Higher consumption of ultra-processed foods is associated with increased risk of fracture among adults: findings from China Health and Nutrition Survey.

Aims: We aimed to assess the association between ultra-processed food (UPF) consumption with diabetes in Chinese adults. Methods: This study included 12,849 eligible adults aged 20 years and over attending at least two surveys in the China Nutrition and Health Survey during 1997–2011. Food intake at each survey was assessed by a 3-day 24-h dietary recall method. UPF was defined based on the NOVA classification. Diabetes was obtained from questionnaires and/or ascertained by fasting blood tests. The association of diabetes with UPF was examined using mix effect logistic regression adjusting for potential confounding factors. Results: The mean age of the participants was 43.3 (SD 14.8) years. The age and gender adjusted mean UPF intake increased four times and the prevalence of diabetes increased eight times in 1997–2011. Compared with non-consumers, the odds ratios (95% CI) of diabetes for those with mean UPF consumption of 1–19 g/day, 20–49 g/day, and ≥50 g/day were 1.21 (0.98, 1.48), 1.49 (1.19, 1.86), and 1.40 (1.08, 1.80), respectively (p trend < 0.001) after adjusted for the measured covariates including lifestyle factors (smoking, alcohol drinking, and physical activity), BMI and hypertension. Conclusions: both UPF consumption and prevalence of diabetes increased among adults in China during 1997–2011. Higher UPF consumption was positively associated with diabetes.

The prevalence of metabolic syndrome (MetS) is increasing and the relationship between ultra-processed food (UPF) consumption and MetS remains uncertain in Chinese adults. This study aimed to examine the longitudinal association of UPF consumption with the risk of MetS and its components in Chinese adults. Adults aged 18 years and above who participated in at least two waves of the China Health and Nutrition Survey (CHNS) in 2009, 2015, and 2018 were included in this analysis. Dietary intake data were collected by three consecutive 24 h dietary recalls and weighing household foods and condiments. Depending on the purpose and extent of food processing, UPFs were classified using the NOVA food classification system. A multivariate Cox proportional risk model was used to explore the association between UPF consumption (grouped by quartile: quartile 1 (Q1), quartile 2 (Q2), quartile 3 (Q3), and quartile 4 (Q4)) and risk of MetS and its components. A total of 5147 adults were included. During a median (IQR) 6.0 (3.0, 9.0) year follow-up with 31,878 person-years, 1712 MetS cases were identified, with an incidence of 33.26%. After multivariable adjustment, the risk of MetS was increased by 17% in the highest quartile with UPF consumption (HR: 1.17, 95% CI: 1.01–1.35, p trend: 0.047), with the lowest quartile as a reference. For the components of MetS, the risk of central obesity, raised triglycerides (TG), reduced high-density lipoprotein cholesterol (HDL-C), and raised blood pressure (BP) was increased by 33% (HR: 1.33, 95% CI: 1.18–1.51, p trend: <0.001), 26% (HR: 1.26, 95% CI: 1.08–1.48, p trend: 0.003), 25% (HR: 1.25, 95% CI: 1.07–1.46, p trend: 0.007), and 16% (HR: 1.16, 95% CI: 1.03–1.32, p trend: 0.018) in the highest quartile with UPF consumption, respectively. Adults aged 45–59 years and living in urban areas with higher UPF consumption had higher odds of MetS. These results indicate that higher long-term UPF consumption was associated with an increased risk of MetS in Chinese adults. Further studies such as intervention trials are needed to confirm the mechanism of correlation between UPF consumption and health-related outcomes. Nutritional education actions are warranted to promote a balanced diet and improve the overall dietary quality of residents to reduce the risk of MetS effectively.

The association between the consumption of ultra-processed food (UPF) with overweight/obesity in Chinese adults has not been investigated. This study included a cohort of 12,451 adults aged >20 years who participated at least twice in the China Nutrition and Health Survey (CNHS) during 1997–2011. Food intake at each survey was assessed using a 3-day 24-h dietary recall. Body weight (kg), height (m), and waist circumference (WC) were measured during the survey. UPF was defined by the NOVA classification. Mixed effect logistic regression analyses were used. The mean UPF consumption of the study population (baseline mean age 43.7 years) increased from 12.0 g in 1997 to 41.5 g in 2011 with the corresponding proportion of UPF in daily diet from 1.0% to 3.6%. The adjusted odds ratios (95% CI) for BMI ≥ 25 kg/m2 for those with mean UPF consumption of 1–19 g/d, 20–49 g/d, and ≥50 g/d were 1.45 (1.26–1.65), 1.34 (1.15–1.57), and 1.45 (1.21–1.74), respectively (p-trend = 0.015), compared with the non-consumers. Similarly, the corresponding adjusted ORs (95% CI) for central obesity were 1.54 (1.38–1.72), 1.35 (1.19–1.54), and 1.50 (1.29–1.74). Higher long-term UPF consumption was associated with increased risk of overweight/obesity among Chinese adults.

