Ultra-processed Food Intake Research Articles

Ultra-processed food intake and prevalence of osteoporosis in US adults aged 50years and older: a cross-sectional analysis.

Using regression analysis and adjusting for covariates, 24-h recall data from adults 50years and over in four cycles of NHANES were examined for associations between prevalence of osteoporosis and intakes of UPF as a proportion of daily energy intake. Mean (SE) intake of UPF as a proportion of total daily energy ranged from 29.5% (0.3) in the lowest quintile to 76.3% (0.3) in the highest. 50.5% of womenand 28.0% of men had osteopenia, 8.2% and 1.8%, respectively, had osteoporosis. Increased risk of osteopenia or osteoporosis was observed in the highest quintile of UPF intake compared to that of the lowest: OR 1.52 (95% CI 1.28, 1.79). The odds of self-reported prior fractures at hip, wrist, or spine in women increased by 1.9% for every percentage increase in proportion of UPF intake (95% CI 1.003, 1.035). Increased risk of fracture was not observed among men. These findings indicate an association between osteoporosis and osteopenia and the intake of UPF as a proportion of total daily energy. Further investigation into the impact of dietary quality on osteoporosis and fracture risk is warranted, particularly in post-menopausal women.

P0622 Total emulsifier intake, but not ultra-processed food consumption is higher in patients with Inflammatory Bowel Disease compared to healthy controls

Abstract Background Ultra-processed food (UPF) intake, which often contains emulsifiers that might affect the intestinal barrier, has been linked to inflammatory bowel disease (IBD) incidence and progression.1 Here, we assessed intake of UPFs, emulsifiers and macronutrients in patients with IBD and healthy controls. Methods Dietary intake was cross-sectionally calculated from Food Frequency Questionnaires (FFQs) and food logs. Two 24-hour dietary recalls in IBD patients attending the infusion unit were compared to two prospective logs from healthy controls from the FOAM study.2 Kruskal Wallis with post-hoc Dunn test was used for continuous data, and Fisher exact test for proportions, with Bonferroni correction for multiple testing. Results We included 186 subjects (Table 1). Assessing food logs, UPF intake was similar in all groups, yet emulsifier intake was higher in UC and CD compared to controls (p=0.03 and p=0.0004, resp). Compared to controls, higher intakes of E402 (UC p=0.02, CD p=0.002), E411 (both p=0.01), E471 (UC p=0.02, CD p=0.0009), as well as carrageenan E407 (UC p=0.001, CD p=0.002), and xanthan gum E415 (UC p=0.03, CD p=0.01) were seen (Fig 1). Intake of E476 was higher in CD compared to controls (p=0.02), while intake of guar gum E412 was higher in UC compared to controls (p=0.02). The proportion of non-consumers of E402 was higher in controls (100%) compared to IBD (CD 83%, UC 67%, p=0.03). Sugar intake was higher in UC (p=0.004) compared to controls. When comparing FFQs, a higher intake of deli meat in CD was seen, compared to UC (p=0.04). Compared to controls, soft drink (UC p=0.0005, CD p=0.001), meat (UC p=0.02, CD p=0.04), and butter intake (UC p=0.03, CD p= 0.005) was higher in IBD. However, intake of breakfast cereals (UC p=6e-13, CD p=1e-10), legumes (UC p=2e-04, CD p=1e-05), meat substitutes (UC 6e-04, CD p=0.02), whole grain pasta and rice (UC p=2e-6, CD p=4e-5), and fibre (UC p=0.01, CD p=0.002) was lower in UC and CD. Coffee (p=0.03), potato (p=0.01), deli meat (p=3e-04), and sodium intake (p=0.02) was higher in CD patients than controls, while nut and seed intake was lower (p=3e-04). For UC, polysaccharide intake was lower in UC than controls (p=0.007). There was no correlation between C-reactive protein and intake of UPFs, emulsifiers, macronutrients or total energy intake (p>0.1). Conclusion We show higher intakes of emulsifiers in patients with IBD compared to controls, while UPF intake was comparable. The concomitant increased intake of specific emulsifiers such as carrageenan and guar gum that have previously been associated with disruption of the intestinal barrier, warrant further investigation into their role in the propagation and maintenance of gut inflammation.

