Ultra-processed food intake is associated with increased gastrointestinal tract symptoms and alterations in gut microbiota in patients with systemic sclerosis

Background: During COVID-19, this study examined data on adolescents' eating habits. It proposes a new 'gateway food model' for ultra-processed foods (UPF). This model shows that certain UPFs when increased (decreased) drive consumption of other UPFs as well. This has important implications for managing hypertension risk factors since studies show that those in the highest tertile of UPF consumption have a higher risk of hypertension (adjusted HR, 1.21; CI, 1.06, 1.37; p = 0.004) (Mendonca, 2016). Methods: The study enrolled 315 participants aged 13-19 years in Florida, U.S. Participants' PIE scores (Processed Intake Evaluation scores, scale 0-100), were calculated based on averaged consumption of 12 ultra-processed food products. PIE scores, before COVID-19 in 2019, and after COVID-19 restrictions were eased in 2022, were assessed in the study. Results: The participants’ mean age was 16.2±1.4 years. The study classified participants into UPF+ (n=135) and UPF- (n=180) groups according to whether they increased or decreased their UPF intake during COVID-19. For both groups, a stepwise regression was employed to identify significant factors for change in UPF intake. In the UPF+ group, increased intake of candy, store pastries, or frozen desserts was associated with increased UPF intake across all other UPFs as well (+31.2, +12.0, or +10.5 respective change in PIE score, p<0.01). Correspondingly, in the UPF- group, reduced intake of biscuits, white bread, or processed meat was associated with decreased overall UPF intake across all other UPFs as well (-9.6, -9.4, -8.6 respective change in PIE score, p<0.01). Conclusions: Hypertension can begin during childhood and may be mediated by a focus on modifiable risk factors such as high UPF intake. These results indicate that for adolescents whose consumption of UPFs has not yet been established, certain gateway UPFs (candy, store pastries, and frozen desserts) should be given priority for preventive dietary interventions since increased intake in these UPFs leads to consumption of all other UPFs as well. In contrast, if an adolescent's UPF eating is already established, other UPFs (biscuits, white bread, or processed meat) can be targeted by dietary interventions as they decrease intake across all other UPFs.

OP0131 Prevalence and Predictors of Small Intestinal Bacterial Overgrowth in Systemic Sclerosis

Study question Is men’s ultra-processed food (UPF) consumption associated with conventional semen quality parameters? Summary answer UPF consumption is unrelated to semen quality parameters among men attending a fertility clinic. What is known already In the USA, UPF comprise more than half of all calories consumed, rising from 51% in 2003 to 54% in 2018 constituting a significant and growing component of the global food supply. Several recent studies have reported an association between UPF consumption and several chronic diseases such as obesity, diabetes, and cardiovascular diseases, among others, however, their impact on semen quality has been scarcely studied. Study design, size, duration We analyzed the relation between UPF intake and semen quality in samples collected for clinical purposes among men who enrolled in the Environment and Reproductive Health (EARTH) study, which enrolled couples seeking fertility care at an academic medical center in Boston (Massachusetts, USA) between 2007 and 2019. Participants/materials, setting, methods 343 men provided a total of 896 semen samples (mean=2.15 semen samples). A 131-item food frequency questionnaire assessed men’s diet, and the NOVA classification system were used to estimate the UPF consumption. Semen volume, total sperm count, sperm concentration, total motility, progressive motility, and normal morphology were set as the main outcomes. Multivariable generalized linear mixed models were used to estimate the associations between UPF consumption, in quartiles, and semen quality parameters. Main results and the role of chance Median (P25, P75) age and BMI was 36.0 (33.6, 38.6) years and 27.0 (24.3, 28.9) kg/m2, respectively. The median consumption of UPF in the study population as 5.7 (4.2, 7.7) servings per day. In general, the UPF consumption was not related to any of the sperm quality parameters examined. The mean differences (95% confidence intervals) between the lowest (reference quartile) and the highest quartile of UPF consumption were: -0.23 mL (-0.63, 0.16) for ejaculate volume, 0.25 x106 sperm (-0.46, 0.95) for total sperm count, 0.34 x106 sperm/mL (-0.36, 1.04) for sperm concentration, 1.54% (-5.61, 8.68) for total motility, 1.66% (-2.94, 6.26) for progressive motility, and 0.28% (-0.73, 1.29) for normal morphology. These associations were adjusted by age, education, BMI, physical activity, ethnicity, smoking status, sexual abstinence and the remaining NOVA groups (unprocessed or minimally processed foods or NOVA1, processed culinary ingredients or NOVA2, and processed foods or NOVA3). Limitations, reasons for caution Our population includes men from a fertility center, so the findings may not be directly translated to the general population. The observational nature of the study limits causality inference. We did not explore possible changes in diet over time, because diet was only assessed once. Wider implications of the findings While we did not find associations between the consumption of UPF and semen quality parameters, due to the rising consumption and heterogeneity of UPF worldwide, further studies regarding the role of UPF in reproductive health would be worthwhile and recommended. Trial registration number No

