Purpose Of Industrial Processing Research Articles

#2481 Reduction in ultra-processed food by providing medically tailored healthy food baskets to patients with CKD: the HELPFUL trial

Abstract Background and Aims Over the past decade, there has been a growing interest in classifying foods based on the extent and purpose of industrial processing according to the NOVA system, which outlines four main food categories: unprocessed and minimally processed foods, processed culinary ingredients, processed foods, and ultra-processed foods (UPFs). The latter is characterized by industrial formulations with an elevated content of additives, sugar, unhealthy fat, and sodium. Increased consumption of UPFs can worsen metabolic derangements that develop as kidney function decreases in patients with chronic kidney disease (CKD). We evaluated food intake according to the NOVA food classification system before and after a medically tailored meal intervention with plant-based food baskets for patients with CKD who had hyperkalemia at inclusion and received sodium zirconium cyclosilicate (SZC) to normalize plasma potassium. Additionally, we aimed to assess the diets’ environmental impact by evaluating the greenhouse gas emissions (GHGE) associated with these dietary changes. Method Data were based on a six-week feasibility one-arm clinical study, the HELPFUL trial (identifier: NCT04207203), that enrolled 26 adult patients with CKD stages 4 and 5, not on dialysis and with plasma potassium 5.1-6.5 mmol/L at inclusion. In the first 3 weeks, patients were guided to adhere to a low-protein and low-potassium diet with concomitant use of SZC. The following 3 weeks, patients received food baskets containing fruits, vegetables, legumes, nuts, and either white meat, fish or egg to provide a healthy low-protein high-potassium diet. To assess dietary changes, 24-hour food recalls were collected at weeks 0, 3 and 6 and subsequently classified according to the NOVA classification. The mean adequacy ratio to the dietary recommended intake (DRI) of 11 nutrients (MAR-11 score) was calculated to assess dietary quality. Furthermore, the 24-hour food recalls were linked to GHGE estimations for analysis of environmental impact using the RISE food climate database which is representative of Swedish food consumption. Statistical analyses using Friedman's test or ANOVA for repeated measures were employed to identify significant differences before and after the plant-based food basket intervention. This study was funded by Astra Zeneca. Results The plasma potassium (mmol/L) normalized after the use of SZC (week 0: 5.52 ± 0.3; week 3: 4.72 ± 0.4; week 6: 4.8 ± 0.4; P < 0.01). Figure 1 shows changes in energy intake according to the NOVA classification. A significant reduction in UPF consumption (P = 0.024) was observed. In the post-hoc analysis, the change between week 3 and 6 was borderline significant (P = 0.052) while that between week 0 and 6 was statistically significant (P = 0.008). The healthy food basket diet led to a significant increase in dietary fibers (P = 0.002) and servings of fruits (P < 0.01), vegetables (P = 0.04), nuts (P < 0.01), poultry (P = 0.02), and fish (P < 0.001) and reduced servings of red meat (P = 0.03). As a result, the MAR-11 score increased significantly (P = 0.021). The GHGE analysis of carbon dioxide equivalents revealed no differences between emissions (median and interquartile range) in week 0 [1.79 (1.24; 3.13)], week 3 [1.79 (1.47; 2.74)] and week 6 [1.87 (1.51; 2.61)]. Conclusion Delivering medically tailored healthy food baskets to patients with CKD with concomitant use of SZC led to increased dietary quality and decreased UPF intake. However, these beneficial changes were not aligned with a decrease in GHGE, highlighting the complex relationship between dietary choices and environmental impact.

