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The Role of Diet Quality in Mediating the Association between Ultra-Processed Food Intake, Obesity and Health-Related Outcomes: A Review of Prospective Cohort Studies.
Dicken, SJ, Batterham, RL
Nutrients. 2021;14(1)
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Diet has long been a cornerstone of weight management, with dietary policies being a core feature of government and health organisation strategies to reduce obesity worldwide. Indeed, poor diets are a leading cause of preventable obesity-related death and non-communicable diseases, including cancer, cardiovascular disease and type 2 diabetes. The aim of this study was to provide novel insights into the relative impact of nutrient content and dietary patterns vs. ultra-processing on obesity and adverse health-related outcomes. This study is a review of prospective cohort studies. Findings show that adjustment for fat, sugar and sodium intake, or adjustment for adherence to a range of healthy or unhealthy dietary patterns has a minimal impact on the adverse associations between UPF intake and a diverse range of health-related outcomes. Authors conclude that their findings raise important questions regarding current policy and future research needs, suggesting that the nature and extent of processing is an important dietary dimension.
Abstract
Prospective cohort studies show that higher intakes of ultra-processed food (UPF) increase the risk of obesity and obesity-related outcomes, including cardiovascular disease, cancer and type 2 diabetes. Whether ultra-processing itself is detrimental, or whether UPFs just have a lower nutritional quality, is debated. Higher UPF intakes are inversely associated with fruit, vegetables, legumes and seafood consumption. Therefore, the association between UPFs and poor health could simply be from excess nutrient intake or from a less healthful dietary pattern. If so, adjustment for dietary quality or pattern should explain or greatly reduce the size of the significant associations between UPFs and health-related outcomes. Here, we provide an overview of the literature and by using a novel approach, review the relative impact of adjusting for diet quality/patterns on the reported associations between UPF intake and health-related outcomes in prospective cohort studies. We find that the majority of the associations between UPFs, obesity and health-related outcomes remain significant and unchanged in magnitude after adjustment for diet quality or pattern. Our findings suggest that the adverse consequences of UPFs are independent of dietary quality or pattern, questioning the utility of reformulation to mitigate against the obesity pandemic and wider negative health outcomes of UPFs.
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Ultra-Processed Food Consumption and Adult Diabetes Risk: A Systematic Review and Dose-Response Meta-Analysis.
Moradi, S, Hojjati Kermani, MA, Bagheri, R, Mohammadi, H, Jayedi, A, Lane, MM, Asbaghi, O, Mehrabani, S, Suzuki, K
Nutrients. 2021;13(12)
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The growing incidence of chronic non-communicable diseases such as type two diabetes mellitus (T2DM) is the major healthcare concern worldwide. The aim of this study was to build on previous work by synthesizing the findings of observational studies investigating the association between ultra-processed food (UPF) intake and the risk of T2DM. This study is a systematic review and dose-response meta-analysis of five studies. Of the five included studies, four were prospective cohort study designs and the other was cross-sectional. Results demonstrate that higher UPF intake was associated with an increased risk of T2DM. Additionally, increasing the intake of processed foods by 10% leads to a 15% increase in the risk of T2DM. A linear positive association was found between UPF intake and the risk of T2DM. Authors conclude by pointing out that to be able to estimate better the actual burden of UPF intakes, new tools should be adapted or progressed to evaluate all UPF consumption dimensions, namely food class, UPF foods specific components, their effects on health and specific processes or additives.
Abstract
(1) Background: Recent individual studies have demonstrated that consumption of ultra-processed food (UPF) may be related to type two diabetes mellitus (T2DM). We aimed to synthesize the results from these individual studies by conducting an updated systematic review and meta-analysis of observational studies evaluating the association between UPF consumption and the risk of T2DM. (2) Methods: A systematic search was conducted using ISI Web of Science, PubMed/MEDLINE and Scopus electronic databases from inception up to August 2021. Data were extracted from five studies (one cross-sectional study and four cohort studies, totaling 230,526 adults from four different countries). Risk ratios (RR) of pooled results were estimated using a random-effects model. (3) Results: Our results revealed that higher UPF consumption was significantly associated with an increased risk of T2DM (RR = 1.74; 95% CI: 1.36, 2.22; I2 = 68.9%; p < 0.001; n = 5). Linear dose-response analysis indicated that each 10% increase in UPF consumption (kcal/d) was associated with a 15% higher risk of T2DM (RR = 1.15; 95% CI: 1.06, 1.26; I2 = 86.0%; p < 0.001; n = 5) among adults. Non-linear dose-response analysis demonstrated a positive linear association between UPF consumption and T2DM (pnonlinearity = 0.13, pdose-response < 0.001; n = 5) among adults. (4) Conclusions: A higher intake of UPF was significantly associated with an increased risk of T2DM. However, underlying mechanisms remain unknown and future experimental studies are warranted.