Advertisement

Potential reductions in ultra-processed food consumption substantially improve population cardiometabolic-related dietary nutrient profiles in eight countries

  • E. Martinez Steele
    Correspondence
    Corresponding author. Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, Av. Dr. Arnaldo, 715, São Paulo 01246-907, Brazil.
    Affiliations
    Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil

    Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
    Search for articles by this author
  • J.A. Marrón Ponce
    Affiliations
    Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
    Search for articles by this author
  • G. Cediel
    Affiliations
    Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil

    School of Nutrition and Dietetics, University of Antioquia, Medellín, Colombia
    Search for articles by this author
  • M.L.C. Louzada
    Affiliations
    Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil

    Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
    Search for articles by this author
  • N. Khandpur
    Affiliations
    Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil

    Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil

    Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
    Search for articles by this author
  • P. Machado
    Affiliations
    Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil

    Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong 3220, Australia
    Search for articles by this author
  • J.-C. Moubarac
    Affiliations
    Département de Nutrition, Université de Montréal, Montréal, Canada
    Search for articles by this author
  • F. Rauber
    Affiliations
    Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil

    Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil

    Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
    Search for articles by this author
  • C. Corvalán
    Affiliations
    CIAPEC, Unidad de Nutrición Pública, INTA, Universidad de Chile, Chile
    Search for articles by this author
  • R.B. Levy
    Affiliations
    Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil

    Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
    Search for articles by this author
  • C.A. Monteiro
    Affiliations
    Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil

    Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
    Search for articles by this author
Published:September 02, 2022DOI:https://doi.org/10.1016/j.numecd.2022.08.018

      Highlights

      • Potential UPF drop in eight countries reduces inadequate nutrient intakes.
      • Higher reductions would be observed for diets with multiple nutrient inadequacies.
      • Lowering UPF is a way to improve CVD-related nutrient profile.

      Abstract

      Background and aims

      The negative effect on dietary nutrient profiles is the most obvious mechanism explaining the higher risk of cardiometabolic diseases associated with increased dietary share of UPF observed in large cohort studies.
      We estimate the proportion of diets with excessive energy density, excessive free sugars or saturated fat contents and insufficient fiber that could be avoided, if UPF consumption was reduced to levels among lowest consumers across eight countries, as well as the proportion of diets with multiple inadequacies.

      Methods and results

      Using nationally-representative cross-sectional surveys from Brazil (2008–09), Chile (2010), Colombia (2005), Mexico (2012), Australia (2011–12), the UK (2008–16), Canada (2015), and the US (2015–16), inadequate energy density (≥2.25 kcal/g) or contents of free sugars (>10% of total energy intake), saturated fats (>10% of total energy intake) and fiber (<25 g/2000 kcal) population attributable fractions were quantified.
      Substantial reductions in nutrient inadequacies would be observed ranging from 50.4% in Chile to 76.8% in US for dietary energy density, from 15.5% in Colombia to 68.4% in Australia for free sugars, from 9.5% in Canada to 35.0% in Mexico for saturated fats, and from 10.3% in UK to 37.9% in Mexico for fiber. Higher reductions would be observed for diets with multiple nutrient inadequacies: from 27.3% in UK to 77.7% in Australia for ≥3 and from 69.4% in Canada to 92.1% in US, for 4 inadequacies.

      Conclusions

      Lowering dietary contribution of UPF to levels among country-specific lowest consumers is a way to improve population cardiometabolic-related dietary nutrient profiles.