Ultra-processed foods (UPFs) consumption, characterized by high levels of sugars, unhealthy fats, and additives, yet low in nutrients, has increased significantly in recent decades(1). Previous studies have demonstrated the link between UPF consumption and Type 2 diabetes (T2D)(2). Considering the variation in these food categories across studies and the scarcity of large-scale studies focusing on specific UPF subgroups, this study aims to explore the prospective association between UPFs, their subgroups, and the incidence of T2D in a UK based cohort study.A total of 7,774 participants aged 40-69 years without T2D (69% men and 31% women) from the Whitehall II cohort, who had dietary intake data at baseline (1993/1994) and follow-up data on T2D incidence available, were included in the analyses. Food intake was assessed using a validated 127item food frequency questionnaire (FFQ). We applied the NOVA classification to categorize FFQ items into four classes based on the level of processing. The intake of UPFs per day was calculated as a percentage of the total daily food intake in grams to account for UPFs that do not provide energy. The incidence of T2D was evaluated from 1993/1994 to 2007/2009 through self- reports and oral glucose tolerance test results. Multivariate Cox regression models were employed to assess the prospective association between UPFs consumption (in quintiles) and T2D risk, adjusting for socioeconomic factors, family history of T2D, lifestyle characteristics, total energy intake, and indicators of nutritional quality.During the 15-year follow-up, 954 cases of T2D were confirmed. In multivariable models adjusted for family history of T2D, socioeconomic, and lifestyle factors, the highest UPF consumption quintile [mean 33% of total daily intake (grams)] was associated with an increased risk of T2D [HR: 1.35, 95% CI: 1.06-1.71] compared to the lowest quintile [mean 9.6% of total daily intake (grams)]. Adjustment for total energy intake slightly increased the risk of T2D [HR: 1.46, 95% CI: 1.12-1.91].Additional adjustments for sugar, sodium, and fat intake further increased the risk of T2D [HR: 1.51, 95% CI: 1.15-1.98]. Among UPFs subgroups, only the intake of soft drinks was significantly associated with an increased risk of T2D [HR: 1.02, 95% CI: 1.01-1.08], whereas no significant associations were found for other UPFs subgroups. Similar results were found after multiple imputation of missing values.In UK midlife adults, higher UPF consumption tends to be prospectively associates with an increased risk of T2D, with notable variations across UPFs subgroups. These findings suggest that the association between UPFs intake and T2D might be independent of nutritional quality and energy intake, indicating that food processing itself could be a contributing factor. This study provides evidence to support efforts to limit UPF consumption as a strategy to alleviate the population burden of T2D.

Background: Many low- and middle-income countries are now facing the “double burden” of malnutrition, one of them is overweight/obesity. Over 340 million children and adolescents were overweight and obesity in 2016. Obesity among adolescents may increase, in part due to changes in the food system, which now offers a wide range of ultra-processed foods (UPF) that minimize preparation time. Indonesia has also a large and rapidly growing market for unhealthy drinks, which are sold in various places including schools and hospitals.
 Objective: This study aimed to investigate the association of UPF and beverages consumption and other related factors with nutritional status of senior high school students in Pontianak, West Kalimantan, Indonesia.
 Methods: This cross-sectional study conducted in Pontianak investigated the association between UPF consumption and nutritional status of SHS students. Data collection was conducted at Imanuel and Petrus SHS Pontianak in June 2023, involving 273 students from grades 10th and 11th. Weight and height measurement was obtained for calculating the BMI for age Z-scores, while UPF and beverages consumption was obtained by FFQ. Structured questionnaire, 24-hours recall, and IPAQ-S were used for assessing sociodemographic status, Total Energy Intake and Physical Activity Level. Data analysis used SPSS version 26.
 Results: The result found 40.3% of students were overweight-obesity; 51.6% consumed excessive UPF and beverages. It showed an inverse association between UPF consumption and nutritional status. The study identifies UPF and beverages consumption, gender, mother's education level, and family income as factors associated with nutritional status among adolescents.
 Conclusion: The consumption of ultra-processed Foods was high, with the highest UPF intake came from snacks and sweets (22.4%). There was inverse association between UPF and beverages consumption with nutritional status. There was also significant association between UPF and beverages, gender, mother education level and family income with nutritional status.