P0768 Ultra Processed Food in Inflammatory Bowel Disease – Friend or Foe? An examination into the contribution of UPFs to nutrient intake in an IBD remission cohort

Abstract Background Ultra-processed foods (UPFs) and their effect on the gut microbiome and their role in the pathogenesis and activity of inflammatory bowel disease (IBD) are attracting increasing interest. Dietary restrictions in Crohn’s Disease (CD) are common, whether self-imposed or result from adherence to advice from health professionals1. Increasing attention in UPFs may lead to further food restrictions and impact on nutrient intake. This study investigated the intake of UPFs of adults with CD during disease remission and explored their contribution to overall macro and micronutrient intake. Methods 195 CD outpatients in clinical remission (HBI <5 and faecal calprotectin <250µg) were recruited from a single UK IBD centre as part of the INTICO 2 observational study. Seven-day food diaries were electronically recorded (Nutritics® Libro) and used to determine dietary adequacy (number of nutrients <LRNI). UPF intake was determined using NOVA Scoring System2 to determine UPF (NOVA 4) intake by two registered dietitians. Product ingredient lists were examined to assign a NOVA score. Consensus on NOVA Scoring was achieved, and a data dictionary was prospectively updated to justify the assigned score. Results Mean Nova 4 score was 39.8 (SD 15.7) per 7 day food diary. Inadequacies of micronutrient intake were common and often multiple, with a mean of 6(SD 4) micronutrients below the LRNI per subject. UPFs contributed significantly to overall macro and micronutrient intake from food with 54% energy, 60% carbohydrates, 55% fat and 50% fibre intake derived from foods categorised as NOVA 4. There was no association between NOVA 4 intake and the degree of nutrient inadequacy as the number of nutrients below RNI in this cohort (Pearson’s Correlation P=0.629). Figure 1 and 2 describe the contribution of each NOVA group to micronutrients and fibre respectively. Conclusion In a CD remission cohort, UPF intake as captured by NOVA score was comparable with what was seen in other reports of healthy adults and other studies of patients with IBD. Eating more UPFs was not associated with a lower intake of micronutrients. Importantly, food categorised as NOVA-4 contributed to a significant proportion of energy, fibre, and micronutrient intake. NOVA scoring does not differentiate between UPFs high in fat, sugar, and salt and those that are not. Advice to "avoid UPFs" must be balanced against the potential consequences of reducing micronutrient intake, especially in those with low or marginal nutrient intakes. A targeted approach to reduce the intake of UPFs that provide little nutritional value is required to maintain nutrient intake. References 1)Holt D.Q., Strauss B.J. & Moore G.T. (2017) Patients with inflammatory bowel disease and their treating clinicians have different views regarding diet. J Hum Nutr Diet. 30, 66–72 doi: 10.1111/jhn.12400 2)SACN statement on processed foods and health. GOV.UK. https://www.gov.uk/government/publications/sacn-statement-on-processed-foods-and-healthOffice. SACN statement on processed foods and health - summary report. GOV.UK. Published July 11, 2023. https://www.gov.uk/government/publications/sacn-statement-on-processed-foods-and-health/sacn-statement-on-processed-foods-and-health-summary-report#results Figure 1: Micronutrient intake characterised by NOVA score Figure 2: Fibre intake characterised by NOVA Score

P1230 Impact of vegan diet on the incidence of Inflammatory Bowel Diseases among Israeli young adults

