Ultra-processed food consumption and its correlates among Italian children, adolescents and adults from the Italian Nutrition & Health Survey (INHES) cohort study.
24 Jun 2021-Public Health Nutrition (Cambridge University Press (CUP))-Vol. 24, Iss: 18, pp 6258-6271
TL;DR: UPF contributes a modest proportion of energy to the diets of Italian adults while being one-quarter of the total energies in children/adolescents and was associated with several psychosocial factors and eating behaviours.
Abstract: OBJECTIVE To assess ultra-processed food (UPF) consumption and its socio-demographic, psychosocial and behavioural correlates in a general population of Italian children, adolescents and adults. DESIGN Cross-sectional telephone-based survey. SETTING Italy, 2010-2013. PARTICIPANTS In total, 9078 participants (5-97 years) from the Italian Nutrition & Health Survey. Dietary intakes were collected by a 1-d 24-h dietary recall. UPF was defined by the NOVA classification and expressed as percentage of total energies. RESULTS Average energy intake from UPF (95 % CI) was 17·3 % (17·1 %, 17·6 %) among adults and 25·9 % (24·8 %, 27·0 %) in children/adolescents. Top sources of UPF were processed meats (32·5 %) and bread substitutes (16·7 %). Among adults, age (β = -3·10; 95 % CI (-4·40, -1·80) for >65 years v. 20-40 years; βs are dimensionless) and residing in Southern Italy (β = -0·73; 95 % CI (-1·32, -0·14) v. Northern) inversely associated with UPF. Screen view during meals was directly linked to UPF, as well as poor self-rated health (β = 5·32; 95 % CI (2·66, 7·99)), adverse life events (β = 2·33; 95 % CI (1·48, 3·18)) and low sleep quality (β = 2·34; 95 % CI (1·45, 3·23)). Boys consumed two-point percent more UPF of the total energy than girls (β = 2·01; 95 % CI (0·20, 3·82)). For all ages, a Mediterranean diet was inversely associated with UPF (β = -4·86; 95 % CI (-5·53, -4·20) for good v. poor adherence in adults and (β = -5·08; 95 % CI (-8·38, -1·77) for kids). CONCLUSIONS UPF contributes a modest proportion of energy to the diets of Italian adults while being one-quarter of the total energies in children/adolescents. UPF was associated with several psychosocial factors and eating behaviours. Increased adherence to Mediterranean diet would possibly result in lower UPF consumption.
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TL;DR: In this article, a quantitative meta-analysis of nationally representative surveys on the consumption of ultra-processed foods and the dietary/nutrient composition of respondents' diets is presented.
Abstract: Excessive consumption of ultra-processed foods (UPFs), as described by the NOVA classification system, represents a potential threat to human health. The nutritional composition of UPFs may explain their observed adverse effects. The present study aimed to provide a quantitative meta-analysis of nationally representative surveys on the consumption of UPFs and the dietary/nutrient composition of respondents’ diets. A systematic search for relevant studies published prior to July 2021 was conducted via electronic databases. The studies that provided the dietary/nutrient composition of foods categorized according to the NOVA classification system were selected. The association between UPFs and other dietary variables was modelled using ordinary least squares linear regression based on aggregated data extracted from the selected articles. Consumption of UPFs represented up to 80% of total caloric intake in the US and Canada, with confectionery and sugar-sweetened beverages being the most consumed items. When considered in relation to other food groups, an inverse linear relation between UPFs and less-processed foods was evident. Increased UPF intake correlated with an increase in free sugars, total fats, and saturated fats, as well as a decrease in fiber, protein, potassium, zinc, and magnesium, and vitamins A, C, D, E, B12, and niacin. In conclusion, the data indicate that increased UPF consumption negatively affects the nutritional quality of diets.
70 citations
TL;DR: Evidence is found for associations between ultra-processed food consumption and adverse mental health, and further rigorously designed prospective and experimental studies are needed to better understand causal pathways.
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.
27 citations
TL;DR: In this article , the association between the consumption of ultra-processed foods and obesity and adiposity measurements has been established in adults, but the situation remains unclear in children and adolescents.
