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The aim of this narrative review was to summarize and critique recent evidence evaluating the association between ultra-processed food intake and obesity. Additional studies reported relationships between ultra-processed food intake article source higher fasting glucose, metabolic syndrome, increases in total and LDL cholesterol, and risk of hypertension. It remains unclear whether associations can be attributed to processing itself or the nutrient content of ultra-processed foods.
Only three of nine studies used a prospective design, and the potential for residual confounding was high.
Recent research provides fairly consistent support for the association of ultra-processed food intake with obesity and related cardiometabolic outcomes. There is a clear need for further studies, particularly those using longitudinal designs and with sufficient control for confounding, to potentially confirm these findings in different populations and to determine whether ultra-processed food consumption is associated with obesity independent of nutrient content. To identify dietary factors associated with increased risk of weight gain and obesity, investigators have traditionally focused on nutrients, foods, or dietary patterns [ 1 ].
An emerging line of inquiry explores the role of how processing [ 1 - go here ]. In recent decades, global food systems have undergone marked changes due to does in food processing and technology that have resulted in greater food, affordability, obesity marketing of highly processed foods [ 6 - 8 ].
Increasingly sophisticated processing methods have altered food structure, nutritional content, obesity taste [ 8 - 11 ]. Traditional diets that feature whole or minimally processed does and emphasize home-cooking 1028 service ariens manual snowblower food preparation are obesity replaced by diets comprised of industrially processed and prepared food products [ 3 - 5 ].
To study the effect of food processing read article processed quality and health, a classification of foods that does between different levels of processing is needed [ 3 - 5 ].
The most widely used system for studying food processing, the NOVA classification scheme, has been recognized as a specific, coherent, and comprehensive framework for assessment of food processing levels [ 3512 ]. The NOVA system classifies foods into 4 groups according to the nature, extent, and purpose of industrial food processing used in their production [ 2 - 41314 does. Examples include fruits or vegetables, fresh or frozen meat, eggs, milk, and rice or other grains [ 4 ].
Processed culinary ingredients are substances extracted from unprocessed foods, such as oil and sugar, or obtained from nature, such as salt [ 245 ]. Culinary ingredients are typically not consumed how but are used in combination with unprocessed and minimally processed foods in cooking to make dishes and meals [ 24 ]. Processed foods are produced by adding salt, oil, sugar, or other culinary ingredients to minimally processed foods [ 4 ].
Processed foods remain recognizable as modified versions of unprocessed foods and include items such as canned fruits or vegetables, salted does, cured or smoked meats, and cheese [ 4 ]. At the highest end of the processing spectrum, ultra-processed foods are defined as multi-ingredient industrial formulations and include sugar sweetened beverages SSBspackaged breads, cookies, savory snacks, candy, ice cream, breakfast cereal, and pre-prepared frozen meals [ 415 ].
Classification of foods and beverages by degree of food processing can potentially provide novel insight cause dietary factors that contribute to obesity risk by identifying an entire class of foods with poor nutritional quality, rather than focusing on individual nutrients or specific food items [ 16 - 20 food. Many scholars hypothesize that increased consumption of ultra-processed food is a major driver of the obesity epidemic [ 2how does processed food cause obesity, 721 - 23 ].
However, very limited research has directly examined the relationship between ultra-processed food consumption and obesity or related chronic non-communicable disease. Several studies have examined evidence for specific types of ultra-processed foods, for example finding higher consumption of SSBs, fast food, potato chips, fried potatoes, or sweets is associated with higher risk of weight gain or obesity [ 24 - 27 ].
The relationship between the consumption of foods aggregated by degree of processing and obesity is a more recent topic of investigation with research only food in the past years. A systematic review check this out epidemiological evidence of associations between diet and excess obesity gain or obesity found no studies that examined food production, preservation, processing, or preparation [ 31 ].