Abstract Background Diet is believed to modulate intestinal inflammation through its regulatory effects on the microbiota, gut immune system, and epithelial barrier function. Previous research, mostly based on questionnaires of food consumption, showed that high dietary intake of total fats, meat and processed food is associated with an increased risk of incident IBD, while plant-based , fiber rich-diet is associated with a reduced risk of incident IBD. Between the years 1998-2017, Vegans enlisted to the Israel Defense forces (IDF) were entitled to a special allowance. Strict requirements for confirmation of vegan status were followed. We assessed whether a vegan diet protect against incident IBD in a cohort of young Israeli adults. Methods A historical prospective cohort including all Israeli adolescents enlisted between 1998-2017. The data gathered included age, sex, body mass index (BMI), country of origin, general intelligence tests (GIT), socioeconomic status (SES), and incident IBD. A multivariate logistic regression model and 1:1 propensity score-matched cohorts were utilized to calculate the OR of developing IBD in vegans compared to controls. Results The study population consisted of 1,049,005 subjects, 630,536 (60%) males, and 5941 (0.57%) vegans. The median follow-up duration was 1046 days (IQR 727-1094). Vegans came from higher SES (6.3 vs. 5.9, p<0.001), were more likely to be of European descent (47.2% vs. 25.8%, p<0.001), and had higher GIT results (63.5 vs 52.6, P<0.001). Along the study period, 2039 (0.19%) subjects developed IBD , 17 among vegans (0.29%), and 2022 among controls (0.19%) (p=0.12). In both groups, the distribution of CD and UC cases was exactly the same, with 70% of cases being CD and 30% being UC. IBD patients were more likely to be male (64.3% vs. 60.1%, p<0.001), from European origins (39% vs. 25.9%, p<0.001), and a higher SES (6.15+- 1.54 vs. 5.94+-1,64, p<0.001). Based on a multivariate logistic regression controlling for sex, country of origin, BMI, GIT and SES, a vegan diet was not associated with a reduction in IBD incidence (OR 1.14, 95% CI 0.68-1.78). Analysis of a 1:1 propensity-score-matched cohort of subjects (n=5484) demonstrated no statistically significant differences between vegans and controls regarding IBD incidence (0.29 vs. 0.32%, p=0.87). An exploratory evaluation of the impact of vegan diet on endoscopic severity was performed only in CD patients and revealed a lower incidence of large ulcers in the vegan group (57%) compared to controls (79%). Conclusion In this nationwide cohort of young Israeli adults, a vegan diet was not associated with a reduction in the incidence of IBD. Endoscoppic disease severity might be milder among vegan CD patients. References Hou JK, Abraham B, El-Serag H. Dietary intake and risk of developing inflammatory bowel disease: a systematic review of the literature. Am J Gastroenterol. 2011;106(4):563-573. doi:10.1038/ajg.2011.44 Narula N, Wong ECL, Dehghan M, et al. Association of ultra-processed food intake with risk of inflammatory bowel disease: prospective cohort study. BMJ. 2021;374:n1554. Published 2021 Jul 14. doi:10.1136/bmj.n1554 Chen J, Wellens J, Kalla R, et al. Intake of Ultra-processed Foods Is Associated with an Increased Risk of Crohn's Disease: A Cross-sectional and Prospective Analysis of 187 154 Participants in the UK Biobank. J Crohns Colitis. 2023;17(4):535-552. doi:10.1093/ecco-jcc/jjac167

P1316 Increased ultra-processed food consumption is associated with inflammation-promoting shift of gut microbiota in Inflammatory Bowel Disease

Abstract Background Previous epidemiologic studies have suggested that increased consumption of ultra-processed food (UPF) can increase the risk of developing inflammatory bowel disease (IBD) by exacerbating gut dysbiosis.1 However, studies directly linking UPF to specific microbial shift in IBD patients are limited. Our study explored differences in gut microbiota profile based on UPF intake in patients with IBD. Methods This multi-centre cohort study included 313 IBD patients from three hospitals. Patients were divided into four quartiles (Q1, Q2, Q3, Q4) based on their percentage UPF consumption, evaluated from the Korea National Health and Nutritional Examination Survey. 16S rRNA sequencing was conducted on stool samples to analyse microbial composition. Subgroup analysis was performed based on IBD activity, whereby faecal calprotectin 250 ug/g was used as a cutoff value for defining active and remission state. UPF quartiles were grouped as Q1, Q2 and Q3, Q4 when conducting subgroup analysis to maintain an adequate number of samples for comparison. Age-adjusted analysis was conducted on patients younger than 50 years. Results General characteristics of the study population showed that there were no significant differences in inflammatory markers between quartiles. However, age was significantly different (p=0.001), with the first quartile having the highest median age of 49 years. Microbial analysis showed differences in beta diversity across quartiles (p=0.046), with the abundance of Lachnospiraceae and Faecalibacterium decreasing as UPF consumption increased. Subgroup analysis showed that patients with active inflammation showed no difference in alpha or beta-diversity, but Lactobacillus was more abundant in Q1, Q2 than Q3, Q4. Patients in remission differed in beta-diversity (p=0.012), with a greater abundance of Lachnospiraceae and Faecalibacterium in Q1, Q2 and Escherichia/Shigella and Veillonella in Q3, Q4. Age-adjusted analysis showed that in active IBD, Lactobacillus was more abundant in Q1, Q2 whereas Enterobacteriaceae was more abundant in Q3, Q4. Age-adjusted analysis of patients in remission showed that Lachnospiraeae, Faecalibacterium, Bifidobacterium were more abundant in Q1, Q2 than Q3, Q4. Conclusion This study suggests that increased UPF consumption is associated with an inflammatory-promoting shift in the gut microbiome of IBD patients. Restricting UPF intake may be important for controlling gut inflammation and preventing IBD relapse.

