel good. 

It’s also why we tend to crave them. 

However, as the study found, participants who ate a lot of ultra-processed foods, particularly foods with artificial sweeteners, were at higher risk for developing depression. 

Researchers are trying to figure out why that is but note it could have to do with how artificial sweeteners affect the brain. 
 
“While there is a link between depression and ultra-processed foods, we can’t say that there is a causal link,” said Dr. Albers. “People who are depressed may reach for ultra-processed food because they are comforting and convenient. When you are feeling depressed, you may not have the energy to shop, prepare or cook food.”  
 
Dr. Albers said if you want to cut back on ultra-processed foods, try swapping out packaged snacks for fruits, nuts or seeds. 

She also suggests reading labels before buying. 

If it has ingredients you can’t pronounce, it’s best to avoid.

Ultra-processed foods – like cookies, chips, frozen meals and fast food – may contribute to cognitive decline

Posted by

0


Scientists have known for years that unhealthy diets – particularly those that are high in fat and sugar – may cause detrimental changes to the brain and lead to cognitive impairment.

Many factors that contribute to cognitive decline are out of a person’s control, such as genetics and socioeconomic factors. But ongoing research increasingly indicates that a poor diet is a risk factor for memory impairments during normal aging and increases the risk of developing Alzheimer’s disease.

But when evaluating how some diets may erode brain health as we age, research on the effects of consuming minimally processed versus ultra-processed foods has been scant – that is, until now.

Two recent large-scale studies suggest that eating ultra-processed foods may exacerbate age-related cognitive decline and increase the risk of developing dementia. In contrast, another recent study reported that ultra-processed food consumption was not associated with worse cognition in people over 60.

Although more research is needed, as a neuroscientist who researches how diet can influence cognition later in life, I find that these early studies add a new layer for considering how fundamental nutrition is to brain health.

Lots of ingredients, minimal nutrition

Ultra-processed foods tend to be lower in nutrients and fiber and higher in sugar, fat and salt compared to unprocessed or minimally processed foods. Some examples of ultra-processed foods include soda, packaged cookies, chips, frozen meals, flavored nuts, flavored yogurt, distilled alcoholic beverages and fast foods. Even packaged breads, including those high in nutritious whole grains, qualify as ultra-processed in many cases because of the additives and preservatives they contain.

Another way to look at it: You are not likely to find the ingredients that make up most of these foods in your home kitchen.

But don’t confuse ultra-processed with processed foods, which still retain most of their natural characteristics, although they’ve undergone some form of processing – like canned vegetables, dried pasta or frozen fruit. A look at three categories of foods.

Parsing the research

In a December 2022 study, researchers compared the rate of cognitive decline over approximately eight years between groups of people that consumed different amounts of ultra-processed foods.

At the beginning of the study, over 10,000 participants living in Brazil reported their dietary habits from the previous 12 months. Then, for the ensuing years, the researchers evaluated the cognitive performance of the participants with standard tests of memory and executive function.

Those who ate a diet containing more ultra-processed foods at the start of the study showed slightly more cognitive decline compared with those that ate little to no ultra-processed foods. This was a relatively modest difference in the rate of cognitive decline between experimental groups. It is not yet clear if the small difference in cognitive decline associated with higher consumption of ultra-processed foods will have a meaningful effect at the level of an individual person.

The second study, with about 72,000 participants in the U.K., measured the association between eating ultra-processed foods and dementia. For the group eating the highest amounts of ultra-processed foods, approximately 1 out of 120 people were diagnosed with dementia over a 10-year period. For the group that consumed little to no ultra-processed foods, this number was 1 out of 170.

Research examining the relationship between health and ultra-processed foods uses the NOVA classification, which is a categorization system based on the type and extent of industrial food processing. Some nutritionists have criticized the NOVA classification for not having clear definitions of food processing, which could lead to misclassification. They also argue that the potential health risks from consuming ultra-processed foods could be explained by low levels of fiber and nutrients and high levels of fat, sugar and salt in the diet rather than the amount of processing.

