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Journal ArticleDOI: 10.1017/S136898002100094X

Ultra-processed foods, changes in blood pressure and incidence of hypertension: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

04 Mar 2021-Public Health Nutrition (Cambridge University Press)-Vol. 24, Iss: 11, pp 3352-3360
Abstract: Objective: To estimate changes in blood pressure and the incidence of hypertension associated with consumption of ultra-processed foods (UPF) by Brazilian civil servants at a 4-year follow-up. Design: Longitudinal analysis of the ELSA-Brasil with non-hypertensive individuals at baseline. We applied the FFQ at the baseline and categorised energy intake by degree of processing, using the NOVA classification. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured at baseline (2008–2010) and again at first follow-up (2012–2014). Incidence of arterial hypertension was defined as SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or antihypertensive medication during the previous 2 weeks. A mixed-effect linear regression model and mixed-effect logistic regression model were used to estimate associations between UPF consumption and, respectively, changes in blood pressure and incidence of hypertension. Setting: Brazil. Participants: Civil servants of Brazilian public academic institutions in six cities (n 8754), aged 35–74 years at baseline (2008–2010). Results: UPF consumption contributed 25·2 % (sd = 9·6) of total energies consumed. After adjustment, participants with high UPF consumption presented a 23 % greater risk of developing hypertension (OR = 1·23, 95 % CI 1·06, 1·44) than those with low UPF consumption. We did not find association between UPF consumption and changes in blood pressure over time. Conclusions: The higher the UPF consumption, the higher the risk of hypertension in adults. Reducing UPF consumption is thus important to promote health and prevent hypertension.

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Topics: Blood pressure (56%)
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Open accessJournal ArticleDOI: 10.3390/NU13041120
Jee-Seon Shim1, Sun-Young Shim1, Hee-Jeung Cha1, Jinhee Kim2  +1 moreInstitutions (2)
29 Mar 2021-Nutrients
Abstract: There is growing evidence for a global transition to a more highly processed diet. While the dietary share of ultra-processed foods depends on a country’s economic status, food choice and consumption are also influenced by the socioeconomic situation of individuals. This study investigated whether ultra-processed food consumption differed across socioeconomic subgroups and over time (2010–2018) in Korea. Cross-sectional data from the Korea National Health and Nutrition Examination Survey 2010–2018 were analyzed. Food and beverages reported in a one-day 24 h recall were classified according to the NOVA food classification criteria. The dietary energy contribution of ultra-processed foods was high among men and urban residents, and increased with education and income level; additionally, it reached its peak in adolescents and thereafter decreased with increasing age. After adjusting the socioeconomic variables, such associations remained significant, except for income level. The overall contribution of ultra-processed foods increased from 23.1% (2010–2012) to 26.1% (2016–2018), and the same trend over time was observed in all age groups and socioeconomic strata. In the Korean population, ultra-processed food consumption differed by individual socioeconomic characteristics, but gradually increased over time, and this trend was consistently found in all socioeconomic subgroups. Future strategies to promote healthy food choices are needed for the Korean population.

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3 Citations


Open accessJournal ArticleDOI: 10.3390/NU13082778
Mirko Marino1, Federica Puppo1, Cristian Del Bo1, Valentina Vinelli1  +3 moreInstitutions (1)
13 Aug 2021-Nutrients
Abstract: A debate is ongoing on the significance and appropriateness of the NOVA classification as a tool for categorizing foods based on their degree of processing. As such, the role of ultra-processed food (UPF) on human health is still not completely understood. With this review, we aimed to investigate the actual level of consumption of UPF across countries and target populations to determine the impact in real contexts. Suitable articles published up to March 2021 were sourced through the PubMed and SCOPUS databases. Overall, 99 studies providing data on the level of UPF consumption expressed as the percentage of total energy intake were identified, for a total of 1,378,454 participants. Most of them were published in Brazil (n = 38) and the United States (n = 15), and the 24 h recall was the most-used tool (n = 63). Analysis of the results revealed that the United States and the United Kingdom were the countries with the highest percent energy intake from UPF (generally >50%), whereas Italy had the lowest levels (about 10%); the latter was inversely associated with adherence to the Mediterranean diet. High variability was also observed based on sex, age, and body mass index, with men, young people, and overweight/obese subjects generally having higher levels of consumption compared to older subjects. Overall, our findings underline the large differences in UPF intake. Since most of the observations derived from studies conducted with food questionnaires are not specifically validated for UPF, further efforts are essential to confirm the results previously obtained and to investigate further the association between UPF consumption and health status, also considering the actual contribution within different dietary patterns, which has been less investigated to date.