P0300 Ultra-processed food consumption affects body composition in a cohort of italian patients with inflammatory bowel disease

Abstract Background Diet is a key factor in the development of IBD, which are showing rising incidence in industrialized countries, where the “Western” diet, rich in ultra-processed foods (UPF), is prevalent. Consumption of UPFs has been linked to an increased risk of both IBD developing and relapse. However, there is limited data on the relationship between UPF intake and body composition in IBD patients. We aimed to evaluate the impact of UPF consumption on body composition in individuals with IBD. Methods In this single-center observational study, we enrolled adult IBD patients. Exclusion criteria were active disease, defined as Harvey-Bradshaw Index > 5 for Crohn’s disease (CD) and Partial Mayo Score > 2 for Ulcerative Colitis (UC), pregnant or breastfeeding women, use of corticosteroids, high physical activity as assessed by the International Physical Activity Questionnaire (IPAQ), and previous bowel surgery. UPF consumption was assessed using country-specific validated food frequency questionnaires (FFQ), whose evaluated foods were categorized based on the NOVA classification into 4 classes according to their degree of processing. The percentage of UPF consumption was divided into 3 tertiles (T1=low; T3=high). Body composition was assessed through bioimpedance analysis. Continuous variables were expressed as mean±standard deviation (SD) or as median and interquartile range (IQR) according to their distribution assessed by the Kolmogorov-Smirnov test. Frequencies were calculated for the categorical variables. The Mann-Whitney rank-sum test, t-test, or ANOVA test was used to compare continuous variables; the Chi-square and Fisher’s exact test were used to compare categorical variables. Multiple linear regression analysis was used for fatty-free mass (FFM) predicted by UPF consumption. Results We enrolled 40 IBD patients (12 UC and 28 CD). The mean age and BMI were 42.5±16.2 years and 25±4.4 kg/m², respectively. UPF consumption was higher in CD than UC patients, both in terms of g/day (823±312 vs 609±248, p=0.04) and % weight (20.3±6.9 vs 15.1±6.1, p=0.028). Patients with T3 UPF consumption compared to T1 had a lower age (37.69±10.7 vs 55.9±17, p=0.001) and lower FFM (0.69±0.06 vs 0.75±0.09, p=0.012). When adjusting for age, sex and disease type the percentage of FFM was lower in T3 compared with T1 (β= -0.56; p=0.002). Higher UPF consumption was associated with FFM reduction in younger IBD patients. Conclusion Our findings emphasize the need for nutrition counseling in IBD patients, focusing on reducing the intake of UPFs, which can exacerbate the disease either by directly inflaming the bowel or by negatively impacting body composition. Further large-scale prospective studies are needed to validate our results.

Cross-Sectional Comparative Analysis of Gut Microbiota in Spanish Adolescents with Mediterranean and Western Diets

Dietary patterns, such as the Mediterranean diet (MD) and the Western diet (WD), influence gut microbiota composition and functionality, which play important roles in energy metabolism and nutrient absorption. Objectives: A descriptive cross-sectional study was designed to evaluate the gut microbiota of 19 Spanish adolescents and to investigate the association of MD and ultra-processed food (UPF) intake with microbial diversity and community structure. Methods: Functional diversity of gut microbiota was evaluated using Biolog EcoPlates, taxonomic composition was assessed with 16S rRNA sequencing via MinION, and phenotypic responses to antibiotics were analyzed using the cenoantibiogram technique under aerobic and anaerobic conditions. Results: Adolescents with higher adherence to the MD exhibited greater functional diversity, as per the Shannon–Weaver index. In addition, this group showed higher abundance of bacterial genera previously described as beneficial, such as Paraclostridium, Anaerobutyricum, Romboutsia, and Butyricicoccus. In contrast, adolescents reporting greater UPF intakes had a microbiota composition similar to those with low adherence to the MD, characterized by decreased abundance of beneficial genera. Regarding antibiotic resistance, significant differences were only observed under anaerobic conditions, with individuals with low adherence to the MD showing more sensitivity for most antibiotics tested. Conclusions: These results suggest that the MD promotes a healthier and more balanced gut environment, potentially improving metabolic functions in adolescents. Despite the lack of differences in α-diversity, comparisons of microbial community structure between adolescents following the MD and those with high UPF (characteristic of the WD) showed clear differences in terms of β-diversity. These findings suggest that dietary patterns influence the composition of the gut microbiota in a more complex manner, beyond just taxonomic richness. The outcomes of this exploratory study highlight opportunities for future research to deepen understanding of the long-term health implications of these dietary patterns, as well as the mechanisms regulating the composition, functionality, and phenotypic responses to antibiotics of gut microbial communities.

Association between higher consumption of ultra-processed foods and risk of diabetes and its complications: A systematic review & updated meta-analysis.