Abstract: According to the NOVA classification, ultra-processed foods are products made through physical, biological and chemical processes and typically with multiple ingredients and additives, in which whole foods are mostly or entirely absent. From a nutritional point of view, they are typically energy-dense foods high in fat, sugar, and salt and low in fiber. The association between the consumption of ultra-processed food and obesity and adiposity measurements has been established in adults. However, the situation remains unclear in children and adolescents.We carried out a systematic review, in which we summarize observational studies investigating the association between the consumption of ultra-processed food, as defined by NOVA classification, and obesity and adiposity parameters among children and adolescents. A literature search was performed using PUBMED and Web of Science databases for relevant articles published prior to May 2021.Ten studies, five longitudinal and five cross-sectional, mainly conducted in Brazil, were included in this review. Four longitudinal studies in children with a follow-up longer than 4 years found a positive association between the consumption of ultra-processed food and obesity and adiposity parameters, whereas cross-sectional studies failed to find an association.These data suggest that a consistent intake of ultra-processed foods over time is needed to impact nutritional status and body composition of children and adolescents. Further well-designed prospective studies worldwide are needed to confirm these findings considering country-related differences in dietary habits and food production technologies.
24 citations
TL;DR: In this paper, the authors examined the relationship between psychological distress resulting from the COVID-19 lockdown and dietary changes and found that increased consumption of ultra-processed foods (UPF) was directly associated with depression (PHQ-9 and depressive items from the Screening Questionnaire for Disaster Mental Health- SQD-D), anxiety (GAD-7), stress (PSS-4), and posttraumatic stress disorder (SQD-P).
Abstract: PURPOSE: To examine the relationship between psychological distress resulting from the COVID-19 lockdown and dietary changes. METHODS: Cross-sectional analysis from 2 retrospective Italian cohorts recruited from May to September 2020: (1) The Moli-LOCK cohort consists of 1401 participants from the Moli-sani Study (n = 24,325) who were administered a telephone-based questionnaire to assess lifestyles and psychological factors during confinement;(2) the ALT RISCOVID-19 is a web-based survey of 1340 individuals distributed throughout Italy who self-responded to the same questionnaire using Google R forms. Psychological distress was measured by assessments of depression (PHQ-9 and depressive items from the Screening Questionnaire for Disaster Mental Health- SQD-D), anxiety (GAD-7), stress (PSS-4), and post-traumatic stress disorder (SQD-P). Diet quality was assessed either as changes in consumption of ultra-processed foods (UPF) or adherence to Mediterranean diet (MD). RESULTS: In ALT RISCOVID-19, increased UPF intake was directly associated with depression (both PHQ-9 and SQD-D;p < 0.0001), anxiety (p < 0.0001), stress (p = 0.001) and SQD-P (p = 0.001);similar results were obtained in the Moli-LOCK cohort except for perceived stress. When psychometric scales were analysed simultaneously, only depression (SQD-D) remained associated with UPF (both cohorts). In both cohorts, psychological distress poorly influenced changes toward an MD, except for depression (SQD-D) that resulted inversely associated in the ALT RISCOVID-19 participants (beta = - 0.16;95% CI - 0.26, - 0.06). CONCLUSIONS: Psychological distress from the COVID-19 confinement is directly associated with unhealthy dietary modifications in two Italian cohorts. In view of possible future restrictive measures to contain pandemic, public health actions are warranted to mitigate the impact of psychological distress on diet quality.
10 citations
TL;DR: Consumption of UPF in southern Italy is in line with those reported in some other Mediterranean countries, although it negatively impacted the nutrient profile, and individuals displaying a “healthier” dietary profile, consumed less UPFs and more unprocessed/minimally processed foods, with minor variation in the other NOVA food categories.