Many ultra-processed foods are high in additives, preservatives or coloring agents, while also having other features of an unhealthy diet, such as being low in fiber and nutrients. Thus, it is unclear if eating food that has undergone more processing has an additional negative impact on health beyond low diet quality.

For example, you could eat a burger and fries from a fast food chain, which would be high in fat, sugar and salt as well as being ultra-processed. You could make that same meal at home, which could also be high in fat, sugar and salt but would not be ultra-processed. More research is needed to determine whether one is worse than the other.

Brain-healthy diets

Even when the processes that lead to dementia are not occurring, the aging brain undergoes biochemical and structural changes that are associated with worsening cognition.

But for adults over the age of 55, a healthier diet could increase the likelihood of maintaining better brain function. In particular, the Mediterranean diet and ketogenic diet are associated with better cognition in advanced age.

The Mediterranean diet emphasizes the consumption of plant-based foods and healthy fats, like olive oil, seeds and nuts. The ketogenic diet is high in fat and low in carbohydrates, with the primary fiber source being from vegetables. Both diets minimize or eliminate the consumption of sugar.

Our research and the work of others show that both diets can reverse some of these changes and improve cognitive function – possibly by reducing harmful inflammation.

Although inflammation is a normal immune response to injury or infection, chronic inflammation can be detrimental to the brain. Studies have shown that excess sugar and fat can contribute to chronic inflammation, and ultra-processed foods might also exacerbate harmful inflammation.

Another way that diet and ultra-processed foods may influence brain health is through the gut-brain axis, which is the communication that occurs between the brain and the gut microbiome, or the community of microorganisms that live in the digestive tract.

Not only does the gut microbiome help with digestion, but it also influences the immune system, while producing hormones and neurotransmitters that are critical for brain function.

Studies have shown that the ketogenic and Mediterranean diets change the composition of microorganisms in the gut in ways that benefit the person. Ultra-processed food consumption is also associated with alterations in the type and abundance of gut microorganisms that have more harmful effects. There’s a war going on in your gut: good bacteria versus bad bacteria.

The uncertainties

Disentangling the specific effects of individual foods on the human body is difficult, in part because maintaining strict control over people’s diets to study them over long periods of time is problematic. Moreover, randomized controlled trials, the most reliable type of study for establishing causality, are expensive to carry out.

So far, most nutritional studies, including these two, have only shown correlations between ultra-processed food consumption and health. But they cannot rule out other lifestyle factors such as exercise, education, socioeconomic status, social connections, stress and many more variables that may influence cognitive function.

This is where lab-based studies using animals are incredibly useful. Rats show cognitive decline in old age that parallels humans. It’s easy to control rodent diets and activity levels in a laboratory. And rats go from middle to old age within months, which shortens study times.

Lab-based studies in animals will make it possible to determine if ultra-processed foods are playing a key role in the development of cognitive impairments and dementia in people. As the world’s population ages and the number of older adults with dementia increases, this knowledge cannot come soon enough.

Ultra-Processed Foods May Be Linked to Increased Risk of Cancer

Posted by

0


Summary: High consumption of ultra-processed foods, including soda, chips, and some white bread products, was associated with an increased risk of developing and dying from certain kinds of cancer, including brain cancer.

Source: Imperial College London

Higher consumption of ultra-processed foods may be linked to an increased risk of developing and dying from cancer, an Imperial College London-led observational study suggests.

Researchers from Imperial’s School of Public Health have produced the most comprehensive assessment to date of the association between ultra-processed foods and the risk of developing cancers.

Ultra-processed foods are food items which have been heavily processed during their production, such as fizzy drinks, mass-produced packaged breads, many ready meals and most breakfast cereals.

Ultra-processed foods are often relatively cheap, convenient, and heavily marketed, often as healthy options. But these foods are also generally higher in salt, fat, sugar, and contain artificial additives. It is now well documented that they are linked with a range of poor health outcomes including obesity, type 2 diabetes and cardiovascular disease.