Effect of a lifestyle intervention among pregnant women with overweight on neonatal adiposity: A randomized controlled clinical trial

BackgroundThe excess neonatal adiposity is considered a risk factor for the development of childhood obesity and the birth weight is a marker of health throughout life. AimsTo evaluate the effect of a lifestyle intervention conducted among pregnant women with overweight on neonatal adiposity and birth weight. MethodsA total of 350 pregnant women were recruited and randomly allocated into the control (CG) and intervention (IG) groups. Pregnant women in the IG were invited to participate in three nutritional counselling sessions based on encouraging the consumption of unprocessed and minimally processed foods, rather than ultra-processed foods, following the NOVA food classification system, which categorizes foods according to the extent and purpose of industrial processing, and the regular practice of physical activity. Neonatal adiposity was estimated using a previously validated anthropometric model. Adjusted linear regression models were used to measure the effect. ResultsAdopting the modified intention-to-treat principle, data from 256 neonates were analyzed for birth weight, and data from 163 for body composition estimation. The treatment had no effect on the proportion of fat mass [β 0.52 (95 % CI -1.03, 2.06); p = .51], fat-free mass [β −0.50 (95 % CI -2.45, 1.45); p = .61] or birth weight [β 53.23 (95 % CI -87.19, 193.64); p = .46]. ConclusionsIn the present study, the lifestyle counselling used had no effect on neonatal adiposity or birth weight. Future studies should investigate the effect of more intensive interventions.

Ultra-processed food consumption and increased risk of metabolic syndrome in Korean adults: A cross-sectional analysis of the KNHANES 2016–2020

ObjectiveThis study aimed to investigate the association between ultra-processed food (UPF) intake and the risk for metabolic syndrome (MetS) in Korean adults. MethodsThe study consisted of 22 688 Korean adults ≥19 y of age from the Korea National Health and Nutrition Examination Survey (KNHANES) 2016–2020. The NOVA classification categorizes foods according to the nature, extent, and purpose of industrial processing. MetS was defined based on the National Cholesterol Education Program Adult Treatment Panel III criteria and a modified waist circumference cut-off for Korean adults. We estimated the usual percent total food intake from UPFs. We used multivariate logistic regression to assess the association between UPFs and risk for MetS, adjusted for age, sex, education level, income level, smoking status, alcohol drinking, physical activity, and total energy intake. We further analyzed the association of UPFs with each component of MetS. ResultsThe median usual percent total food intake from UPFs was 22%, and the midpoint of intake ranged from 3% (quartile 1) to 48% (quartile 4). The group with the highest UPF consumption had a 19% higher risk for developing MetS than the lowest quartile of UPF consumption (odds ratio [OR],1.19; 95% confidence interval [CI], 1.06–1.33; Ptrend = 0.006). In analysis of the relationship between UPF intake and MetS components, a higher UPF was associated with an increased risk for hypertension (OR, 1.13; 95% CI, 1.01–1.26; Ptrend = 0.037) and abdominal obesity (OR, 1.19; 95% CI, 1.07–1.33; Ptrend = 0.001), but had no significant association with other components (hyperglycemia, hypertriacylglycerolmia, and low high-density lipoprotein cholesterol, all P > 0.05). ConclusionHigher UPF contribution to total daily food intake is associated with an increased risk for MetS, particularly with a higher risk for hypertension and abdominal obesity.

The increasing trend in the consumption of ultra-processed food products is associated with a diet related to chronic diseases in Colombia-Evidence from national nutrition surveys 2005 and 2015.