      Keywords

      Abbreviations:

      Population attributable fraction (PAF), Confidence interval (CI), Ultra-processed foods (UPF)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Nutrition, Metabolism and Cardiovascular Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • National Academies of Sciences, Engineering, and Medicine
        High and rising mortality rates among working-age adults. Chapter: 9 Cardiometabolic Diseases.
        The National Academies Press, Washington, DC2021https://doi.org/10.17226/25976
      1. World Health Organization. Cardiovascular diseases (CVDs) fact sheet. WHO. www.who.int/news-room/factsheets/detail/cardiovascular-diseases-(cvds)

        • Roth G.A.
        • Johnson C.
        • Abajobir A.
        • Abd-Allah F.
        • Abera S.F.
        • Abyu G.
        • et al.
        Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015.
        J Am Coll Cardiol. 2017; (PMID: 28527533)
        • Lichtenstein A.H.
        • Appel L.J.
        • Vadiveloo M.
        • Hu F.B.
        • Kris-Etherton P.M.
        • Rebholz C.M.
        • et al.
        2021 Dietary guidance to improve cardiovascular health: a scientific statement from the American heart association.
        Circulation. 2021; 144 (Dec 7) (Epub 2021 Nov 2. PMID: 34724806): e472-e487https://doi.org/10.1161/CIR.0000000000001031
        • Monteiro C.A.
        • Cannon G.
        • Levy R.B.
        • Moubarac J.C.
        • Louzada M.L.
        • Rauber F.
        • et al.
        Ultra-processed foods: what they are and how to identify them.
        Publ Health Nutr. 2019; 22 (Apr): 936-941https://doi.org/10.1017/S1368980018003762
        • Srour B.
        • Fezeu L.K.
        • Kesse-Guyot E.
        • Allès B.
        • Méjean C.
        • Andrianasolo R.M.
        • et al.
        Ultra-processed food intake and risk of cardiovascular disease: prospective cohort study (NutriNet-Santé).
        BMJ. 2019; 365 (May 29): l1451https://doi.org/10.1136/bmj.l1451
        • Juul F.
        • Vaidean G.
        • Lipon Y.
        • Deierlein A.L.
        • Parekh N.
        Ultra-processed foods and incident cardiovascular disease in the framingham offspring study.
        J Am Coll Cardiol. 2021; 77 (Mar 30) (PMID: 33766258): 1520-1531https://doi.org/10.1016/j.jacc.2021.01.047
        • Mendonça R.D.
        • Lopes A.C.
        • Pimenta A.M.
        • Gea A.
        • Martinez-Gonzalez M.A.
        • Bes-Rastrollo M.
        Ultra-processed food consumption and the incidence of hypertension in a mediterranean cohort: the seguimiento universidad de Navarra project.
        Am J Hypertens. 2017; 30: 358-366
        • Srour B.
        • Fezeu L.K.
        • Kesse-Guyot E.
        • Allès B.
        • Debras C.
        • Druesne-Pecollo N.
        • et al.
        Ultraprocessed food consumption and risk of type 2 diabetes among participants of the NutriNet-santé prospective cohort.
        JAMA Intern Med. 2019; (Dec 16)https://doi.org/10.1001/jamainternmed.2019.5942
        • Levy R.B.
        • Rauber F.
        • Chang K.
        • Louzada M.L.D.C.
        • Monteiro C.A.
        • Millett C.
        • et al.
        Ultra-processed food consumption and type 2 diabetes incidence: a prospective cohort study.
        Clin Nutr. 2021; 40 (May) (Epub 2020 Dec 28): 3608-3614https://doi.org/10.1016/j.clnu.2020.12.018
        • Llavero-Valero M.
        • Escalada-San Martín J.
        • Martínez-González M.A.
        • Basterra-Gortari F.J.
        • de la Fuente-Arrillaga C.
        • Bes-Rastrollo M.
        Ultra-processed foods and type-2 diabetes risk in the SUN project: a prospective cohort study.
        Clin Nutr. 2021; 40 (May) (Epub 2021 Apr 5): 2817-2824https://doi.org/10.1016/j.clnu.2021.03.039
        • Rauber F.
        • Campagnolo P.D.
        • Hoffman D.J.
        • Vitolo M.R.