The first UK study of its kind used UK Biobank records to collect information on the diets of 200,000 middle-aged adult participants. Researchers monitored participants’ health over a 10-year period, looking at the risk of developing any cancer overall as well as the specific risk of developing 34 types of cancer. They also looked at the risk of people dying from cancer.

The study found that higher consumption of ultra-processed foods was associated with a greater risk of developing cancer overall, and specifically with ovarian and brain cancers. It was also associated with an increased risk of dying from cancer, most notably with ovarian and breast cancers.

For every 10 percent increase in ultra-processed food in a person’s diet, there was an increased incidence of 2 percent for cancer overall, and a 19 percent increase for ovarian cancer specifically.

Each 10 percent increase in ultra-processed food consumption was also associated with increased mortality for cancer overall by 6 percent, alongside a 16 percent increase for breast cancer and a 30 percent increase for ovarian cancer.

These links remained after adjusting for a range of socio-economic, behavioral and dietary factors, such as smoking status, physical activity and body mass index (BMI).

The Imperial team carried out the study, which is published in eClinicalMedicine, in collaboration with researchers from the International Agency for Research on Cancer (IARC), University of São Paulo, and NOVA University Lisbon.

Previous research from the team reported the levels of consumption of ultra-processed foods in the UK, which are the highest in Europe for both adults and children. The team also found that higher consumption of ultra-processed foods was associated with a greater risk of developing obesity and type 2 diabetes in UK adults, and a greater weight gain in UK children extending from childhood to young adulthood.

Dr. Eszter Vamos, lead senior author for the study, from Imperial College London’s School of Public Health, said, “This study adds to the growing evidence that ultra-processed foods are likely to negatively impact our health including our risk for cancer. Given the high levels of consumption in UK adults and children, this has important implications for future health outcomes.

“Although our study cannot prove causation, other available evidence shows that reducing ultra-processed foods in our diet could provide important health benefits. Further research is needed to confirm these findings and understand the best public health strategies to reduce the widespread presence and harms of ultra-processed foods in our diet.”

Dr. Kiara Chang, first author for the study, from Imperial College London’s School of Public Health, said, “The average person in the UK consumes more than half of their daily energy intake from ultra-processed foods.

“This is exceptionally high and concerning as ultra-processed foods are produced with industrially derived ingredients and often use food additives to adjust color, flavor, consistency, texture, or extend shelf life.

This shows chips
The study found that higher consumption of ultra-processed foods was associated with a greater risk of developing cancer overall, and specifically with ovarian and brain cancers.

“Our bodies may not react the same way to these ultra-processed ingredients and additives as they do to fresh and nutritious minimally processed foods. However, ultra-processed foods are everywhere and highly marketed with cheap price and attractive packaging to promote consumption. This shows our food environment needs urgent reform to protect the population from ultra-processed foods.”

The World Health Organization and the United Nations’ Food and Agriculture Organization has previously recommended restricting ultra-processed foods as part of a healthy sustainable diet.

There are ongoing efforts to reduce ultra-processed food consumption around the world, with countries such as Brazil, France and Canada updating their national dietary guidelines with recommendations to limit such foods. Brazil has also banned the marketing of ultra-processed foods in schools. There are currently no similar measures to tackle ultra-processed foods in the UK.

Dr. Chang added, “We need clear front of pack warning labels for ultra-processed foods to aid consumer choices, and our sugar tax should be extended to cover ultra-processed fizzy drinks, fruit-based and milk-based drinks, as well as other ultra-processed products.

“Lower income households are particularly vulnerable to these cheap and unhealthy ultra-processed foods. Minimally processed and freshly prepared meals should be subsidized to ensure everyone has access to healthy, nutritious and affordable options.”

The researchers note that their study is observational, so does not show a causal link between ultra-processed foods and cancer due to the observational nature of the research. More work is needed in this area to establish a causal link.

Ultra-processed foods: how functional is the NOVA system?

Posted by

0


Abstract

Background

In the NOVA classification system, descriptive criteria are used to assign foods to one of four groups based on processing-related criteria. Although NOVA is widely used, its robustness and functionality remain largely unexplored. We determined whether this system leads to consistent food assignments by users.