Ultra-processed food products (UPF) have been related to chronic diseases (CD). Public health politics has been establishing strategies to decrease the consumption of these products in the country. i) To assess the trend of the consumption of UPF between 2005 and 2015. (ii) its association with sociodemographic factors and the overall dietary content of nutrients related to CD in 2015. (iii) to estimate the Population Attributable Fraction of unhealthy nutrient intake in Colombia in 2015 due to ultra-processed food consumption. We used data from the first (2005) and the last (2015) National Surveys of the Nutritional Status in Colombia. Food consumption was assessed using a 24-hour food recall. The NOVA classification classified the food items according to the extent and purpose of industrial processing. The consumption of processed and UPF increased in Colombia between 2005 and 2015. In 2015, no significant differences were found in the consumption of UPF between men and women but significant differences by age, wealth index, area of residence, and ethnicity (p<0.001). A significant positive association was found between the dietary share of UPF and the content of CD-related nutrients such as free sugars, total fats, saturated fats, trans-fats, and sodium. The prevalence of excessive intake of all CD-related nutrients (according to WHO recommendations) increased across quintiles of the dietary share of UPF. With the reduction of UPF consumption to the level seen among the 20% lowest consumers [1.0% (0-4.5%) of the total energy from UPF], the prevalence of excessive nutrient intake was almost three-fourths lower for trans fats; around one third lower for free sugar and saturated fats, 26% lower for sodium and 15% lower for total fat. In Colombia, the increasing trend in the consumption of UPF is associated with increasing intake of CD-related nutrients. Thus, reducing the consumption of UPF is a potentially effective way to achieve the nutritional goals of the WHO for the prevention of CD.

Evaluation of food purchasing in the Brazilian School Feeding Programme: feasibility of the requirements and recommendations.

To analyse the purchase of food for school feeding, according to the extent and purpose of industrial processing and variety, exploring the feasibility of achieving the requirements and recommendations of the Brazilian School Feeding Programme, and the variety of unprocessed or minimally processed foods according to the purchase of ultra-processed foods. Secondary data from 2016 from the Accountability Management System of the National Fund for Educational Development, concerning the food items purchased, were used to explore the feasibility of the requirements and recommendations. The foods were grouped according to the NOVA classification system. Variety was assessed by counting different types of unprocessed or minimally processed foods. Brazil. 3698 Brazilian municipalities. Energy share from unprocessed or minimally processed foods was 44·1 % while that of ultra-processed foods was 29·9 %. The average of unprocessed or minimally processed food types purchased annually was 33·8 items. Of the municipalities, 35·8 % were within the limit established for the expenditure of funds for the purchase of processed and ultra-processed foods, while 8·7 % followed the recommendation for variety. The proportion of ultra-processed foods did not influence the variety of food items purchased. The results showed the feasibility of achieving the requirements and recommendations and underscored the importance of continued efforts to promote the inclusion of unprocessed or minimally processed foods in the school feeding programme while addressing the challenges associated with expenditure limits of processed and ultra-processed foods and enhancing variety, which is strategic to promote adequate and healthy meals.

Food additives and PAHO’s nutrient profile model as contributors’ elements to the identification of ultra-processed food products

The NOVA classification system categorizes foods according to the extent and purpose of industrial processing. Ultra-processed food products (UPF) are frequently composed of excessive amounts of sugars, salt, oils, and fats, and cosmetic additives designed to make them palatable and/or appealing. We aimed to describe the presence of critical nutrients in excess and cosmetic additives in packaged foods and beverages and to evaluate the proportion of UPF that can be correctly identified through the presence of critical nutrients in excess or the presence of cosmetic additives in food products. A total of 9851 items available in Brazilian supermarkets containing lists of ingredients and nutrition facts panels were analyzed. Cosmetic additives and critical nutrients in excess, according to Pan American Health Organization (PAHO)’s nutrient profile model, were assessed. All food items were categorized into the four NOVA classification groups. Relative frequencies of items with at least one critical nutrient in excess and one type of cosmetic additive were estimated. For UPF, 82.1% had some cosmetic additive, and 98.8% had some cosmetic additive or a nutrient in excess. This combined criterion allowed the identification of 100.0% of sweet cookies, salted biscuits, margarine, cakes and sweet pies, chocolate, dairy beverages, and ice cream. Combining the presence of cosmetic additives and the PAHO’s nutrient profile model contributes to the identification of UPF.

Consumption of ultra-processed foods and associated factors in children from Barbacena (MG), Brazil.