Attention-deficit/hyperactivity disorder (ADHD) has been linked to unhealthy dietary patterns, but its association with ultra-processed food (UPF) consumption remains underexplored. This study assessed the association between ADHD and UPF intake among children. Data were obtained from the 2015-2016 Israeli Kids Health and Nutrition Survey, a nationally representative cross-sectional study. Parents/guardians provided demographic, health, and dietary information via face-to-face interviews. Anthropometrics were measured, and dietary intake was assessed using a 24-hour recall. UPF consumption (grams/day and % of total food weight) was classified by the NOVA system and categorized by the median. Adjusted logistic and linear regressions examined associations between ADHD and UPF. Of 1135 children aged 6-11 years included, 111 had physician-diagnosed ADHD. Median UPF intake was 342.9 grams/day and 16.7% of total food weight. Adjusted for age, sex, socioeconomic status, and intakes of energy, dietary fiber, and alpha-linolenic acid, ADHD was significantly associated with above-median UPF consumption, as grams/day (OR = 1.622, 95% CI: 1.010-2.604) and as % of total food weight (OR = 1.652, 95% CI: 1.058-2.578). Linear regression models yielded similar associations. No differences in UPF intake were found by stimulant treatment status. ADHD is associated with higher UPF consumption, with potential influences in either direction. This study is the first to demonstrate an adjusted association between physician-diagnosed attention-deficit/hyperactivity disorder (ADHD) and higher consumption of ultra-processed foods (UPFs) in children, both in absolute food weight and as a percentage of total food weight intake, independent of stimulant treatment status. Findings add to the literature by moving beyond general unhealthy dietary patterns to focus on UPF intake, a growing public health concern. The observed association may reflect ADHD-related eating behaviors, potential contributions of UPF constituents to ADHD-related symptoms, or both, with implications for ADHD care and child public health.

SummaryBackgroundChildren and adolescents are increasingly exposed to processed food in China, however, its association with obesity has not been investigated.ObjectivesTo assess the consumption of ultra‐processed food (UPF) and its association with overweight/obesity among children and adolescents in China.MethodsA total of 3437 children and adolescents aged 6–18 years, participating at least twice in the China Nutrition and Health Survey, were included. Food intake was collected using a 3‐day 24‐h dietary recall method at home visits. Body weight, height and waist circumference (WC) were measured during the survey. UPF was defined by food process levels using NOVA classification. Overweight/obesity was defined by the international age‐ and sex‐specific BMI and WC cut‐offs. The association between UPF consumption and overweight/obesity was assessed using mixed effect logistic regression analyses adjusted for socio‐demographic, economic, behavioural, dietary and health factors.ResultsThe mean daily UPF consumption of the study population (mean age 9.3 years) increased from 9.7 in 1997 to 60.0 grams in 2011. The adjusted odds ratios (OR) (95% CI) for overweight/obesity (using BMI) for UPF consumption of 0, 1–49, 50–99 and ≥ 100 g/day were 1.00, 1.38 (0.98–1.94), 2.01 (1.25–3.24) and 1.53 (0.82–2.86), respectively (p‐trend =0.013). Similarly, the corresponding adjusted ORs (95% CI) for central obesity (using WC) were 1.00, 1.84 (1.30–2.60), 2.13 (1.30–3.48) and 2.15 (1.14–4.05) (p‐trend<0.001).ConclusionsHigher long‐term UPF consumption was associated with an increased risk of overweight/obesity among children and adolescents in China.

