Abstract
Ultra-processed food consumption has been associated with several health outcomes such as obesity, hypertension, cardiovascular disease and cancer. The deleterious nutrient profile of these products, and the presence of food additives, neoformed contaminants and contact materials such as phthalates and bisphenol may be some of the potential pathways through which ultra-processed food influences disease outcomes. The aim of this study was to examine the association between dietary contribution of ultra-processed foods and urinary biomarker concentrations of parent compounds or their metabolites including Di(2-ethylhexyl) phthalate (ΣDEHP), Di-isononyl phthalate (ΣDiNP), Monocarboxynonyl phthalate (mCNP), Mono (3-carboxypropyl) phthalate (mCPP), Monobenzyl phthalate (mBzP), Bisphenol A (BPA), Bisphenol F (BPF) and Bisphenol S (BPS), in the US. Participants from the cross-sectional 2009-2016 National Health and Nutrition Examination Survey, aged 6+ years, with urinary measures and with one 24-hour dietary recall were included in the study. Ultra-processed foods were identified based on the NOVA classification system, a four-group food classification based on the extent and purpose of industrial food processing. Linear regression was used to compare average urinary creatinine-standardized concentrations across quintiles of energy contribution of ultra-processed foods. Models incorporated survey sample weights and were adjusted for different sociodemographic and life-style variables. Adjusted geometric means of ΣDiNP, mCNP, mCPP, mBzP and BPF increased monotonically from the lowest to the highest quintile of ultra-processed food consumption. As both phthalates/bisphenol and ultra-processed foods have been previously associated with insulin resistance, diabetes, general/abdominal obesity and hypertension, our results suggest the possibility of contact materials in ultra-processed foods as one link between ultra-processed food and these health outcomes. Future studies could confirm findings and further explore these mechanisms of action.
Highlights
Ultra-processed foods are defined by NOVA classification, as industrial formulations of food-derived substances that contain little or no whole food and often include flavorings, colorings, emulsifiers and other cosmetic additives [1]
Concentrations of some biomarkers varied according to BMI status, physical activity and smoking status
Levels varied according to excess total energy intake and excess total fat intakes, and fat in ultra-processed foods derived total energy intake
Summary
Ultra-processed foods are defined by NOVA (not an acronym) classification, as industrial formulations of food-derived substances (such as oils, fats, sugars, starch, protein isolates) that contain little or no whole food and often include flavorings, colorings, emulsifiers and other cosmetic additives [1]. Ultra-processed foods have a higher content in total fat, saturated fat, added sugar, energy density, and salt, together with a lower fibre, vitamin and mineral density, as compared to non-ultra-processed foods. Their consumption results in an overall deterioration of the nutritional quality of the diet [1, 19]. Cosmetic additives frequently added to ultra-processed foods (such as glutamates, emulsifiers, sulfites and carrageenan) or several compounds that are neoformed during their processing (such as acrylamide or acrolein) could promote disease [14]. The fact that diets were matched for total calories, macronutrients and fiber, suggests that mechanisms other than the dietary nutrient profile, like quicker eating time or reduced signs of satiety, might explain these results [22]
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