        Consumption of ultra-processed food products and its effects on children's lipid profiles: a longitudinal study.
        Nutr Metabol Cardiovasc Dis. 2015; 25: 116-122https://doi.org/10.1016/j.numecd.2014.08.001
        • Mendonça R.D.
        • Pimenta A.M.
        • Gea A.
        • de la Fuente-Arrillaga C.
        • Martinez-Gonzalez M.A.
        • Lopes A.C.
        • et al.
        Ultraprocessed food consumption and risk of overweight and obesity: the University of Navarra Follow-Up (SUN) cohort study.
        Am J Clin Nutr. 2016; 104: 1433-1440https://doi.org/10.3945/ajcn.116.135004
        • Beslay M.
        • Srour B.
        • Méjean C.
        • Allès B.
        • Fiolet T.
        • Debras C.
        • et al.
        Ultra-processed food intake in association with BMI change and risk of overweight and obesity: a prospective analysis of the French NutriNet-Santé cohort.
        PLoS Med. 2020; 17 (Aug 27) (PMID: 32853224; PMCID: PMC7451582)e1003256https://doi.org/10.1371/journal.pmed.1003256
        • Schnabel L.
        • Kesse-Guyot E.
        • Allès B.
        • Touvier M.
        • Srour B.
        • Hercberg S.
        • et al.
        Association between ultraprocessed food consumption and risk of mortality among middle-aged adults in France.
        JAMA Intern Med. 2019; 179 (Apr 1): 490-498https://doi.org/10.1001/jamainternmed.2018.7289
        • Hall K.D.
        • Ayuketah A.
        • Brychta R.
        • Cai H.
        • Cassimatis T.
        • Chen K.Y.
        • et al.
        Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake.
        Cell Metabol. 2019; 30 (Jul 2) (e3 Epub 2019 May 16): 67-77https://doi.org/10.1016/j.cmet.2019.05.008
        • Juul F.
        • Vaidean G.
        • Parekh N.
        Ultra-processed foods and cardiovascular diseases: potential mechanisms of action.
        Adv Nutr. 2021; 12 (Oct 1) (PMID: 33942057; PMCID: PMC8483964): 1673-1680https://doi.org/10.1093/advances/nmab049
        • Costa Louzada M.L.
        • Martins A.P.
        • Canella D.S.
        • Baraldi L.G.
        • Levy R.B.
        • Claro R.M.
        • et al.
        Ultra-processed foods and the nutritional dietary profile in Brazil.
        Rev Saude Publica. 2015; 49: 38https://doi.org/10.1590/S0034-8910.2015049006132
        • Cediel G.
        • Reyes M.
        • Corvalán C.
        • Levy R.
        • Uauy R.
        • Monteiro C.
        Ultra-processed foods drive to unhealthy diets: evidence from Chile.
        Publ Health Nutr. 2020; 1–10 ([Epub ahead of print]) (PMID: 32338229)https://doi.org/10.1017/S1368980019004737
        • Parra D.C.
        • da Costa-Louzada M.L.
        • Moubarac J.C.
        • Bertazzi-Levy R.
        • Khandpur N.
        • Cediel G.
        • et al.
        Association between ultra-processed food consumption and the nutrient profile of the Colombian diet in 2005.
        Salud Publica Mex. 2019; 61 (Mar-Apr): 147-154https://doi.org/10.21149/9038
        • Marrón-Ponce J.A.
        • Flores M.
        • Cediel G.
        • Monteiro C.A.
        • Batis C.
        Associations between consumption of ultra-processed foods and intake of nutrients related to chronic non-communicable diseases in Mexico.
        J Acad Nutr Diet. 2019; S2212–2672: 31402-31403https://doi.org/10.1016/j.jand.2019.04.020
        • Machado P.P.
        • Martinez Steele E.
        • Levy R.
        • Sui Z.
        • Rangan A.
        • Woods J.
        • et al.
        Ultra-processed foods and recommended intake levels of nutrients linked to non-communicable diseases in Australia: evidence from a nationally representative cross-sectional study.
        BMJ Open. 2019; 9 (Aug 28)e029544https://doi.org/10.1136/bmjopen-2019-029544
        • Rauber F.
        • da Costa Louzada M.L.
        • Steele E.M.
        • Millett C.