Objective: Ultra-processed food (UPF) has been shown to increase the cardiometabolic health risks. We aimed to determine the association between UPF intake based on the NOVA classification and the risk of hypertension incidence during 1997−2015. Methods: Data from 15,054 adults aged ≥ 20 years (47.4% males) attending the China Nutrition and Health Survey (CNHS) were used. Food intake at each survey was assessed by a 3-day 24 h dietary recall and weighed food record method between 1997−2011. Cox regression was used to assess the association between UPF intake and incident hypertension. Results: During a mean average of 9.5 years (SD 5.5) of follow up, 4329 hypertension incident cases were identified. The incident rates (per 1000) for non-consumers and 1−49, 50−99, and ≥100 g/day of UPF intake were 29.5 and 29.5, 33.4, and 36.3, respectively. Compared with non-consumers, the hazard ratios (95% CI) for UPF intake of 1−49, 50−99, and >100 g/day were 1.00 (0.90−1.12), 1.17 (1.04−1.33), and 1.20 (1.06−1.35), respectively, (p = 0.001) after adjusting for potential confounding factors. There was a significant interaction between UPF intake and age with a higher risk in the younger group (<40 years) than in the older one. Conclusion: UPF consumption was dose-responsively associated with increased risk of hypertension among Chinese adults, especially in younger groups.

Timing of Energy Intake and Ultra-Processed Food Consumption Are Associated With Obesity in Adults in the United Kingdom: A Pooled Cross-Sectional Analysis of the National Diet and Nutrition Survey (2008-2019).

Nutrition and Kidney Health: Processing Emerging Evidence About Foods

BackgroundHigh consumption of UPFs has been proposed as a key driver in the global rise of non-communicable diseases. UK adolescents consume 66% of their daily energy (kcal/d) from UPFs. However,...

BackgroundA high dietary consumption of ultra-processed foods (UPF) has been associated with abnormal semen analysis parameters in males; however, it is unclear whether there is an impact on female reproduction. The objective of this study is to assess whether high consumption of UPF is associated with female infertility.MethodsA cross-sectional analysis of females aged 18–45 years who participated in the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2018 was performed. Females were eligible for inclusion if they provided a 24-h dietary recall and responded to a question regarding infertility. Foods reported during a 24-h dietary recall were classified according to the Nova system. The relative percentage of total energy consumed from UPF and unprocessed/minimally processed foods within a 24-h period was calculated.ResultsThe prevalence of infertility was 11%. The overall mean percentage of daily UPF and unprocessed/minimally processed food intake among respondents was 57 and 29%, respectively. There was no difference in the odds of female infertility when comparing females in the lowest tertile of UPF consumption to peers in the middle [aOR = 1.37, 95% CI (0.96, 1.95)] or highest tertile of consumption [aOR = 1.26, 95% CI (0.91, 1.74)]. Similarly, there was no difference in the odds of infertility between participants in the middle [aOR = 1.39, 95% CI (0.83, 2.33)] or highest tertile [aOR = 0.73, 95% CI (0.34, 1.54)] of unprocessed/minimally processed food consumption relative to those in the lowest tertile. In an intermediate model removing body mass index (BMI) as a covariate, an increased odds of infertility was noted among females with the highest tertile of UPF consumption relative to those in the lowest tertile [aOR = 1.46, 95% CI (1.01, 2.09)].ConclusionAmong women of reproductive age, high consumption of UPF is associated with female infertility. BMI is a mediator of the association between UPF and female infertility.

Obesity is associated with chronic disease and burdens individuals and health systems heavily. Obesity prevalence has increased globally in recent decades. Concurrently, consumption of natural and home-prepared foods has decreased while that of industrial and ultra-processed foods (UPFs) that may play a role in obesity etiology, has increased. Our aim was to assess the extent of UPF consumption, nutrition quality and obesity prevalence in Israel, using data from a cross-sectional National Health and Nutrition survey conducted in 2014-16 on a representative sample of 25-64Y individuals who were face-to-face interviewed and anthropometrically measured. Participants reported 24h dietary intake. Consumed foods were coded into 4 groups based on the NOVA method which classifies foods by their level of processing, from unprocessed foods to UPFs. Obesity prevalence was determined by body mass index (≥30Kg/m2), relative fat mass and waist circumference. Univariable and multivariable logistic regression models adjusted for potential confounders were used to assess associations between UPFs consumption and obesity prevalence. In 2,563 participants (mean age=42.2±11.1Y, 46.8% males), average UPFs consumption was 34.5% of total energy intake. Highest quartile of UPFs consumption was associated with younger age (p = 0.0015), lower physical activity (p &amp;lt; 0.001) and current smoking (p = 0.0162). High consumption of UPFs was significantly associated with higher intake of energy, carbohydrates, saturated fat, and thiamin, and lower intake of protein, monounsaturated fatty acids, dietary fiber, folic acid, vitamin B12, Vitamin C, zinc and total fats. No association was found between UPFs consumption and obesity prevalence. In conclusion, high consumption of UPFs is associated with higher likeliness of unhealthy behaviors and lower nutrition quality in 25-64Y Israeli individuals. No association was found between UPFs consumption and obesity prevalence. Key messages • Consumption of ultra-processed foods is associated with lower nutrition quality. • Consumption of ultra-processed foods was not associated with obesity prevalence.