Methods

French food and nutrition specialists completed an online survey in which they assigned foods to NOVA groups. The survey comprised two lists: one with 120 marketed food products with ingredient information and one with 111 generic food items without ingredient information. We quantified assignment consistency among evaluators using Fleiss’ κ (range: 0–1, where 1 = 100% agreement). Hierarchical clustering on principal components identified clusters of foods with similar distributions of NOVA assignments.

Results

Fleiss’ κ was 0.32 and 0.34 for the marketed foods (n = 159 evaluators) and generic foods (n = 177 evaluators), respectively. There were three clusters within the marketed foods: one contained 90 foods largely assigned to NOVA4 (91% of assignments), while the two others displayed greater assignment heterogeneity. There were four clusters within the generic foods: three clusters contained foods mostly assigned to a single NOVA group (69–79% of assignments), and the fourth cluster comprised 28 foods whose assignments were more evenly distributed across the four NOVA groups.

Conclusions

Although assignments were more consistent for some foods than others, overall consistency among evaluators was low, even when ingredient information was available. These results suggest current NOVA criteria do not allow for robust and functional food assignments.

Introduction

There is increasing evidence that foods are not the simple sum of their nutrients [1]. When characterizing foods, it is essential to consider factors such as processing and formulation, which have grown more and more complex over the years. Whether carried out within households, artisanal settings, or factories, food processing aims to ensure product safety, digestibility, and palatability. It also seeks to improve shelf life and simplify meal preparation [2]. Human diets are progressively incorporating larger quantities of industrially processed foods [3]. At present, several systems are used to classify foods according to processing-related criteria [4,5,6,7,8,9,10] each employing different criteria and metrics.

NOVA is, by far, the most common of such systems [9]. Its stated purpose is to classify “all foods according to the nature, extent, and purposes of the industrial processes they undergo” [10]. In the NOVA system, foods are assigned to one of four groups: (i) NOVA1 contains “unprocessed or minimally processed foods,” namely the edible parts of plants or animals that have been taken straight from nature or that have been minimally modified/preserved; (ii) NOVA2 contains “culinary ingredients,” such as salt, oil, sugar, or starch, which are produced from NOVA1 foods; (iii) NOVA3 contains “processed foods,” such as freshly baked breads, canned vegetables, or cured meats, which are obtained by combining NOVA1 and NOVA2 foods; and (iv) NOVA4 contains “ultra-processed foods,” namely ready-to-eat industrially formulated products that are “made mostly or entirely from substances derived from foods and additives, with little if any intact Group 1 food” [9].

Nutritional epidemiologists are increasingly using NOVA to explore relationships among the consumption of highly processed foods and diet quality or health outcomes. Indeed, NOVA was used in 95% of the studies on this topic published between 2015 and 2019, and which have been included in a recent systematic review [11]. Furthermore, policymakers are moving to use NOVA assignments to guide public health decisions. For example, several Latin America countries have constructed dietary guidelines based on using NOVA [12, 13], and the French government is drawing upon NOVA in its objective to reduce ultra-processed food consumption by 20% [14].

It thus seems likely that NOVA will be employed in an ever-broader range of contexts. Nevertheless, aside from some sparse past work [15, 16], the system’s robustness, functionality, and consistency remain poorly characterized. Because its classification approach is purely descriptive in nature, it opens the door to ambiguity and differences in interpretation [17]. Indeed, even experts face difficulties and have disagreements when employing it [18,19,20].

Here, we explored the robustness and functionality of the NOVA classification system by determining whether a large number of food and nutrition specialists arrived at consistent food assignments when applying the system’s criteria. We also differences in assignments among evaluators and the relationships between NOVA assignments and food nutritional quality based on known nutrient profiling systems.