To evaluate the prevalence of ultra-processed food consumption and associated factors among children enrolled in the public school system of the city of Barbacena, Minas Gerais, Brazil. This is a cross-sectional study conducted with schoolchildren aged 7-9 years, of both sexes, enrolled in state public schools. Food intake was assessed using the Previous Day Food Questionnaire and the level of physical activity by the Previous Day Physical Activity Questionnaire. The listed foods were classified according to the extent and purpose of industrial processing, using the NOVA classification. Pearson's χ2 test, Fisher's exact test, χ2 with Yates correction, and Poisson regression were used in the statistical analysis, estimating the crude and adjusted prevalence ratio, with 95% confidence intervals. The prevalence of daily ultra-processed food consumption was 69.6%. After adjusted analyses, the consumption of ultra-processed food was associated with the omission of breakfast, mid-afternoon snack, supper, low physical activity, and consumption of risk foods. On the other hand, consumption of in natura or minimally processed foods was associated with older age, the consumption of lunch, mid-afternoon snack, dinner, and protective foods. There is a high prevalence of ultra-processed foods consumption, associated with unhealthy dietary habits among schoolchildren. This highlights the need for nutritional counseling and educational actions, favoring healthy eating in childhood.

Ultra-Processed Foods as Ingredients of Culinary Recipes Shared on Popular Brazilian YouTube Cooking Channels.

Social media platforms are readily accessible sources of information about cooking, an activity deemed crucial for the improvement of a population’s diet. Previous research focused on the healthiness of the content shared on websites and blogs, but not on social media such as YouTube®. This paper analysed the healthiness of 823 culinary recipes retrieved from 755 videos shared during a six-month period on ten popular Brazilian YouTube® cooking channels. Recipes were categorized by type of preparation. To assess recipes’ healthiness, ingredients were classified according to the extension and purpose of industrial processing, in order to identify the use of ultra-processed foods. Additionally, a validated framework developed from criteria established in both editions of the Dietary Guidelines for the Brazilian Population was employed. Recipes for cakes and baked goods, puddings, snacks and homemade fast foods, which were among the most frequently posted, contained the lowest proportion of unprocessed/minimally processed ingredients and the highest proportion of ultra-processed ingredients. Recipes containing whole cereals, fruits, legumes, nuts, and seeds were scarce. Results indicate that users should be critical about the quality of recipes shared on YouTube® videos, also indicating a need for strategies aimed at informing individuals on how to choose healthier recipes or adapt them to become healthier.

Elaboration and validation of an instrument for qualitative assessment of food preparations offered to workers

The assessment of food preparations offered to workers, taking into consideration the use of ingredients according to the type of industrial processing, is important in order to promote the health of this population. This study aimed to elaborate and validate an instrument to qualitatively assess food preparations offered to workers by food services, focusing on the extent and purpose of the industrial processing of food ingredients. Methodological and multiple-case studies were conducted based on the realities of three food services. The instrument, which was denominated the Score for Qualitative Assessment of Preparations (EAQP), comprised ten questions that assessed the classification of ingredients according to the extent and purpose of industrial processing, as well as other Brazilian and international recommendations on healthy eating. This instrument can be applied in relation to at least four different preparations (salad, main course, side dish, and dessert) and classifies the quality of preparations into four levels of quality (high, intermediate, low, and very low). The instrument presented a satisfactory content validity index for scale in the two stages of content validation (0.940 and 0.966). In the discriminant analysis, the instrument was applied to 384 preparations and showed 98.44% agreement between the criteria for classifying the quality of the preparations. The EAQP is the first instrument to assess individual food preparations in a practical and easy way, taking into account the extent and purpose of the industrial processing of ingredients. The EAQP can be used in food services by professionals to evaluate the quality of preparations and to plan menus. It can help to replace processed and ultra-processed ingredients, contributing to promote healthy preparations for consumers.