        • Monteiro C.A.
        • Levy R.B.
        Ultra-processed food consumption and chronic non-communicable diseases-related dietary nutrient profile in the UK (2008⁻2014).
        Nutrients. 2018; 10 (May 9)https://doi.org/10.3390/nu10050587
        • Moubarac J.C.
        • Batal M.
        • Louzada M.L.
        • Martinez Steele E.
        • Monteiro C.A.
        Consumption of ultra-processed foods predicts diet quality in Canada.
        Appetite. 2017; 108 (Jan 1) (Epub 2016 Nov 4): 512-520https://doi.org/10.1016/j.appet.2016.11.006
        • Martínez Steele E.
        • Popkin B.M.
        • Swinburn B.
        • Monteiro C.A.
        The share of ultra-processed foods and the overall nutritional quality of diets in the US: evidence from a nationally representative cross-sectional study.
        Popul Health Metrics. 2017; 15 (Feb 14): 6https://doi.org/10.1186/s12963-017-0119-3
        • Mozaffarian D.
        Dietary and policy priorities for cardiovascular disease, diabetes, and obesity: a comprehensive review.
        Circulation. 2016; 133: 187-225https://doi.org/10.1161/CIRCULATIONAHA.115.018585
        • Steele E.M.
        • Batis C.
        • Cediel G.
        • Louzada M.L.D.C.
        • Khandpur N.
        • Machado P.
        • et al.
        The burden of excessive saturated fatty acid intake attributed to ultra-processed food consumption: a study conducted with nationally representative cross-sectional studies from eight countries.
        J Nutr Sci. 2021; 10 (Jun 4) (PMID: 34164122; PMCID: PMC8190718): e43https://doi.org/10.1017/jns.2021.30
        • World Cancer Research Fund
        Food, nutrition, physical activity, and the prevention of cancer: a global perspective.
        American Institute for Cancer Research, Washington: DC2007
        • World Health Organization
        Healthy diet. Fact sheet N°394.
        World Health Organization, Geneva2018
      2. Draft guidelines on saturated fatty acid and trans-fatty acid intake for adults and children. WHO, 2018
        • Joint WHO/FAO
        Expert consultation on diet, nutrition and the prevention of chronic diseases (2002: geneva, Switzerland) World health organization. Diet, nutrition and the prevention of chronic diseases.
        Report of a joint FAO/WHO Expert Consultation. 2003; 916 (World Heal Organ Tech Rep Ser [Internet]) ([cited 2017 Dec 13]): 61-71
        • Steenland K.
        • Armstrong B.
        An overview of methods for calculating the burden of disease due to specific risk factors.
        Epidemiology. 2006; 17: 512-519
        • Rezende L.F.M.
        • Eluf-Neto J.
        Population attributable fraction: planning of diseases prevention actions in Brazil.
        Rev Saude Publica. 2016; 50: 30
        • Luiten C.M.
        • Steenhuis I.H.
        • Eyles H.
        • Ni Mhurchu C.
        • Waterlander W.E.
        Ultra-processed foods have the worst nutrient profile, yet they are the most available packaged products in a sample of New Zealand supermarkets--CORRIGENDUM.
        Publ Health Nutr. 2016; 19: 539https://doi.org/10.1017/S1368980015002840
        • Buttriss J.L.
        Food reformulation: the challenges to the food industry.
        Proc Nutr Soc. 2013; 72 (Feb) (Epub 2012 Dec 11. PMID: 23228239): 61-69https://doi.org/10.1017/S0029665112002868
        • Vaclavik Vickie A.
        • Christian Elizabeth W.
        Essentials of food science.
        4th ed. Springer, US2014
        • Mba O.I.
        • Dumont M.J.
        • Ngadi M.
        Palm oil: processing, characterization and utilization in the food industry – a review.
        Food Biosci. 2015; : 26-41https://doi.org/10.1016/j.fbio.2015.01.003
        • Ozyurt V.H.
        • Ötles S.
        Effect of food processing on the physicochemical properties of dietary fibre.