Discussion

In this study, we explored the robustness and functionality of the NOVA classification system by asking food and nutrition specialists to implement the system as intended by its creators [9]. We had them assess a list of marketed foods and a list of generic foods commonly consumed in France. The most striking result was that evaluators were inconsistent in their assignments, regardless of professional background; the mean values of Fleiss’ κ never exceeded 0.34. Many foods were not consistently assigned to the same NOVA group. In particular, the HCPC analysis indicated that assignments were highly heterogeneous for 30 marketed foods (25% of the total) and 28 generic foods (25% of the total). Finally, we found that an appreciable percentage of the foods commonly considered to be ultra-processed (NOVA4maj) were of acceptable nutritional quality.

To date, only one previous study has addressed similar questions. It found that reliability between two evaluators was lower with the NOVA system than with two other similar classification systems [16]; it highlighted that the risk of misclassification was higher when using NOVA probably because its four groups are not clearly defined. We found support for this idea using a much larger number of evaluators.

Surprisingly, providing detailed ingredient information did not improve evaluator consistency nor did it affect evaluator confidence levels. The latter were high or very high for most of the assignments, whether or not ingredient information was present. This result suggests that evaluators relied on their own knowledge or subjective feelings about the foods when making their assignments.

Some foods had a wider range of assignments. For instance, plain unsweetened dairy products were assigned to all four NOVA groups (cluster V; Table 3). This result may be tied to ambiguity in NOVA criteria [9]. On the one hand, “yogurt with no added sugar or artificial sweeteners” is specifically cited as an example of a NOVA1 food. On the other hand, it is clearly stated that non-alcoholic fermentation, the process by which yogurt is made (i.e., lactic fermentation), is characteristic of NOVA3 foods. It is further mentioned that “substances […], such as casein, lactose, whey”—ingredients often present in yogurt—are “only found in ultra-processed products,” meaning NOVA4 foods [9]. It was equally hard to determine whether other foods belonged in NOVA3 or NOVA4 (e.g., see cluster U; Table 3). One source of uncertainty is the indication that ultra-processed foods (NOVA4) “are industrial formulations, typically with five or more and usually many ingredients,” which may have led some evaluators to assign foods with long ingredient lists to NOVA4, even if they did not contain ingredients typical of NOVA4, such as “substances not commonly used in culinary preparations.” This reference to culinary versus industrial processes for preparing foods may also have led to misunderstanding: for example, corn starch is not necessarily a common ingredient in French households, which may have resulted in corn starch-containing foods being assigned to NOVA4. However, corn starch is also cited as an example of a NOVA2 item [9], and its presence may thus have led to NOVA3 assignments as well. Finally, uncertainty can stem from the processing procedure. For example, popcorn cakes may be treated as a food that has undergone extrusion cooking, leading some evaluators to arrive at a NOVA4 assignment. However, other evaluators may have opted for NOVA3 instead, given the food’s simple ingredient list. Overall, NOVA appears to be overly reliant on non-hierarchical criteria that cannot be applied rigorously and systematically in the absence of an unambiguous decision tree.

In the case of the generic foods, evaluators had no information about ingredients. When considering the 28 generic mixed dishes, two-thirds of the assignments were NOVA4, likely because evaluators assumed the foods had been industrially produced. Other evaluators arrived at assignments of NOVA3, likely assuming the foods were homemade. Interestingly, we observed the same ambiguity surrounding the generic yogurts and fromage frais as for the marketed dairy foods, underscoring the contradictory criteria of NOVA regarding these products. We also discovered that foods perceived to be industrial in nature were more likely to be assigned to NOVA4. For example, evaluators largely placed commercial orange juice in NOVA4, even though “fresh, squeezed, chilled, frozen, or dried fruits” are mentioned among the NOVA1 examples [9]. Similarly, 70% of evaluators classified coffee as NOVA1. Coffee torrefaction is often industrial in nature, and food technology specialists view it as a high-impact process whose elevated temperatures lead to high acrylamide levels [34]. However, the NOVA system surprisingly allows torrefaction in association with NOVA1 foods because it is a traditional processing method. Similarly, the evaluators seem to have based their assignments of coffee on cultural rather than scientific knowledge, likely because this beverage is familiar and frequently consumed in France.