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3 Citations


Journal ArticleDOI: 10.1017/S1368980021002767
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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Topics: Population (51%)

2 Citations



Journal ArticleDOI: 10.1016/J.CND.2021.08.004
Charlotte Debras1, Bernard Srour1, Eloi Chazelas1, Chantal Julia1  +7 moreInstitutions (1)
Abstract: Resume Au cours des dernieres decennies, l’offre agro-alimentaire s’est considerablement etoffee en matiere d’aliments dits « ultra-transformes » (AUT). Il s’agit de produits ayant subi d’importants procedes de transformation impactant fortement la matrice alimentaire et/ou contenant des additifs alimentaires ou autres substances d’origine industrielle (huiles hydrogenees, maltodextrine, sirop de glucose, etc.). Dans la cohorte NutriNet-Sante (2009-en cours), sept etudes ont ete realisees, sur des sous-echantillons allant de 26 000 a plus de 100 000 participants. Ces travaux ont mis en evidence des associations entre consommation d’AUT et incidences de cancers, maladies cardiovasculaires, mortalite, diabete de type 2, symptomes depressifs, surpoids et obesite, et presence de troubles fonctionnels digestifs. Les analyses tenaient compte de nombreux facteurs de confusion potentiels, y compris nutritionnels. Au-dela des aspects de qualite nutritionnelle, d’autres facteurs pourraient donc etre impliques, tels que certains additifs alimentaires, des composes neoformes lors des procedes de transformation, ou des contaminants issus des emballages. Ces resultats sont en coherence avec un nombre croissant d’etudes epidemiologiques et experimentales recentes a travers le monde qui suggerent un role etiologique des AUT dans la survenue de differentes maladies. Sur la base de ces travaux, les autorites de sante publique en France et dans divers pays recommandent aujourd’hui d’en limiter la consommation.

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Journal ArticleDOI: 10.1249/01.MSS.0000078924.61453.FB
Abstract: CRAIG, C. L., A. L. MARSHALL, M. SJOSTROM, A. E. BAUMAN, M. L. BOOTH, B. E. AINSWORTH, M. PRATT, U. EKELUND, A. YNGVE, J. F. SALLIS, and P. OJA. International Physical Activity Questionnaire: 12-Country Reliability and Validity. Med. Sci. Sports Exerc., Vol. 35, No. 8, pp. 1381-1395, 2003. Background: Physical inactivity is a global concern, but diverse physical activity measures in use prevent international comparisons. The International Physical Activity Questionnaire (IPAQ) was developed as an instrument for cross-national monitoring of physical activity and inactivity. Methods: Between 1997 and 1998, an International Consensus Group developed four long and four short forms of the IPAQ instruments (administered by telephone interview or self-administration, with two alternate reference periods, either the "last 7 d" or a "usual week" of recalled physical activity). During 2000, 14 centers from 12 countries collected reliability and/or validity data on at least two of the eight IPAQ instruments. Test-retest repeatability was assessed within the same week. Concurrent (inter-method) validity was assessed at the same administration, and criterion IPAQ validity was assessed against the CSA (now MTI) accelerometer. Spearman's correlation coefficients are reported, based on the total reported physical activity. Results: Overall, the IPAQ questionnaires produced repeatable data (Spearman's clustered around 0.8), with comparable data from short and long forms. Criterion validity had a median of about 0.30, which was comparable to most other self-report validation studies. The "usual week" and "last 7 d" reference periods performed similarly, and the reliability of telephone administration was similar to the self-administered mode. Conclusions: The IPAQ instruments have acceptable measurement properties, at least as good as other established self-reports. Considering the diverse samples in this study, IPAQ has reasonable measurement properties for monitoring population levels of physical activity among 18- to 65-yr-old adults in diverse settings. The short IPAQ form "last 7 d recall" is recommended for national monitoring and the long form for research requiring more detailed assessment. Key Words: MEASUREMENT, SURVEILLANCE, EPIDEMIOLOGY

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Topics: Criterion validity (57%), Population (51%)

12,593 Citations


Open accessBook
01 Jul 2004-
Abstract: Preface.Acknowledgments.PART I: INTRODUCTION TO LONGITUDINAL AND CLUSTERED DATA.1. Longitudinal and Clustered Data.2. Longitudinal Data: Basic Concepts.PART II: LINEAR MODELS FOR LONGITUDINAL CONTINUOUS DATA.3. Overview of Linear Models for Longitudinal Data.4. Estimation and Statistical Inference.5. Modelling the Mean: Analyzing Response Profiles.6. Modelling the Mean: Parametric Curves.7. Modelling the Covariance.8. Linear Mixed Effects Models.9. Residual Analyses and Diagnostics.PART III: GENERALIZED LINEAR MODELS FOR LONGITUDINAL DATA.10. Review of Generalized Linear Models.11. Marginal Models: Generalized Estimating Equations (GEE).12. Generalized Linear Mixed Effects Models.13. Contrasting Marginal and Mixed Effects Models.PART IV: ADVANCED TOPICS FOR LONGITUDINAL AND CLUSTERED DATA.14. Missing Data and Dropout.15. Some Aspects of the Design of Longitudinal Studies.16. Repeated Measures and Related Designs.17. Multilevel Models.Appendix A: Gentle Introduction to Vectors and Matrices.Appendix B: Properties of Expectations and Variances.Appendix C: Critical Points for a 50:50 Mixture of Chi-Squared Distributions.References.Index.