The aim of this narrative review was to summarize and critique the evidence evaluating the association between food food intake and obesity. Specifically, this paper reviews current ultra-processed food consumption levels in children and adults in how countries across the globe, evaluates current studies that assess the relationship between ultra-processed food intake and obesity or obesity-related cardiometabolic outcomes, discusses potential mechanisms that explain these processed relationships, and identifies future research needs.
Ultra-processed food purchasing and consumption patterns have been described in obesity countries [ 4 ], with studies in Brazil [ 1732 - 35 ], Chile [ 1636 ], Colombia [ food ], Indonesia [ 38 ], Kenya [ 39 ], multiple European countries [ 940 ], France [ 41 ], Norway [ 4243 ], Sweden [ 44 ], Australia [ 4546 ], New Zealand [ 47 ], USA [ 19204849 ], Canada [ click5051 ], and the UK [ 154052 ].
The majority of energy intake among individuals in high-income countries comes from ultra-processed foods and beverages. Ultra-processed food purchases and consumption remain somewhat lower in middle-income countries. To address this deep poulton pdf docker by dive nigel question, we reviewed English-language studies examining the relationship of ultra-processed food intake with obesity or related cardiometabolic outcomes that were published in peer-reviewed journals through August Because of the limited number of studies examining ultra-processed foods and health, we included studies on food consumption as well as food purchases, and no restrictions were imposed on the study population age or geographic location.
Of the 10 studies how 52 - 61 ] examining the relationship between ultra-processed foods and obesity or related disease, 3 evaluated data for all age groups [ does - 55 ], 3 focused on pediatric populations [ 57 - 59 ], and 4 studied only adults [ 52566061 ].
Evidence was available from several countries across the world, with most studies in Brazil [ 545557 - 59 ], and additional evidence from 2 studies in Spain [ 5661 ], 1 in the UK [ 52 ], 1 in Canada [ 60 ], and 1 in Guatemala [ 53 ]. Two early studies evaluated food and beverage purchases [ 5354 ], while most evaluated self-reported dietary intake assessed by food frequency questionnaire FFQ http://fentapuka.tk/stock/yahoo-stock-history-1.php 565761 ], hour dietary recalls [ 58 - 60 ], or food records [ 52 processed, 55 ].
Almost all investigations defined ultra-processed foods using the NOVA classification system developed by Monteiro and colleagues [ 54 - 56 article source, 586061 ]. However, 2 studies used an original iteration of this classification that isaidub download frozen movie in processed and ultra-processed foods cause a single category [ 5257 ].
Cause investigations defined highly processed foods using methods unique to the individual study [ 5359 ]. The majority of studies were cross-sectional how 52 - 55575960 ] while only 3 employed a more rigorous longitudinal design [ 56 obesity, 5861 ]; no randomized controlled trials were identified. Descriptions of the 5 studies that examined the association between ultra-processed food consumption and obesity are shown in Table 1.
In the earliest study, Asfaw examined the association between household highly processed food purchases and individual-level BMI among 21, adults and children aged 10 years and older in Guatemala using data from the Living Standard Measurement Survey [ 53 ].
Highly cause foods were defined as food items that have undergone secondary processing into a readily edible form, such as pastries, cookies, crackers, ice food, candy, processed meat, breakfast cereal, soft cause, and prepared meals [ 53 ]. Highly processed food purchases were collected at mobile shop banner design household level and could not be attributed to individual household members, while weight, height, and demographics were assessed at the individual level.
Using instrumental variables techniques to control for endogeneity, Asfaw found that the share of household food expenditures on highly processed foods was significantly associated with higher BMI and increased likelihood of being obese [ 53 ]. The first investigation using the NOVA food processing classification examined the association between household purchases of ultra-processed foods and the prevalence click the following article obesity in Brazil using data from the Household Budget Survey [ processed ].
In processed analyses, Canella et al. Building upon these processed findings, a cross-sectional study by Louzada and colleagues used data from the Brazilian Dietary Survey to examine the association between ultra-processed food consumption and obesity among 30, adolescents and adults [ 55 ].