The definition of levels of food processing, as proposed by the NOVA classification, is complex and multidimensional [17]. It does not really reflect the intensity of the processes used, but is a mix of technological considerations based more on socio-cultural aspects than on physical-chemical ones occurring during food processing. Furthermore, NOVA criteria associates such so-called technological dimensions with formulation considerations, such as the use of some specific ingredients, or the number of total ingredients involved in the recipe. Separating the level of thermo-mechanical energy undergone by the raw material from the formulation of the food (and in particular from the addition of additives) could be a way for building a robust indicator of the level of food processing. Such an indicator of food processing could help for better understanding if the links observed between ultra-processed food consumption and health are mainly due to the food structure or to the food composition (specific ingredients and additives). For this, the construction of an analysis grid by major categories of unit operations required for food processing would be necessary. Understanding the links between the consumption of highly processed foods and health must necessarily integrate very interdisciplinary skills including food process engineering, food sciences, nutrition, and nutritional epidemiology.

Several studies have found that people who consume more ultra-processed foods (i.e., as defined by NOVA) have higher sugar and lower fiber intake; few differences exist from low ultra-processed foods consumers in their sodium, total fat, and saturated fat intake, but consumption of vitamins and minerals may vary [35,36,37,38,39,40,41]. Here, we found that foods most commonly assigned to NOVA4 (i.e., NOVA4maj foods) could vary substantially in their nutrient profiles, possibly in relation to the large heterogeneity of their composition. Thus, diet quality is more likely to be determined by specific consumer choices from among NOVA4 foods than by a food’s assignment to NOVA4 in and of itself. Confusing messages may arise from front-of pack labeling, such as when products with a NOVA4 label, signifying their ultra-processed nature, would also bear a label conveying their good nutritional quality (e.g., Nutri-Score “A”).

This study has limitations. First, regarding the choice of the food lists, there were only three food categories for the marketed foods and different results might have been obtained if other categories had been used. Our goal was to balance survey duration with reasonable food representation, allowing us to explore potentially conflicting NOVA assignments. Representativeness was greater for the generic foods, which were taken from the results of a population-level dietary survey. Second, while all the evaluators were French, they were specialists in human nutrition and/or food technology; their expertise should thus have served to overcome potential cultural bias and ensure the validity of our data set.

Third, the survey’s structure did not allow evaluators to modify earlier assignments, meaning they could not apply any understanding they developed as they advanced. Hypothetically, the ability to modify assignments could have slightly improved evaluator consistency, as could have allowing real-life discussions among evaluators. Finally, the representativeness of evaluators is also questionable.

However, our study also had several strengths. First, we obtained data from more than 150 evaluators for a total of 231 foods, yielding a much larger data set and more powerful statistical analysis than in previous studies [16, 42]. Second, extreme caution was taken to avoid influencing the evaluators in any way. Our online survey interface facilitated participation and created controlled study conditions. All evaluators were given the exact same information about NOVA, taken from the original publications. The survey set-up provided easy access to the description of the NOVA system, accessible in full detail or as a summary. The food lists and blocks appeared in a randomized order to avoid habituation bias.

Third, the vast majority of evaluators appeared to take the assignment process seriously. Just 7 evaluators (less than 2% of the total) failed to do so. The sensitivity analyses confirmed the robustness of our findings. Consequently, we feel confident that we obtained data from individuals who assessed the foods as best they could, given current NOVA criteria. All the evaluators were specialists in human nutrition and/or food technology and thus represent the body of individuals who may have to use NOVA in their professional lives.

NOVA “multidimensionnel”

Conclusions

Overall, our results suggest improvements should be made to the NOVA classification system to enhance assignment consistency. Indeed, we observed that a large percentage of the food assignments were discordant, regardless of whether ingredient information was provided. This finding raises questions about how functional NOVA is in its current form. It should also spur reflection on the reliability of conclusions from epidemiological studies that use NOVA as well as on NOVA’s ability to guide public health policy or provide useful information to consumers. While the concept of ultra-processed foods has certainly entered the consumer consciousness, our results indicate that NOVA criteria do not currently allow foods to be unequivocally defined as ultra-processed.