        Acta Sci Pol Technol Aliment. 2016; 15 (Jul-Sep) (PMID: 28071023): 233-245https://doi.org/10.17306/J.AFS.2016.3.23
        • Guillon F.
        • Champ M.
        Structural and physical properties of dietary fibres, and consequences of processing on human physiology.
        Food Res Int. 2000; 33: 233-245
        • Scrinis G.
        • Monteiro C.A.
        Ultra-processed foods and the limits of product reformulation.
        Publ Health Nutr. 2018; 21 (Jan) (Epub 2017 Jul 13. PMID: 28703086): 247-252https://doi.org/10.1017/S1368980017001392
        • Lichtenstein A.H.
        • Appel L.J.
        • Vadiveloo M.
        • Hu F.B.
        • Kris-Etherton P.M.
        • Rebholz C.M.
        • et al.
        American heart association council on lifestyle and cardiometabolic health; council on arteriosclerosis, thrombosis and vascular biology; council on cardiovascular radiology and intervention; council on clinical cardiology; and stroke council. 2021 dietary guidance to improve cardiovascular health: a scientific statement from the American heart association.
        Circulation. 2021; (Nov 2:CIR0000000000001031) (Epub ahead of print. PMID: 34724806)https://doi.org/10.1161/CIR.0000000000001031
        • Baker P.
        • Machado P.
        • Santos T.
        • Sievert K.
        • Backholer K.
        • Hadjikakou M.
        • et al.
        Ultra-processed foods and the nutrition transition: global, regional and national trends, food systems transformations and political economy drivers.
        Obes Rev. 2020; 21 (Dec) (Epub 2020 Aug 6. PMID: 32761763)e13126https://doi.org/10.1111/obr.13126
        • Popkin B.M.
        • Barquera S.
        • Corvalan C.
        • Hofman K.J.
        • Monteiro C.
        • Ng S.W.
        • et al.
        Towards unified and impactful policies to reduce ultra-processed food consumption and promote healthier eating.
        Lancet Diabetes Endocrinol. 2021; 9 (Jul) (Epub 2021 Apr 15. PMID: 33865500; PMCID: PMC821714): 462-470https://doi.org/10.1016/S2213-8587(21)00078-4
        • Prentice R.L.
        • Mossavar-Rahmani Y.
        • Huang Y.
        • Van Horn L.
        • Beresford S.A.
        • Caan B.
        • et al.
        Evaluation and comparison of food records, recalls, and frequencies for energy and protein assessment by using recovery biomarkers.
        Am J Epidemiol. 2011; 174: 591-603
        • Herrick K.A.
        • Rossen L.M.
        • Parsons R.
        • Dodd K.W.
        Estimating usual dietary intake from national health and nutrition examination survey data using the National Cancer Institute method.
        Vital Health Stat. 2018; 2 (National Center for Health Statistics)
        • World Health Organization
        Follow-up to the political declaration of the high-level meeting of the general assembly on the prevention and control of non-communicable diseases: sixty-sixth World health assembly (WHA66.10).
        World Health Organization, Geneva, Switzerland2013
        • McLean R.M.
        Measuring population sodium intake: a review of methods.
        Nutrients. 2014; 6 (Published 2014 Oct 28): 4651-4662https://doi.org/10.3390/nu6114651
        • Baraldi L.G.
        • Martinez Steele E.
        • Canella D.S.
        • Monteiro C.A.
        Consumption of ultra-processed foods and associated sociodemographic factors in the USA between 2007 and 2012: evidence from a nationally representative cross-sectional study.
        BMJ Open. 2018; 8 (Mar 9) (PMID: 29525772; PMCID: PMC5855172)e020574https://doi.org/10.1136/bmjopen-2017-020574
        • Vandevijvere S.
        • Pedroni C.
        • De Ridder K.
        • Castetbon K.
        The cost of diets according to their caloric share of ultraprocessed and minimally processed foods in Belgium.
        Nutrients. 2020; 12 (Sep 11) (PMID: 32933051; PMCID: PMC7551888): 2787https://doi.org/10.3390/nu12092787