Abstract
PurposeTo describe the patterns of ultra-processed foods (UPFs) consumption in the Netherlands; to test if exposure to the food environment is associated with UPFs consumption; and if this association differed across educational levels and neighbourhood urbanisation.MethodsCross-sectional study using 2015-data of 8104 older adults from the Dutch EPIC cohort. Proportion of UPFs consumption was calculated from a validated food-frequency questionnaire. Exposure to the food environment was defined as proximity and availability of supermarkets, fast-food restaurants, full-service restaurants, convenience stores, candy stores and cafés. Consumption of UPFs was expressed as both percentage of total grams and total kilocalories.ResultsThe study population was aged 70(± 10 SD) years and 80.5% was female. Average UPFs consumption was 17.8% of total food intake in grams and 37% of total energy intake. Those who consumed greater amounts of UPFs had a poorer overall diet quality. Adjusted linear regression models showed that closer proximity and larger availability to any type of food retailer was associated with lower UPFs consumption (both in grams and kilocalories). Somewhat stronger significant associations were found for proximity to restaurants (β = − 1.6%, 95% confidence interval (CI) = − 2.6; − 0.6), and supermarkets (β = − 2.2%, 95%CI = − 3.3; − 1.1); i.e., Individuals living within 500 m from the closest supermarket, as compared to 1500 m, had 2.6% less calories from UPFs. No differences were found on analyses stratified for urbanisation and education.ConclusionsUsing various measures of exposure to the food environment, we found that exposure to restaurants and supermarkets was associated with somewhat lower consumption of UPFs.
Highlights
An unhealthy diet is a leading risk factor for non-communicable disease and premature mortality [1]
In this study we aim to (1) describe the pattern of ultra-processed foods (UPFs) consumption among older adults in the Netherlands and to explore how UPFs consumption relates to overall diet quality; (2) explore whether or not the availability of and proximity to different types of food retailers near the home is associated with consumption of UPFs
Since higher consumption of UPFs has been associated with lower educational attainment [6, 23]; and patterns of food consumption and health outcomes may differ for urban and rural areas [29, 30], we aim to (3) explore if the associations we identify differ across levels of educational attainment and neighbourhood urbanisation
Summary
An unhealthy diet is a leading risk factor for non-communicable disease and premature mortality [1]. Other methods of food processing have been introduced, like those referred to as ultra-processing. This includes industrial processes such as extrusion, pre-frying, and the addition of substances such as colour, stabilisers, artificial preservatives, flavours and flavour enhancers. While traditionally processed foods are a part of a healthy diet, ultra-processed foods (UPFs) are generally energy dense, high in added sugar, fat and salt, and low in fibre, and, diminish diet quality [5,6,7,8,9,10]. Evidence from a randomized controlled trial suggests that diets including many ultra-processed foods lead to higher energy intake and higher body weight even after adjustment for sugar, fat, fibre, and other macronutrients content [11]. Causal mechanisms liking UPFs to health outcomes still need to be better understood, the consumption of UPFs has been associated with adverse health outcomes including obesity, metabolic syndrome, cancer, type II diabetes, cardiovascular diseases, and all-cause mortality [13,14,15,16,17,18,19]
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