Ultra-Processed Foods Linked to Colorectal Cancer Risk, CV Death

Posted by

0


Making fresh foods available and affordable will promote public heath, editorialists say

A photo of three slices of previously frozen cooked pizza on a plate on a blue plaid tablecloth.

Regular consumption of ultra-processed foods was associated with an increased risk of colorectal cancer, all-cause mortality, and cardiovascular mortality, according to findings from two studies published in The BMJ.

In the first paper, which analyzed three prospective U.S. cohort studies, men in the highest quintile of consumption had a 29% higher risk of developing colorectal cancer compared with those in the lowest (HR 1.29, 95% CI 1.08-1.53, P=0.01), with an even greater association seen for distal colon cancer (HR 1.72, 95% CI 1.24-2.37, P<0.001), reported Fang Zhang, MD, of Tufts University in Boston, and colleagues.

These associations remained significant even after adjusting for BMI and nutritional quality indicators, they noted, and no association between ultra-processed food intake and colorectal cancer was seen among women.

In the second paper, which involved an Italian prospective study, an adjusted multivariable analysis showed a higher risk of all-cause mortality (HR 1.19, 95% CI 1.04-1.35) and cardiovascular mortality (HR 1.32, 95% CI 1.06-1.64) among adults in the highest quarter of the Food Standards Agency Nutrient Profiling System (FSAm-NPS) dietary index compared with the lowest quarter.

When looking at only those who fell within the two highest categories of ultra-processed food intake, based on the NOVA classification system, the associations remained for all-cause mortality (HR 1.19, 95% CI 1.05-1.36) and cardiovascular mortality (HR 1.27, 95% CI 1.02-1.58), reported Marialaura Bonaccio, PhD, of IRCCS Neuromed in Pozzilli, Italy, and colleagues.

In an accompanying editorial, Carlos Monteiro, MD, PhD, and Geoffrey Cannon, MA, both of the University of São Paulo in Brazil, noted that “the overall positive solution includes making supplies of fresh and minimally processed foods … available, attractive, and affordable. And sustaining national initiatives to promote and support freshly prepared meals made with fresh and minimally processed foods, using small amounts of processed culinary ingredients and processed foods.”

“Enacted, this will promote public health. It will also nourish families, society, economies, and the environment,” they added.

Colorectal Cancer

For their study, Zhang and colleagues used data on healthcare workers from three large U.S. prospective cohorts, including 46,341 men from the Health Professionals Follow-up Study from 1986-2014, 67,425 women from the Nurses’ Health Study I from 1986-2014, and 92,482 women from the Nurses’ Health Study II from 1991-2015. The NOVA classification system was used to assess levels of ultra-processed foods, and only physicians were blinded.

Over 24 to 28 years of follow-up, 3,216 cases of colorectal cancer were documented, 1,294 in men and 1,922 in women.

A higher consumption of meat/poultry/seafood-based ready-to-eat products was associated with an increased risk of colorectal cancer in men (HR 1.44, 95% CI 1.20-1.73), as was higher consumption of sugar-sweetened beverages (HR 1.21, 95% CI 1.01-1.44), while ready-to-eat or heat mixed dishes were linked to an increased risk for women (HR 1.17, 95% CI 1.01-1.36).

Interestingly, dairy-based desserts and yogurt were tied to a 17% lower risk of colorectal cancer among women (HR 0.83, 95% CI 0.71-0.97).

Potential explanations for the different patterns between the sexes might be due to the effects of obesity or sex hormones, Zhang and team noted.

They also acknowledged that the self-administered validated food frequency questionnaires used in the study included a limited list of pre-defined foods, which was a limitation to their study.

Cardiovascular/All-Cause Mortality

In the so-called Moli-sani study, Bonaccio and colleagues examined data on 22,895 participants (mean age 55, 52% women) in Molise, Italy from March 2005 to December 2010.

Over a median follow-up of 12.2 years, 2,205 participants died.

