Abstract
ObjectiveThe objective of this study was to examine the associations between ultra-processed food consumption and risk of obesity among UK adults.MethodsParticipants aged 40–69 years at recruitment in the UK Biobank (2006–2019) with dietary intakes collected using 24-h recall and repeated measures of adiposity––body mass index (BMI), waist circumference (WC) and percentage of body fat (% BF)––were included (N = 22,659; median follow-up: 5 years). Ultra-processed foods were identified using the NOVA classification and their consumption was expressed as a percentage of total energy intake. Multivariable Cox proportional hazards regression models were used to estimate hazard ratios (HR) of several indicators of obesity according to ultra-processed food consumption. Models were adjusted for sociodemographic and lifestyle characteristics.Results947 incident cases of overall obesity (BMI ≥ 30 kg/m2) and 1900 incident cases of abdominal obesity (men: WC ≥ 102 cm, women: WC ≥ 88 cm) were identified during follow-up. Participants in the highest quartile of ultra-processed food consumption had significantly higher risk of developing overall obesity (HR 1.79; 95% CI 1.06─3.03) and abdominal obesity (HR 1.30; 95% CI 1.14─1.48). They had higher risk of experiencing a ≥ 5% increase in BMI (HR 1.31; 95% CI 1.20─1.43), WC (HR 1.35; 95% CI 1.25─1.45) and %BF (HR 1.14; 95% CI 1.03─1.25), than those in the lowest quartile of consumption.ConclusionsOur findings provide evidence that higher consumption of ultra-processed food is strongly associated with a higher risk of multiple indicators of obesity in the UK adult population. Policy makers should consider actions that promote consumption of fresh or minimally processed foods and reduce consumption of ultra-processed foods.
Highlights
Ultra-processed foods, as defined by the NOVA food classification system, are industrial formulations of substances derived from foods, which typically contain cosmetic additives and little, if any, whole foods [1]
We investigated whether the associations between consumption of ultra-processed foods and risk of obesity differed according to body mass index (BMI) status at baseline by stratifying the Cox regression models
The linearity assumption between intake of ultra-processed food and risks of obesity, abdominal obesity, ≥ 5% increase in BMI, ≥ 5% increase in waist circumference (WC) and ≥ 5% increase in BF were assessed using restricted cubic spline (Supplementary figure S1)
Summary
Ultra-processed foods, as defined by the NOVA food classification system, are industrial formulations of substances derived from foods, which typically contain cosmetic additives (i.e. flavours and colours) and little, if any, whole foods [1]. Some examples of ultra-processed foods are soft drinks, flavoured dairy drinks, sweet or savoury packaged snacks, confectionery, breakfast cereals, packaged breads and buns, reconstituted meat products and pre-prepared frozen or shelf-stable dishes. These formulations are extremely palatable, convenient, often sold in large portion sizes, and aggressively marketed [2, 3]. A growing body of evidence has suggested that the consumption of ultra-processed foods increases the risk of obesity. Recent population-based cross-sectional studies have demonstrated a positive association between the consumption of ultra-processed foods and obesity in Brazil [11], the United States [12] and Canada [13]. A two-week, cross-over, randomized controlled trial of 20 weight-stable adults found that higher consumption of ultraprocessed foods led to increased energy intake and a substantial gain in body weight and fat mass [14]
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