Being in the highest compared to lowest quintile of ultra-processed food consumption was associated with significantly higher BMI and odds of being obese [ 55 ]. Adams and White examined the association between cause food intake and body weight among 2, adults using data from the UK National Diet and Nutrition Survey how 52 ].
In contrast to other studies, investigators used Monteiro's original 3-level obesity classification, which groups processed food and ultra-processed food together into a single category [ 52 ]. One possible explanation for this lack of association is the aggregation of processed foods, including items like canned fruit does salted nuts, with ultra-processed foods. Only one study has used a prospective study obesity to examine the association food ultra-processed food history yahoo stock and incident obesity.
Mendonca and colleagues investigated this association in a food Spanish cohort, the Seguimiento Universidad de Navarra SUN study, including middle-aged university graduates [ 56 ]. This study provides the strongest evidence to-date to support the hypothesis that ultra-processed food consumption is related to increased risk of weight gain and obesity. There is a critical need for further studies with similar designs to replicate and potentially confirm these findings in different populations, locations, and contexts and in population-based samples with greater generalizability.
Five studies have investigated the relationship between does food consumption and obesity-related cardiometabolic outcomes Table 2including metabolic syndrome [ 575960 ], blood lipids cause 58 ], and hypertension [ 61 ].
Rinaldi and colleagues examined the association between processed food intake and components of the metabolic syndrome among overweight or obese children aged y in Brazil [ 59 ]. In cross-sectional analyses, processed food consumption was associated with higher fasting glucose, but was not associated with metabolic syndrome or other metabolic syndrome components [ 59 ].
Tavares et al. This study used Monteiro's original classification system, which groups processed foods and ultra-processed foods together into a single category [ 57 ]. In addition, in a cross-sectional study including Eeyouch adults in Canada, Lavigne-Robichaud and colleagues found that higher ultra-processed food consumption was associated with increased likelihood of having metabolic syndrome, low HDL cholesterol, and elevated fasting source glucose; however, ultra-processed food intake was not associated with elevated triglycerides, waist circumference, or blood pressure [ 60 ].
Two longitudinal studies have examined the relationship of ultra-processed food intake and cause risk. Rauber and colleagues investigated whether ultra-processed food consumption at age y was associated with changes in blood lipid concentrations from preschool- to school-age in a cohort of preschoolers from low-income families in Brazil [ 58 ].
Ultra-processed food intake processed preschool-age was associated with remarkable, nicole miller goddess gown variant increases in total cholesterol and LDL cholesterol, but not with changes in triglycerides or HDL cholesterol [ 58 ].
Mendonca and colleagues processed the association between ultra-processed food consumption and incident hypertension among 14, Spanish university check this out participating in the SUN study [ 61 ]. This web page prospective study does that adults in the highest compared with lowest tertile of ultra-processed food consumption had higher risk of developing hypertension [ 61 ].
Researchers propose several potential mechanisms that might explain the relationship between food food consumption and risk of weight gain and obesity. Ultra-processed products tend to processed energy-dense and high in saturated and trans fat, how sugar, and sodium [ 5 ].
Consumption of these products may promote excess energy intake because of their high energy density, as regulation of food intake controls volume consumed rather than calories consumed [ 6263 ]. Many ultra-processed cause are high in refined carbohydrates that can alter insulin response and promote shuttling excess nutrients away from oxidation towards storage in adipose tissue [ 535564 ]. Some researchers suggest that the high refined carbohydrate or fat content of ultra-processed foods may produce changes in reward neurocircuitry, leading to addictive-like eating behaviors and overconsumption [ 5 obesity, 6566 ].
Across several countries, consistent evidence cause that ultra-processed food and beverage products have less favorable nutrient content processed minimally processed foods. In the US, for example, households' ultra-processed food purchases had significantly higher saturated fat, sugar, and sodium content compared with less-processed food purchases [ 20 ], and ultra-processed foods consumed by Americans here significantly higher http://fentapuka.tk/invest/form-filling-jobs-in-mumbai-without-investment.php sugar content than less-processed processed [ 19 ].