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.

Objective: To assess the consumption of ultra-processed food and sugar-sweetened beverages and to identify the association of this consumption with overweight among vegetarians. Methods: A cross-sectional study with a convenience sampling method was conducted. Data were collected using an online questionnaire from 8/24/2015 to 10/8/2015. Subjects were male and female vegetarians aged &gt;16 years. Using a food frequency questionnaire, we assessed the weekly consumption of ultra-processed food and sugar-sweetened beverages and described the frequency of daily consumption overall and according to type of vegetarianism. The association between overweight and excessive daily intake of ultra-processed food was analyzed by multiple logistic regression (OR [95CI%]). Results: Information was retrieved from 503 individuals (29.8±8.5 years old); 83.7% were women. The most frequent types of vegetarianism in our sample were ovo-lacto (45.5%) and vegan (41.7%), and the median time of vegetarianism was 5.3 years. The consumption of sugar-sweetened beverages (≥2x/day) and ultra-processed food (≥3x/day) was 21.0% and 16.0%, respectively, and regarding the different vegetarianism types, vegans showed the lowest frequency of excessive daily sugar-sweetened beverages and ultra-processed food consumption. In the multivariable analysis, consumption of ultra-processed food ≥3x/day (2.33 [1.36-4.03]), male sex (1.73 [1.01-2.96]), age ≥35 years (2.03 [1.23-3.36]) and not preparing one’s food (1.67 [0.95-2.94]) were independently associated with overweight. Conclusion: Although vegetarianism is frequently associated with a healthier diet and, consequently, prevention of poor health outcomes, this study found that the excessive consumption of sugar-sweetened beverages and ultra-processed food was associated with overweight.

Background/objectiveThere is limited knowledge on how diet affects the epigenome of children. Ultra-processed food (UPF) consumption is emerging as an important factor impacting health, but mechanisms need to be uncovered. We therefore aimed to assess the association between UPF consumption and DNA methylation in children.MethodsWe conducted a meta-analysis of epigenome-wide association studies (EWAS) from a total of 3152 children aged 5–11 years from four European studies (HELIX, Generation XXI, ALSPAC, and Generation R). UPF consumption was defined applying the Nova food classification system (group 4), and DNA methylation was measured in blood with Illumina Infinium Methylation arrays. Associations were estimated within each cohort using robust linear regression models, adjusting for relevant covariates, followed by a meta-analysis of the resulting EWAS estimates.ResultsAlthough no CpG was significant at FDR level, we found suggestive associations (p-value < 10–5) between UPF consumption and methylation at seven CpG sites. Three of them, cg00339913 (PHYHIP), cg03041696 (intergenic), and cg03999434 (intergenic), were negatively associated, whereas the other four, cg14665028 (NHEJ1), cg18968409 (intergenic), cg24730307 (intergenic), and cg09709951 (ATF7), were positively associated with UPF intake. These CpGs have been previously associated with health outcomes such as carcinomas, and the related genes are mainly involved in pathways related to thyroid hormones and liver function.ConclusionWe only found suggestive changes in methylation at 7 CpGs associated with UPF intake in a large EWAS among children: although this shows a potential impact of UPF intake on DNAm, this might not be a key mechanism underlying the health effects of UPFs in children. There is a need for more detailed dietary assessment in children studies and of intervention studies to assess potential epigenetic changes linked to a reduction in UPF in the diet.Graphical abstract

Nutrition and Kidney Health: Processing Emerging Evidence About Foods

Introduction: Ultra-processed food (UPF) consumption is linked to adverse health outcomes, including cardiovascular disease and all-cause mortality. Asian Americans (AAs) are the fastest growing ethnic group in the United States (US), yet their dietary patterns have seldom been described. Objectives: To characterize UPF consumption among AAs and determine whether acculturation is associated with increased UPF consumption. Methods: The National Health and Nutrition Examination Survey (NHANES) is an annual, cross-sectional survey representative of the US population. We examined NHANES dietary data, combining years in which AAs were over-sampled (2011-2018). We included 2,404 AAs ≥ 18 years old with valid 24-hour dietary recall data. Using day 1 dietary recalls, we characterized UPF consumption as the percentage of caloric intake from UPFs, using the NOVA classification system. This framework classifies foods from any culture based on degree of industrial processing. Acculturation was characterized by nativity, nativity/years in the US, home language, and an acculturation index (based on a sum of levels related to nativity/years in the US and home language). We assessed the relationship between each acculturation measure and UPF consumption using linear regression analyses adjusted for age, sex, marital status, education, income, self-reported health, and self-reported diet quality. All analyses accounted for the complex survey design. Results: Among all AAs, the percentage of caloric intake attributable to UPFs was 39.3% (95% CI: 38.1-40.5). In adjusted regression analyses, UPF consumption was 14% (95% CI: 9.5-17.5; p&lt;0.05) greater among those with the highest vs. lowest acculturation index score, 12% (95% CI: 8.5-14.7: p&lt;0.05) greater among those who speak English only vs. non-English only in the home, 12% (95% CI: 8.6-14.7: p&lt;0.05) greater among US-born vs. foreign-born AAs, and 15% (95% CI: 10.7-18.3: p&lt;0.05) greater among US-born vs. foreign-born AAs with less than ten years in the US. Conclusions: Among AAs, UPF consumption was common, and acculturation was strongly associated with greater proportional UPF intake. As the US-born AA population continues to grow, UPF consumption in this group is likely to increase. Further research is necessary to characterize trends in dietary patterns across disaggregated AA subgroups to better inform culturally tailored dietary interventions.