Fluxograma de decisão para classificação de alimentos conforme a extensão e propósito do processamento industrial: atualização e aplicação prática

ABSTRACT Objective To describe the development and update of an instrument for food categorisation according to the extension and purpose of industrial processing, and to test its practical application. Methods After updating the instrument based on a recent publication on the NOVA classification, it was applied by five researchers to a database of 108 food items. These items are part of a database of foods announced in the health-related sections of supermarket promotional circulars. The Cohen’s weighted kappa coefficient was calculated to determine intra-rater agreement; Fleiss’ kappa and Kendall’s coefficient were applied to determine inter-rater agreement. Results In the updated version, two classes of additives and eight substances considered by the most recent publication as specific to ultra-processed foods were added. The intra-rater agreement was 100% (p&lt;0.001), indicating an “almost perfect” agreement; Fleiss’ agreement among all raters ranged from 74% to 97% (p&lt;0.001), which represents an agreement that ranged from “strong” to “almost perfect”; Kendall’s W was higher than 0.93 (p&lt;0.001) among all raters. Conclusion The updated instrument showed high agreement and proved to be a methodologically sound and applicable tool for the purpose of classifying foods by the extension and purpose of industrial processing.

Consumption of ultra-processed foods and associated factors in adults: evidence from the 2008-2009 Campinas Health Survey.

The aim of the present study was to evaluate the consumption of ultra-processed (UP) foods and associated factors among adults. We used cross-sectional data on 947 adults from the 2008-2009 Campinas Health Survey. Food consumption data were collected using the 24-h dietary recall method and food items were classified according to NOVA classification based on the nature, extent and purpose of industrial processing. Linear regression models were run to evaluate the association between the consumption UP foods and predictor variables with a 5% significance level. The average daily energy intake per capita was 2000.6 kcal and UP foods represented 24.1% of this intake. UP food consumption was higher among women and increased with the increase in schooling. Consumption was also higher among young adults between 20 and 29 years old as well as ex-smokers and individuals who were physically active at leisure. The results show that there is still time to intervene in favor of the health of the adult population. Thus, studies dedicated to the investigation of food intake from the perspective of the NOVA classification, the possible repercussions for health and the evaluation of food and nutrition actions and policies should be prioritized in the current context of Brazil.

Predictor factors of glycemic control in children and adolescents with type 1 diabetes mellitus treated at a referral service in Rio de Janeiro, Brazil

AimTo evaluate the predictive factors of glycemic control in children and adolescents with type 1 diabetes mellitus (T1DM). MethodsCross-sectional study at a referral service in Rio de Janeiro, Brazil. Sociodemographic, anthropometric, clinical, and dietary factors were evaluated. Food consumption was evaluated by 24 h dietary recall and the NOVA system was adopted for classifying the foods according to the extent and purpose of industrial processing. The predictive factors were evaluated by multivariate linear regression, adopting p < 0.05. ResultsOne hundred and twenty children and adolescents participated, with a mean age of 11.74 years (±2.88) and HbA1c of 8.13% (±1.26). The mean diabetes duration was 6.68 years (±3.33) and the insulin used was 1.05 units per kilogram of ideal weight (IU/kg of ideal weight; ±0.46) About 80% (n = 96) used carbohydrate counting and it was verified that 24.27% (±17.89) of the participants’ total calories came from ultraprocessed foods. For each year of diagnosis with T1DM and for each IU/kg of weight used, HbA1c increased by 0.087% (β = 0.087, p = 0.007) and 0.651%, respectively (β = 0.651; p = <0.001). Use of carbohydrate counting was associated with a 1.058% reduction in HbA1c (β = −1.058; p = 0.001). ConclusionDisease duration and insulin dose were directly reflected in HbA1c concentrations, while carbohydrate counting showed an inverse association.

Ultra-processed foods: what they are and how to identify them.