Abstract: Ultra-processed food (UPF) consumption has been the focus of major attention due to their potential effects on human health. The aim of this study was to investigate the intake of UPFs in a sample of southern Italian individuals and assess its relationship with nutrient profile and dietary quality parameters. A cross-sectional study was conducted on 1936 individuals older than 18 years randomly selected from the general population. A total of 110 food times have been categorized based on the level of processing using the NOVA classification. The average daily energy intake of the sample was 2091.1 kcal, 38.7% of which were from the NOVA group of unprocessed/minimally processed foods, 5.7% from processed culinary ingredients, 38.3% from processed foods, and 17.9% from the UPFs group. UPFs were more consumed among young, unmarried individuals, with high cultural level, smokers, and often eating out of home. The mean energy share of UPFs varied from 6.3% of total daily energy intake for individuals in the lowest quintile of UPF consumption to 34.2% for those in the upper quintile. Within the UPF group, the highest energy contribution was provided by fast foods and sweets. Compared to the lowest quintile of UPF consumption, individuals in the highest quintile consumed, on average, additional 300 kcals per day and less fiber. Some plant-derived vitamins, such as vitamin A and vitamin C showed an inverse trend toward increasing shares of UPF consumption, while sodium intake increased. A significant higher intake of UPFs in individuals meeting the European and Italian dietary recommendations for carbohydrates, vitamin B12, vitamin D, and vitamin E was found, while UPFs were less consumed among those meeting the recommendations for total fats, fiber, sodium, potassium, and vitamin C. Finally, individuals displaying a “healthier” dietary profile, such as higher adherence to either the Mediterranean diet, the Dietary Approaches to Stop Hypertension, the Alternate Diet Quality Index, and the Diet Quality Index-International, consumed less UPFs and more unprocessed/minimally processed foods, with minor variation in the other NOVA food categories. In conclusion, consumption of UPF in southern Italy is in line with those reported in some other Mediterranean countries, although it negatively impacted the nutrient profile. It is important to monitor the consumption of UPFs before their availability and popularity put the grounds on younger generations’ dietary habits.
4 citations
References
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TL;DR: The proposed cut off points, which are less arbitrary and more internationally based than current alternatives, should help to provide internationally comparable prevalence rates of overweight and obesity in children.
Abstract: Objective To develop an internationally acceptable definition of child overweight and obesity, specifying the measurement, the reference population, and the age and sex specific cut off points. Design International survey of six large nationally representative cross sectional growth studies. Setting Brazil, Great Britain, Hong Kong, the Netherlands, Singapore, and the United States. Subjects 97 876 males and 94 851 females from birth to 25 years of age. Main outcome measure Body mass index (weight/height 2 ). Results For each of the surveys, centile curves were drawn that at age 18 years passed through the widely used cut off points of 25 and 30 kg/m 2 for adult overweight and obesity. The resulting curves were averaged to provide age and sex specific cut off points from 2›18 years. Conclusions The proposed cut off points, which are less arbitrary and more internationally based than current alternatives, should help to provide internationally comparable prevalence rates of overweight and obesity in children.
14,792 citations
"Ultra-processed food consumption an..." refers methods in this paper
...BMI in children/adolescents was categorised according to specific values for children considering sex and age(32)....
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TL;DR: Greater adherence to the traditional Mediterranean diet is associated with a significant reduction in total mortality.
Abstract: BACKGROUND Adherence to a Mediterranean diet may improve longevity, but relevant data are limited. METHODS We conducted a population-based, prospective investigation involving 22,043 adults in Greece who completed an extensive, validated, food-frequency questionnaire at base line. Adherence to the traditional Mediterranean diet was assessed by a 10-point Mediterranean-diet scale that incorporated the salient characteristics of this diet (range of scores, 0 to 9, with higher scores indicating greater adherence). We used proportional-hazards regression to assess the relation between adherence to the Mediterranean diet and total mortality, as well as mortality due to coronary heart disease and mortality due to cancer, with adjustment for age, sex, body-mass index, physical-activity level, and other potential confounders. RESULTS During a median of 44 months of follow-up, there were 275 deaths. A higher degree of adherence to the Mediterranean diet was associated with a reduction in total mortality (adjusted hazard ratio for death associated with a two-point increment in the Mediterranean-diet score, 0.75 [95 percent confidence interval, 0.64 to 0.87]). An inverse association with greater adherence to this diet was evident for both death due to coronary heart disease (adjusted hazard ratio, 0.67 [95 percent confidence interval, 0.47 to 0.94]) and death due to cancer (adjusted hazard ratio, 0.76 [95 percent confidence interval, 0.59 to 0.98]). Associations between individual food groups contributing to the Mediterranean-diet score and total mortality were generally not significant. CONCLUSIONS Greater adherence to the traditional Mediterranean diet is associated with a significant reduction in total mortality.
3,634 citations
"Ultra-processed food consumption an..." refers methods in this paper
...ated by the Mediterranean Diet Score (MDS) as proposed by Trichopoulou et al.(28) and categorised into tertiles as good (MDS≥ 5 points), average (4 points) and poor adherence...
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...Adherence to the Mediterranean diet in adults was evaluated by the Mediterranean Diet Score (MDS) as proposed by Trichopoulou et al.(28) and categorised into tertiles as good (MDS≥ 5 points), average (4 points) and poor adherence (0–3 points)....