Background & aimsUltra-processed food (UPF) intake has increased sharply over the last few decades and has been consistently asserted to be implicated in the development of non-communicable diseases. We aimed to evaluate and update the existing observational evidence for associations between ultra-processed food (UPF) consumption and human health. MethodsWe searched Medline and Embase from inception to March 2023 to identify and update meta-analyses of observational studies examining the associations between UPF consumption, as defined by the NOVA classification, and a wide spectrum of health outcomes. For each health outcome, we estimated the summary effect size, 95% confidence interval (CI), between-study heterogeneity, evidence of small-study effects, and evidence of excess-significance bias. These metrics were used to evaluate evidence credibility of the identified associations. ResultsThis umbrella review identified 39 meta-analyses on the associations between UPF consumption and health outcomes. We updated all meta-analyses by including 122 individual articles on 49 unique health outcomes. The majority of the included studies divided UPF consumption into quartiles, with the lowest quartile being the reference group. We identified 25 health outcomes associated with UPF consumption. For observational studies, 2 health outcomes, including renal function decline (OR: 1.25; 95% CI: 1.18, 1.33) and wheezing in children and adolescents (OR: 1.42; 95% CI: 1.34, 1.49), showed convincing evidence (Class I); and five outcomes were reported with highly suggestive evidence (Class II), including diabetes mellitus, overweight, obesity, depression, and common mental disorders. ConclusionsHigh UPF consumption is associated with an increased risk of a variety of chronic diseases and mental health disorders. At present, not a single study reported an association between UPF intake and a beneficial health outcome. These findings suggest that dietary patterns with low consumption of UPFs may render broad public health benefits.

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,...

ObjectiveTo examine the effect of the consumption of ultraprocessed food on diet quality, and cardiometabolic risk (CMR) in an occupational cohort.DesignCross-sectional.SettingOccupational cohort.Participants53 163 British police force employees enrolled (2004–2012) into...

We examined the associations of overall and group-specific ultra-processed food (UPF) consumption with long-term weight change and type 2 diabetes (T2D) progression following gestational diabetes mellitus (GDM)-complicated pregnancies. We included 4,207 women with a history of GDM from the Nurses' Health Study II (1991-2021). UPF intake (servings/day) was assessed via food frequency questionnaires every 4 years and quantified per the NOVA classification. Diet quality was evaluated using the Alternate Healthy Eating Index-2010 (AHEI). Associations between UPF intake changes and weight changes (kg) were assessed using generalized estimating equations (GEE) (n = 3,781). Cox regression models estimated adjusted hazard ratios (HRs) and 95% CIs of habitual UPF intake modeled by time-updated cumulative averages with T2D risk. Joint associations of UPF and AHEI with weight change and T2D risk were examined using the same GEE and Cox regression models, respectively. T2D developed in 1,040 participants. Increased UPF consumption was associated with greater weight gain (P-trend < 0.0001; quartile 1 [Q1] vs. Q4: 0.52 kg vs. 1.65 kg). Habitual UPF consumption was positively associated with T2D risk: adjusted HRs (95% CIs) for Q1 to Q4 were 1.00 (ref), 1.07 (0.87, 1.32), 1.25 (1.03, 1.53), and 1.20 (0.99, 1.46), respectively (P-trend = 0.04). These associations persisted in women with higher AHEI scores. When modeling UPF and AHEI jointly, only women with stable or decreased UPF intake and increased AHEI achieved 4-year weight maintenance. In women with a history of GDM, UPF consumption was associated with weight gain and higher T2D risk, even among those with higher diet quality.

Ultra-processed food consumption and type 2 diabetes incidence: A prospective cohort study