The present commentary contains a clear and simple guide designed to identify ultra-processed foods. It responds to the growing interest in ultra-processed foods among policy makers, academic researchers, health professionals, journalists and consumers concerned to devise policies, investigate dietary patterns, advise people, prepare media coverage, and when buying food and checking labels in shops or at home. Ultra-processed foods are defined within the NOVA classification system, which groups foods according to the extent and purpose of industrial processing. Processes enabling the manufacture of ultra-processed foods include the fractioning of whole foods into substances, chemical modifications of these substances, assembly of unmodified and modified food substances, frequent use of cosmetic additives and sophisticated packaging. Processes and ingredients used to manufacture ultra-processed foods are designed to create highly profitable (low-cost ingredients, long shelf-life, emphatic branding), convenient (ready-to-consume), hyper-palatable products liable to displace all other NOVA food groups, notably unprocessed or minimally processed foods. A practical way to identify an ultra-processed product is to check to see if its list of ingredients contains at least one item characteristic of the NOVA ultra-processed food group, which is to say, either food substances never or rarely used in kitchens (such as high-fructose corn syrup, hydrogenated or interesterified oils, and hydrolysed proteins), or classes of additives designed to make the final product palatable or more appealing (such as flavours, flavour enhancers, colours, emulsifiers, emulsifying salts, sweeteners, thickeners, and anti-foaming, bulking, carbonating, foaming, gelling and glazing agents).

Criticism against the NOVA classification: who are the protagonists?

The NOVA classification is based on the extent and purpose of industrial processing of foods and beverages. It is increasingly used by health authorities as an effective proxy for the healthiness of these products. In particular, the consumption of ultra-processed food and beverage products (UPP) is associated with an increased risk of developing non-communicable diseases. NOVA has also been criticised. In this paper, our hypothesis was that this criticism came from individuals who had relationships with the UPP industry, one way or another. Between August and December 2018, we undertook a series of searches on PubMed, Google and Web of Science, to map the relationships between these individuals and the UPP industry. In total, we identified thirty-two materials criticising the NOVA classification, most of which were non-peer-reviewed. We identified 38 individuals as authors of these documents, among which we found 33 who had relationships with the UPP industry. Among the five individuals for whom we found no relationships with the industry, three were recent graduates and one had no known affiliation. During our analysis, we identified three types of relationships. The first one was when these individuals directly worked with the industry. The second type of relationship was conflicts of interest that individuals declared in their publications, or that they did not declare, but that we found online. The third type of relationship was when the organisations that hosted or presented the criticism of NOVA had relationships with the UPP industry. This study showed that there is currently a need for greater transparency in research and scientific reviews, as many of these relationships were not declared in the materials criticising NOVA.

Specificities of changes in the concentrations of heavy metals in milk thistle (Silybum marianum (L.) Gaertn.)

Aim. To investigate the content of heavy metals in the seeds of milk thistle (Silybum marianum (L.) Gaertn.) and in the product of its processing – oil. To reveal possible changes in the concentration of heavy metals in the years of cultivating this plant. Methods. The fi eld and spectrometric methods were applied; the results were processed using the technologies, common for agriculture, plant production and statistics. Results. The content of heavy metals in the seeds of milk thistle was defi ned. It was determined that their concentration exceeds maximal acceptable coeffi cient for the medicinal plant material. It was established that in 2013 the seeds of milk thistle accumulated several times more Ba, Ca, Fe, Mg, Mo, Sr, V compared to the indices of 2014, while Al, Co, Ag were found only in the samples of the seeds, harvested in 2013. Conclusions. As the regulatory documents regarding many relevant elements, which belong to heavy metals, do not specify maximal accept- able coeffi cients for the content of the latter in the medicinal plant material, it is reasonable to conduct complex studies, involving the specialists of relevant fi elds, in order to stipulate this gradation. In the Kyiv region the milk thistle plants accumulate a large amount of such heavy metals as cadmium, manganese, strontium, and zinc, which exceeds maximal acceptable degrees of accumulation and testifi es to partial pollution of region soils. It was established that the concentration of the main part of heavy metals in the product of processing milk thistle – oil – is decreased to the value under the threshold of analytic devices. This fact proves the pros- pects of growing milk thistle for industrial processing purposes.

‘Candidatus Liberibacter solanacearum’

<i>‘Candidatus</i> Liberibacter solanacearum’