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3,555 Citations


Open accessJournal ArticleDOI: 10.1161/CIRCULATIONAHA.107.689935
Ravi Dhingra, Lisa M. Sullivan1, Paul F. Jacques2, Thomas J. Wang3  +8 moreInstitutions (5)
31 Jul 2007-Circulation
Abstract: Background—Consumption of soft drinks has been linked to obesity in children and adolescents, but it is unclear whether it increases metabolic risk in middle-aged individuals. Methods and Results—We related the incidence of metabolic syndrome and its components to soft drink consumption in participants in the Framingham Heart Study (6039 person-observations, 3470 in women; mean age 52.9 years) who were free of baseline metabolic syndrome. Metabolic syndrome was defined as the presence of 3o f the following: waist circumference 35 inches (women) or 40 inches (men); fasting blood glucose 100 mg/dL; serum triglycerides 150 mg/dL; blood pressure 135/85 mm Hg; and high-density lipoprotein cholesterol 40 mg/dL (men) or 50 mg/dL (women). Multivariable models included adjustments for age, sex, physical activity, smoking, dietary intake of saturated fat, trans fat, fiber, magnesium, total calories, and glycemic index. Cross-sectionally, individuals consuming 1 soft drink per day had a higher prevalence of metabolic syndrome (odds ratio [OR], 1.48; 95% CI, 1.30 to 1.69) than those consuming 1 drink per day. On follow-up (mean of 4 years), new-onset metabolic syndrome developed in 765 (18.7%) of 4095 participants consuming 1 drink per day and in 474 (22.6%) of 2059 persons consuming 1 soft drink per day. Consumption of 1 soft drink per day was associated with increased odds of developing metabolic syndrome (OR, 1.44; 95% CI, 1.20 to 1.74), obesity (OR, 1.31; 95% CI, 1.02 to 1.68), increased waist circumference (OR, 1.30; 95% CI, 1.09 to 1.56), impaired fasting glucose (OR, 1.25; 95% CI, 1.05 to 1.48), higher blood pressure (OR, 1.18; 95% CI, 0.96 to 1.44), hypertriglyceridemia (OR, 1.25; 95% CI, 1.04 to 1.51), and low high-density lipoprotein cholesterol (OR, 1.32; 95% CI 1.06 to 1.64). Conclusions—In middle-aged adults, soft drink consumption is associated with a higher prevalence and incidence of multiple metabolic risk factors. (Circulation. 2007;116:480-488.)

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Topics: Blood serum (55%), Impaired fasting glucose (54%), Saturated fat (54%) ... read more

842 Citations


Journal ArticleDOI: 10.1021/ACS.EST.5B05387
Da Chen1, Da Chen2, Kurunthachalam Kannan3, Hongli Tan2  +4 moreInstitutions (4)
Abstract: Numerous studies have investigated the environmental occurrence, human exposure, and toxicity of bisphenol A (BPA). Following stringent regulations on the production and usage of BPA, several bisphenol analogues have been produced as a replacement for BPA in various applications. The present review outlines the current state of knowledge on the occurrence of bisphenol analogues (other than BPA) in the environment, consumer products and foodstuffs, human exposure and biomonitoring, and toxicity. Whereas BPA was still the major bisphenol analogue found in most environmental monitoring studies, BPF and BPS were also frequently detected. Elevated concentrations of BPAF, BPF, and BPS (i.e., similar to or greater than that of BPA) have been reported in the abiotic environment and human urine from some regions. Many analogues exhibit endocrine disrupting effects, cytotoxicity, genotoxicity, reproductive toxicity, dioxin-like effects, and neurotoxicity in laboratory studies. BPAF, BPB, BPF, and BPS have been show...

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Topics: Bisphenol (58%), Environmental exposure (57%), Bisphenol S (55%) ... read more

598 Citations


Open accessJournal ArticleDOI: 10.1093/AJE/KWR294
Abstract: Although low- and middle-income countries still bear the burden of major infectious diseases, chronic noncommunicable diseases are becoming increasingly common due to rapid demographic, epidemiologic, and nutritional transitions. However, information is generally scant in these countries regarding chronic disease incidence, social determinants, and risk factors. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) aims to contribute relevant information with respect to the development and progression of clinical and subclinical chronic diseases, particularly cardiovascular diseases and diabetes. In this report, the authors delineate the study's objectives, principal methodological features, and timeline. At baseline, ELSA-Brasil enrolled 15,105 civil servants from 5 universities and 1 research institute. The baseline examination (2008-2010) included detailed interviews, clinical and anthropometric examinations, an oral glucose tolerance test, overnight urine collection, a 12-lead resting electrocardiogram, measurement of carotid intima-media thickness, echocardiography, measurement of pulse wave velocity, hepatic ultrasonography, retinal fundus photography, and an analysis of heart rate variability. Long-term biologic sample storage will allow investigation of biomarkers that may predict cardiovascular diseases and diabetes. Annual telephone surveillance, initiated in 2009, will continue for the duration of the study. A follow-up examination is scheduled for 2012-2013.

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Topics: Cohort study (52%), Longitudinal study (51%)

473 Citations


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