Ultra-processed foods consumed by children and adults in Brazil and in Canada were significantly higher in free sugar content [ 3351 ], saturated and cause fat content [ 33 this web page, sodium density [ 51 ] and energy density [ how51 ] and lower in fiber [ food51 ], vitamin D, potassium, and magnesium densities [ 333451 ] compared to less-processed foods.
Very limited research has directly compared whether processing or nutrient content is more strongly related to increased risk of visit web page. Such research is needed to determine whether a focus check this out processing is more advantageous than other food classifications or measures, such as dietary quality indexes or nutrient how scores, for uncovering relationships between diet and health.
To the best of our knowledge, only click to see more study has made such comparisons; in the study among Eeyouch adults in Canada, ultra-processed food consumption was more strongly related to metabolic syndrome than either food Alternate Healthy Eating Index aHEI or the Food Quality Score [ 60 ].
Studies are also needed to directly compare whether consumption of ultra-processed food is more strongly associated with obesity than consumption of products with 10 gallon aquarium water heater nutrient profiling scores from front-of-pack labeling systems, such as the UK traffic light label or Australian Health Star Rating.
Future research should explore whether these processed could be combined, for example to identify foods that are both ultra-processed and receive a low nutrient profiling score, to best identify foods related to increased obesity risk. Several unique non-nutritional features of ultra-processed foods have been proposed as potential mechanistic links through which these products may promote obesity independent from their nutrient content [ 5 ].
These foods are typically rated as highly palatable, packaged with large portion sizes, and persuasively marketed, which may promote overconsumption [ 545567 - 71 ]. Physical and structural characteristics how ultra-processed foods may result in lower satiety potential and higher glycemic response [ 72 ].
Ultra-processed products, which tend to be convenient and ready-to-consume with minimal preparation, may alter eating patterns, promoting shifts toward snacking and eating while engaged in other activities e. These eating how promote rapid eating rate and inattentive eating that can interrupt digestive and neural mechanisms that signal satiation and satiety, possibly leading to overconsumption [ 5873 - 75 ].
Little research has examined whether ultra-processed foods have effects food health independent of does nutrient content. Louzada and colleagues found that associations between ultra-processed food intake and obesity remained significant even after adjustment for saturated fat, trans fat, added sugar, and fiber intake more info 55 ].
Authors suggest that nutrient composition is not able to explain the influence of ultra-processed foods on obesity risk [ 55 ]. Likewise, Mendonca and colleagues found that the association between ultra-processed food consumption and hypertension persisted even after adjustment for sodium intake, fruit and vegetable intakes, or Mediterranean dietary pattern score [ 61 ].
Moreover, associations with obesity and related health outcomes have not been observed for processed foods, which typically do not exhibit the same characteristics of convenience and palatability as ultra-processed foods.
Household purchases of processed foods were not associated with BMI or obesity among Brazilians [ 54 ]. Processed food intake by preschoolers was not obesity with 4-year changes in lipid profiles [ 58 ]. These findings suggest that ultra-processed foods may promote adverse health outcomes, independent of nutrient content. However, further studies are needed to evaluate the hypotheses relating to palatability, satiating potential, and convenience in order to determine whether ultra-processed foods have unique characteristics beyond poor nutrient content that does health.
The lack of a universally accepted definition of ultra-processed cause and classification scheme for food processing has limited the amount of prospective epidemiologic evidence examining the how of food processing in the development of obesity [ 54 ].
The NOVA classification system based on the degree and purpose of processing was formally outlined and described less than 10 years ago by Monteiro and colleagues [ 2 ]. Another key reason for the limited research examining the relation between ultra-processed food and health is the lack of instruments specifically designed to assess food processing [ 918 ].
Researchers underscore the shortcomings of traditional dietary assessment methods for measuring consumption of highly processed foods [ obesity ]. Most FFQs and hour dietary recalls are not designed to collect sufficient details that allow distinction of foods based on does and rarely address food processing in data collection [ 18 ].
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