Recent epidemiologic studies on the association between higher consumption of ultra-processed foods (UPF) and risk of incident diabetes have reported conflicting results in populations worldwide. We conducted an updated systematic review and meta-analysis to quantify the magnitude of this association. PubMed and Embase databases were systematically searched (from 2009 to November 14, 2024) for prospective cohort studies reporting data on the association between UPF intake (defined by the NOVA classification) and the risk of incident diabetes or its complications in adults (>18 years). Meta-analysis was performed using random-effects modelling to obtain pooled hazard ratios (HRs) with 95 % confidence intervals (CIs), and the GRADE approach was applied to evaluate the certainty of evidence. We included 14 prospective cohort studies with 692,508 participants. The highest UPF consumption was significantly associated with an increased risk of diabetes (n = 9 studies; HR 1.24, 95 % CI 1.14 to 1.34, I2 = 69 %) compared with the lowest UPF intake (very low certainty of evidence). Subgroup analysis showed that studies published in 2024 had a smaller effect size compared with earlier studies. There were no significant differences between subgroups based on study location, duration of follow-up, method and frequency of dietary intake assessment, and risk of bias. Sensitivity analyses did not alter these results. Each 10 % increase in total UPF consumption was associated with a 13 % (n = 4 studies; HR 1.13, 95 % CI 1.08 to 1.18, I2 = 37 %) increased risk. Preliminary data from 4 cohort studies also suggest that high UPF consumption may be associated with complications in diabetic patients, including microvascular/cardiovascular disease, chronic kidney disease, and mortality. UPF consumption is associated with a higher risk of incident diabetes and may contribute to its complications. Urgent public health efforts should prioritize the reduction of UPF consumption.

Micronutrients or processing? An analysis of food and drink items from the UK National Diet and Nutrition Survey based on micronutrient content, the Nova classification and front of package traffic light labelling.

Increased ultra-processed food (UPF) intake is associated with adverse health outcomes. However, with limitations in UPF evidence, and partial overlap between UK front of package labelling (FOPL) and degree of food processing, the value of food processing within dietary guidance is unclear. This study compared food and drink from the UK National Diet and Nutrition Survey (NDNS) database based on micronutrient content, Nova classification and FOPL. The aim was to examine the micronutrient contributions of UK food and drink to UK government dietary micronutrient recommendations for adult females and males, aged 19-64 years, based on the degree of food processing and FOPL. NDNS items were coded into minimally processed food (MPF), processed culinary ingredients (PCI), processed food (PF) and UPF, and FOPL traffic lights. MPF, PF and UPF provided similar average contributions per 100g to micronutrient recommendations. Per 100kcal, MPF provided the greatest average contribution to micronutrient recommendations (14.4% [interquartile range (IQR):8.2-28.1]), followed by PF (7.7% [IQR:4.6-10.9], then UPF (5.8% [IQR:3.1-9.7]). After adjusting for healthy/unhealthy items (presence of 1+ red FOPL), MPF had higher odds of an above average micronutrient contribution per 100kcal than UPF (odds ratio (OR): 5.9x (95%CI:4.9, 7.2)), and PF (OR:3.2 (95%CI:2.4, 4.2)). MPFs were more likely to provide greater contributions to dietary micronutrient recommendations than PF or UPF per 100kcal. These findings suggest that UPF or PF diets are less likely to meet micronutrient recommendations than an energy-matched MPF diet. The results are important for understanding how consumers perceive the healthiness of products based on FOPL.

Social and economic patterning in UPF intake in toddlerhood and middle childhood: longitudinal data from the UK Gemini cohort.

Children's consumption of ultra-processed food (UPF) may contribute to inequalities in obesity and wider health. Socioeconomic patterning in younger UK children's UPF intake is unknown. To investigate socioeconomic patterning of UK toddlers' (21-months) and children's (7-years) UPF intake across several household and neighbourhood indicators. Secondary analysis of data from a prospective longitudinal cohort study using parent-report sociodemographic data and 3-day diet diaries. /setting: Participants were children from the UK Gemini study of n=4,804 twins born in 2007. At 21-months and 7-years, n=2,591 and n=592 children had at least 2-days of dietary data, respectively. Percentage energy from UPF at 21-months and 7-years-of-age, classified using the NOVA system. Unadjusted linear regression models were run for household socioeconomic position (SEP) composite score, Index of multiple deprivation decile, income, occupation level, mother's age, education of mother and partner, child's ethnicity, sex, and age. Adjusted multivariable linear regression models were adjusted for ethnicity and all SEP indicators except SEP composite score (Adjusted 1), in addition to child sex and age (Adjusted 2). Missing data were addressed with multiple imputation and inverse probability weighting. Confidence intervals and P-values were adjusted to account for clustering within families. Children of lower SEP had higher UPF intake across several indicators. Mother's education was the strongest predictor, with postgraduate education associated with 8.64% (95% CI -12.08 to -5.20; P<0.001) and 10.12% (95% CI -15.68 to -4.56; P<0.001) less energy from UPF at 21-months and 7-years, respectively, compared to no educational qualifications in Adjusted model 2. UK children from more disadvantaged backgrounds consumed a greater proportion of their energy from UPF. Mother's education seemed the most influential factor. Socioeconomic inequalities, particularly in maternal education, may drive disparities in diet quality and associated health outcomes. Addressing these gaps is essential to reduce childhood obesity and improve long-term health in socioeconomically disadvantaged populations.