Whether ultra-processed food (UPF) consumption is associated with the risk of kidney stone is not explored. Furthermore, it remains unclear if kidney stone-related genetic predisposition could affect this association. Therefore, we aim to examine the associations of UPF consumption, genetic predisposition, and their interactions with the risk of kidney stone. In this study, 166,427 middle-aged participants from the UK Biobank were enrolled. UPF intake was assessed according to the NOVA food classification system and based on 24-h dietary recalls. A polygenic-risk score (PRS) of 20 single-nucleotide polymorphisms was calculated for kidney stone. Cox proportional hazards regression model was used to investigate the hazard ratio (HR) and 95% confidence interval (CI) for the risk of incident kidney stone. After 1,510,300 person-years of follow-up, 1369 participants developed kidney stone. UPF consumption was positively associated with the risk of kidney stone (P for trend < 0.01). Compared with participants in the first tertile of UPF intake, those in the third tertile had a 24% (HR: 1.24; 95% CI 1.07-1.43) increased risk of kidney stone. Compared to total UPF intake, the consumption of UPF excluding yogurt and cereals was associated with a greater risk of kidney stones (HR: 1.32; 95% CI 1.15-1.51). Even though no significant interaction effect between UPF and PRS was found (P for interaction = 0.09), this association was only observed in participants with low and middle PRS, but not in those with high PRS. In the joint association analysis, compared to participants with low UPF consumption and PRS, those with high UPF consumption and PRS experienced the highest risk of kidney stone (HR: 1.95, 95% CI 1.51, 2.51). This association was consistently observed in participants regardless of sex, age, and BMI. The results demonstrated that higher consumption of UPF is associated with an increased risk of kidney stone. These insights could prove valuable for informing public health policies aimed at preventing kidney stone. Further intervention studies are needed to confirm and elaborate on our results.

Associations between ultra-processed food consumption and kidney function in an older adult population with metabolic syndrome

Due to its rising prevalence, which parallels that of ultraprocessed food (UPF) consumption, inadequate micronutrient intake in childhood is a public health concern. This study aimed to evaluate the association between UPF consumption and inadequate intake of 20 micronutrients in a sample of children from the Mediterranean area. Cross-sectional information from participants in the “Seguimiento del Niño para un Desarrollo Óptimo” (SENDO) project 2015–2021 was used. Dietary information was gathered with a previously validated 147-item semi-quantitative food frequency questionnaire and the NOVA system was used to classify food items. Children were classified by tertiles of energy intake from UPF. Twenty micronutrients were evaluated, and inadequate intake was defined using the estimated average requirement as a cutoff. Crude and multivariable adjusted OR (95% CI) for the inadequacy of ≥ 3 micronutrients associated with UPF consumption were calculated fitting hierarchical models to take into account intra-cluster correlation between siblings. Analyses were adjusted for individual and family confounders. This study included 806 participants (51% boys) with a mean age of 5 years old (SD: 0.90) and an average energy intake from UPF of 37.64% (SD: 9.59). An inverse association between UPF consumption and the intake of 15 out of the 20 micronutrients evaluated was found (p < 0.01). After the adjustment for individual and family confounders, compared with children in the first tertile of UPF consumption, those in the third tertile showed higher odds of inadequate intake of ≥ 3 micronutrients (OR 2.57; 95%CI [1.51–4.40]). Conclusion: High UPF consumption is associated with increased odds of inadequate intake of micronutrients in childhood.What is Known:• Micronutrient deficiency is among the 20 most important risk factors for disease and affect around two billion people worldwide.• UPF are rich in total fat, carbohydrates and added sugar, but poor in vitamins and minerals.What is New:• Compared with children in the 1sttertile of UPF consumption, those in the 3rdtertile had 2.57 times higher odds (95% CI: 1.51-4.40) of inadequate intake of ≥ 3 micronutrients after adjusting for potential confounders.• The adjusted proportions of children with inadequate intake of ≥ 3 micronutrients were 23%, 27% and 35% in the 1st, 2nd, and 3rdtertiles of UPF consumption respectively.

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 surveySetting: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.