The authors jointly analyzed the the FSAm-NPS — used to derive the Nutri-Score front-of-pack label — and the NOVA classification system to assess mortality, finding that the magnitude of the relationship between the FSAm-NPS dietary index and all-cause mortality was attenuated by 22.3%, which was slightly higher than that for cardiovascular mortality (15.4% attenuated), while mortality risks linked to high ultra-processed food intake were not changed.

“So the problem with ultra-processed products has been suggested to be simply their poor nutrient profiles,” Monteiro and Cannon noted.

Study limitations included possible recall bias from self-reported dietary data, as well as possible social desirability bias, since ultra-processed food intake may have been underreported, Bonaccio and team said.

Feeling Anxious or Blue? Ultra-Processed Foods May Be to Blame

Posted by

0


Summary: Consuming high amounts of highly processed foods can impact mental health, increasing the risk of anxiety and depression.

Source: FAU

Do you love those sugary-sweet beverages, reconstituted meat products and packaged snacks? You may want to reconsider based on a new study that explored whether individuals who consume higher amounts of ultra-processed food have more adverse mental health symptoms.

Although ultra-processed foods are convenient, low cost, quick to prepare or ready-to-eat, these industrial formulations of processed food substances (oils, fats, sugars, starch, protein isolates) contain little or no whole food.

They result from extensive “physical, biological, and chemical processes” that create food products that are deficient in original and natural food. Ultra-processed foods typically include flavorings, colorings, emulsifiers and other cosmetic additives.

While there is some evidence regarding ultra-processed food consumption and depression, data are sparse regarding other adverse mental health symptoms including anxiety and mentally unhealthy days.

Researchers from Florida Atlantic University’s Schmidt College of Medicine and collaborators explored a nationally representative sample of the United States population to determine if individuals who consume high amounts of ultra-processed foods report significantly more adverse mental health symptoms including depression, anxiety and mentally unhealthy days.

They measured mild depression, number of mental unhealthy days and number of anxious days in 10,359 adults 18 and older from the U.S. National Health and Nutrition Examination Survey.

Results of the study, published in the journal Public Health Nutrition, showed that individuals who consumed the most ultra-processed foods as compared with those who consumed the least amount had statistically significant increases in the adverse mental health symptoms of mild depression, “mentally unhealthy days” and “anxious days.”

They also had significantly lower rates of reporting zero “mentally unhealthy days” and zero “anxious days.”

Findings from this study are generalizable to the entire U.S. as well as other Western countries with similar ultra-processed food intakes.

“The ultra-processing of food depletes its nutritional value and also increases the number of calories, as ultra-processed foods tend to be high in added sugar, saturated fat and salt, while low in protein, fiber, vitamins, minerals and phytochemicals,” said Eric Hecht, M.D., Ph.D., corresponding author and an affiliate associate professor in FAU’s Schmidt College of Medicine.

This shows a woman at a vending machine
More than 70 percent of packaged foods in the U.S. are classified as ultra-processed food and represent about 60 percent of all calories consumed by Americans.

“More than 70 percent of packaged foods in the U.S. are classified as ultra-processed food and represent about 60 percent of all calories consumed by Americans. Given the magnitude of exposure to and effects of ultra-processed food consumption, our study has significant clinical and public health implications.”

Researchers used the NOVA food classification for the study, which is a widely used system recently adopted by the Food and Agricultural Organization of the United Nations. NOVA considers the nature, extent and purpose of food processing in order to categorize foods and beverages into four groups: unprocessed or minimally processed foods, processed culinary ingredients, processed foods and ultra-processed foods.

“Data from this study add important and relevant information to a growing body of evidence concerning the adverse effects of ultra-processed consumption on mental health symptoms,” said Charles H. Hennekens, M.D., Dr.PH, co-author, the first Sir Richard Doll Professor of Medicine, and senior academic advisor, FAU Schmidt College of Medicine.

“Analytic epidemiologic research is needed to test the many hypotheses formulated from these descriptive data.”

According to the National Institute of Mental Health, nearly 1 in 5 adults live with a mental illness. Mental illnesses, including depression and anxiety, are leading causes of morbidity, disability and mortality.

Abstract

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

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.