The Cross-Sectional Association Between Ultra-Processed Food Intake and Metabolic Dysfunction-Associated Steatotic Liver Disease

The Cross-Sectional Association Between Ultra-Processed Food Intake and Metabolic Dysfunction-Associated Steatotic Liver Disease

Whole-grain modified Nova ultra-processed food definitions: a cross-sectional analysis of the impact on cardiometabolic risk measures when excluding high whole-grain foods from the ultra-processed food category in Australia.

Ultra-processed foods (UPF), defined using the Nova classification system, are associated with increased chronic disease risk. More recently, evidence suggests the UPF subgroup of whole-grain breads and cereals is in fact linked with reduced chronic disease risk. This study aimed to explore associations of cardiometabolic risk measures with Nova UPF intake v. when foods with ≥ 25 or ≥ 50 % whole grains are excluded from the definition. We considered dietary data from the Australian National Nutrition and Physical Activity Survey 2011-2012. Impacts on associations of UPF intake (quintiles) and cardiometabolic risk measures were analysed using regression models. The median proportion of UPF intake from high whole-grain foods was zero for all quintiles. Participants in the highest Nova UPF intake quintile had significantly higher weight (78·1 kg (0·6)), BMI (27·2 kg/m2 (0·2)), waist circumference (92·7 cm (0·5)) and weight-to-height ratio (0·55 (0·003)) compared with the lowest quintile (P< 0·05). Associations were the same when foods with ≥ 25 and ≥ 50 % whole grains were excluded. Adjusted R-squared values remained similar across all approaches for all outcomes. In Australia, high whole-grain foods considered UPF may not significantly contribute to deleterious cardiometabolic risk associations. Until conclusive evidence on Nova UPF is available, prioritisation should be given to the nutrient density of high whole-grain foods and their potential contribution to improving whole-grain intakes and healthful dietary patterns in Australia.

Ultra-processed food intake in relation to metabolic health status in Iranian adolescents with overweight and obesity

Ultra-processed food intake in relation to metabolic health status in Iranian adolescents with overweight and obesity

Association between gut microbiota and ultra-processed foods consumption among the patients with type 2 diabetes: a cross-sectional study

BackgroundThis study aimed to explore the relationship between ultra-processed foods (UPFs) consumption and gut microbiota in patients with type 2 diabetes (T2D).MethodsThis cross-sectional study included 362 participants with T2D. UPFs consumption was assessed using a brief-type self-administered diet history questionnaire, quantified as the density of UPFs intake (g/1000 kcal). Gut microbial composition was evaluated via 16S rRNA gene sequencing. We investigated the association between gut microbiota, previously identified as relevant to T2D, and the density of UPFs intake using Spearman rank correlation coefficients. Multiple regression analysis, adjusting for age, sex, BMI, smoking status, exercise, and medication use, was conducted to further investigate these associations.ResultsThe mean age of participants was 68 (63–74) years. The density of UPFs intake showed significant associations with Bifidobacterium (r = 0.11, p = 0.031), Lactobacillus (r = 0.11, p = 0.046), Ruminococcus (r = −0.12, p = 0.019), Roseburia (r = 0.11, p = 0.045). After adjusting for covariates in multiple regression analysis, Ruminococcus and Roseburia showed modest negative (β = −0.11, p = 0.038) and positive (β = 0.12, p = 0.033) correlations, with the density of UPFs intake among participants with T2D, respectively.ConclusionsThe density of UPFs intake was modestly inversely associated with Ruminococcus among patients with T2D and modestly positively associated with Roseburia.

Associations of Ultra-Processed Food Intake with the Incidence of Cardiometabolic and Mental Health Outcomes Go Beyond Specific Subgroups-The Brazilian Longitudinal Study of Adult Health.