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TL;DR: Significant differences in the relation of psychosocial factors to risk of myocardial infarction in 24767 people from 52 countries were found, suggesting that approaches aimed at modifying these factors should be developed.
2,110 citations
TL;DR: It is proposed here that the main driving force now shaping the global food system is transnational food manufacturing, retailing and fast food service corporations whose businesses are based on very profitable, heavily promoted ultra‐processed products, many in snack form.
Abstract: The relationship between the global food system and the worldwide rapid increase of obesity and related diseases is not yet well understood. A reason is that the full impact of industrialized food processing on dietary patterns, including the environments of eating and drinking, remains overlooked and underestimated. Many forms of food processing are beneficial. But what is identified and defined here as ultra-processing, a type of process that has become increasingly dominant, at first in high-income countries, and now in middle-income countries, creates attractive, hyper-palatable, cheap, ready-to-consume food products that are characteristically energy-dense, fatty, sugary or salty and generally obesogenic. In this study, the scale of change in purchase and sales of ultra-processed products is examined and the context and implications are discussed. Data come from 79 high- and middle-income countries, with special attention to Canada and Brazil. Results show that ultra-processed products dominate the food supplies of high-income countries, and that their consumption is now rapidly increasing in middle-income countries. It is proposed here that the main driving force now shaping the global food system is transnational food manufacturing, retailing and fast food service corporations whose businesses are based on very profitable, heavily promoted ultra-processed products, many in snack form.
1,092 citations
TL;DR: It is concluded that the ever-increasing production and consumption of ultra-processed products is a world crisis, to be confronted, checked and reversed as part of the work of the UN Sustainable Development Goals and its Decade of Nutrition.
Abstract: Given evident multiple threats to food systems and supplies, food security, human health and welfare, the living and physical world and the biosphere, the years 2016-2025 are now designated by the UN as the Decade of Nutrition, in support of the UN Sustainable Development Goals. For these initiatives to succeed, it is necessary to know which foods contribute to health and well-being, and which are unhealthy. The present commentary outlines the NOVA system of food classification based on the nature, extent and purpose of food processing. Evidence that NOVA effectively addresses the quality of diets and their impact on all forms of malnutrition, and also the sustainability of food systems, has now accumulated in a number of countries, as shown here. A singular feature of NOVA is its identification of ultra-processed food and drink products. These are not modified foods, but formulations mostly of cheap industrial sources of dietary energy and nutrients plus additives, using a series of processes (hence 'ultra-processed'). All together, they are energy-dense, high in unhealthy types of fat, refined starches, free sugars and salt, and poor sources of protein, dietary fibre and micronutrients. Ultra-processed products are made to be hyper-palatable and attractive, with long shelf-life, and able to be consumed anywhere, any time. Their formulation, presentation and marketing often promote overconsumption. Studies based on NOVA show that ultra-processed products now dominate the food supplies of various high-income countries and are increasingly pervasive in lower-middle- and upper-middle-income countries. The evidence so far shows that displacement of minimally processed foods and freshly prepared dishes and meals by ultra-processed products is associated with unhealthy dietary nutrient profiles and several diet-related non-communicable diseases. Ultra-processed products are also troublesome from social, cultural, economic, political and environmental points of view. We conclude that the ever-increasing production and consumption of these products is a world crisis, to be confronted, checked and reversed as part of the work of the UN Sustainable Development Goals and its Decade of Nutrition.
1,063 citations
"Ultra-processed food consumption an..." refers background or methods in this paper
...Major adverse life events (yes/no) were assessed by asking participants whether in the past year they had experienced one or more of the following: (1) marital separation or divorce; (2) business failure; (3) major intra-family conflict; (4) death or major illness of a close family member; (5) loss of job or retirement, violence; (6) death of a spouse; (7) major personal injury or illness or (8) other major stress....
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...none; (2) little; (3) moderate; (4) good; (5) very good...
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...Psychological stress was assessed through two singleitem questions relating to stress at work and home by asking participants how often in the past year they had felt stressed by indicating one of the following response options: (1) never; (2) sometimes; (3) most of the times; (4) often and (5) always....
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...honey and butter); (3) processed foods with salt, sugar or oil (e....
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...Level of financial stress was defined as (1) little or none; (2) moderate or (3) high....
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