Background/Objectives: Avoidance of ultra-processed foods (UPFs) has been recommended to achieve a healthy diet, but whether it applies equally to all UPFs is uncertain. We evaluated individual UPF subgroups in the prediction of cardiometabolic and mental health outcomes. Methods: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is an occupational cohort study of 15,105 adults (35-74 years) recruited in 2008-2010. We followed participants up to 2018 to ascertain elevated weight and waist gains and the onset of metabolic syndrome, hypertension, metabolic dysfunction-associated steatotic liver disease, diabetes, common mental disorders, depressive episodes, and anxiety disorders. Results: In adjusted robust Poisson regression, greater overall UPF intake at the baseline predicted all studied outcomes. Various subgroups of UPF, most frequently processed meat and sweetened beverages, individually conferred a greater risk, and nearly all predicted at least one studied outcome. Considering all subgroups and outcomes, a broad pattern of overall risk was present. When subgroups not individually predictive of these outcomes were aggregated, increased risk (for a one-standard deviation change) was observed for elevated weight (RR = 1.05; 95% CI 1.01-1.11) and waist (RR = 1.05; 95% CI 1.00-1.10) gains, and for the incidence of common mental (RR = 1.06; 95% CI 1.01-1.12), and anxiety (RR = 1.09; 95% CI 1.02-1.16) disorders. Conclusions: UPFs overall and their subgroups predicted future cardiometabolic and mental health outcomes. The pattern of individual UPF subgroup associations varied across outcomes, and the aggregate of subgroups not individually predicting risk also predicted large gains in overall and central adiposity and the incidence of mental health disorders. While additional studies investigating other outcomes are needed, these findings justify avoidance of overall UPF intake in health promotion and disease prevention.

Gut Microbiota: Association with Fiber Intake, Ultra-Processed Food Consumption, Sex, Body Mass Index, and Socioeconomic Status in Medical Students.

To evaluate the differences in the gut microbiota composition in medical students according to fiber intake, ultra-processed food (UPF) consumption, sex, body mass index, and socioeconomic status. A cross-sectional study was conducted with 91 medical students, and 82 fecal samples were analyzed. Sociodemographic and dietary data were collected via questionnaires, UPF consumption was assessed using the NOVA classification, and trained nutritionists performed anthropometry. DNA extraction and 16S rRNA sequencing were performed for the microbial analysis. Bioinformatics and statistical tests included the Dunn and Kruskal-Wallis tests, a PCoA analysis, PERMANOVA, ANOVA, Spearman's rank correlation, and alpha and beta diversity metrics. Dietary fiber intake strongly influences gut microbiota composition. Lower fiber intake was associated with a higher prevalence of Parabacteroides and Muribaculaceae. Prevotella was more prevalent in individuals with lower UPF intake, while Phascolarctobacterium was prevalent in those with higher UPF consumption. Significant differences were associated with sex and UPF consumption but not BMI or SES. Women consumed more UPF, which correlated with distinct gut microbiota profiles. This study highlights the significant impact of diet, particularly fiber intake and UPF, on gut microbiota composition, emphasizing the importance of dietary habits in maintaining gut health.

Association between consumption of ultra-processed foods and glycemic self-monitoring in women with gestational diabetes mellitus and their newborns: A cohort study.

To evaluate the association between the consumption of ultra-processed foods (UPFs) and outcomes of self-monitoring of blood glucose in pregnant woman with gestational diabetes mellitus (GDM) and the occurrence of hypoglycemia in their newborns. Prospective cohort study of pregnant woman with GDM who were followed up from the second trimester of pregnancy in high-risk prenatal care until the immediate postpartum period. Dietary intake was assessed using 24-h recalls and analyzed according to the Nova Classification. The glycemic profile was assessed by self-monitoring of fasting and postprandial capillary glycemia (pregnant) and by capillary glycemia in the first 48 h of life (neonate). Multilevel binary logistic regression models were used to assess the relationship between increasing UPF intake, considering the highest tertile of UPF consumption, and women's glycemic control and the occurrence of neonatal hypoglycemia. UPFs provided 15% of calories consumed; 33.3% (n = 30) and 52.3% (n = 45) of the women had hyperglycemia in the second and third trimesters of pregnancy, respectively. After adjustment it was observed that UPF consumption had no significant association with maternal glycemic control but it showed a positive association with the occurrence of neonatal hypoglycemia (odds ratio [OR] 1.144, 95% confidence interval [CI] 1.037-1.262, p = 0.007). These data reinforce the need to address food processing during high-risk prenatal care in order to help reduce the negative impacts of UPF consumption on the mother-infant dyad.

Inappropriate Diet Exacerbates Metabolic Dysfunction-Associated Steatotic Liver Disease via Abdominal Obesity.

Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a refined categorization of non-alcoholic fatty liver disease (NAFLD), highlighting the intricate relationship between hepatic steatosis and metabolic dysfunction. Abdominal obesity (AO), a key diagnostic criterion for metabolic dysfunction, predominantly results from inappropriate diet and unhealthy dietary habits. To comprehensively investigate which dietary factors contribute to MASLD through AO and to understand the underlying biological mechanisms, we initially conducted a systematic review of meta-analysis articles in the PubMed database from the past decade, summarizing dietary factors that affect AO. Subsequently, we conducted targeted searches in the PubMed database for these dietary factors and provided a narrative review of the mechanisms of how these dietary factors lead to AO and how AO exacerbates MASLD. A diet characterized by excessive intake of energy, carbohydrates, fructose, or ultra-processed foods (UPFs) is considered inappropriate. Inappropriate diet leads to the formation of MASLD and AO by enhancing pathways such as de novo lipid synthesis (DNL) in the liver, insulin resistance (IR), gut-liver dysfunction, and inflammation. Dietary interventions for inappropriate diets can effectively intervene in and improve MASLD and AO. The mechanism of inappropriate diet on abdominal fat deposition is through excessive energy or the activation of the enzyme 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD-1) to increase endocortisol secretion. Then, the excessive accumulation of visceral fat facilitates a rapid and augmented flux of free fatty acids (FFAs) to the liver and initiates a series of deleterious effects, including oxidative stress (OS), endoplasmic reticulum stress (ERS), activation of protein kinase C (PKC) pathways, and inflammation. Additionally, FFAs may mediate excessive lipid deposition and hepatocellular damage through the action of hormones. These pathways to liver damage exacerbate MASLD and progression to metabolic dysfunction-associated steatohepatitis (MASH) and fibrosis. Furthermore, investigating other potential mechanisms by which AO may influence MASLD could offer new recommendations for the treatment guidelines of MASLD.

A Pilot Study of a Novel Dietary Intervention Targeting Ultra-Processed Food Intake.

Ultra-processed foods (UPFs) are harmful to health but ubiquitous in the modern food environment, comprising almost 60% of the average American diet. This study assessed the feasibility, acceptability, and preliminary efficacy of a novel behavioral intervention designed to reduce UPF intake. Fourteen adults participated in an 8-week pilot intervention, which consisted of weekly group sessions, individual meal planning sessions, and financial support. Dietary intake was assessed using three Automated Self-Administered 24-h Dietary Recalls (ASA24) at both baseline and post-treatment. The intervention was highly feasible and acceptable. Qualitative data demonstrated that participants were enthusiastic about the benefits of reducing UPF intake and found the intervention highly valuable. Participants reduced average daily calories from UPF by 48.9%, number of UPFs consumed by almost half, total daily calorie intake by 612 calories/day, sodium consumption by 37% and sugar consumption by 50%. There were no significant changes in fruit or vegetable intake. Participants lost an average of 3.5kg (SD=3.0kg). This pilot data suggests that behavioral interventions to reduce UPF intake will be well-received and are capable of success despite the barriers of the United States food environment. Future research should prioritize behavioral interventions targeting UPF consumption alongside policy changes.

Processed and ultra-processed foods are associated with depression and anxiety symptoms in a cross-sectional sample of urban Lebanese adults.

While low dietary quality has been linked to poor mental health, evidence on more direct relations of specific dietary quality indicators, namely degrees of food processing, with mental health disorders remains limited. This study aims to investigate the association between food groups' intakes, defined based on their degree of food processing, with depression and anxiety symptoms in a sample of Lebanese adults. We hypothesized that higher intakes of ultra-processed foods (UPF) will be related to higher risk of depression and anxiety while an opposite association will be observed for unprocessed or minimally processed foods (MPF). Data come from a Lebanese cross-sectional study (n = 188 adults). The NOVA classification was adopted for evaluating the intakes of the 4 food groups: unprocessed or minimally processed foods (MPF); processed culinary ingredients (PCI); processed foods (PF) and ultra-processed foods (UPF). Associations between food group intakes in quartiles with depression and anxiety symptoms were analyzed using multivariable regression analyses adjusted for several confounders. Median energy intake was 2481.65 (2617.2) kcal/d, with 36.12% of Total Energy Intakes coming from MPF, 29.71% from PF, 25.25% from UPF, and 5.75% from PCI. Among participants, 33% and 27.7% had elevated depression and anxiety symptoms, respectively. Higher PF intake was associated with significantly lower odds of both depression and anxiety symptoms while a higher UPF intake was associated with higher odds of depression. Results confirm the hypothesized links between UPF and adverse mental health outcomes and highlight the need for further studies on PF intakes and mental health given the culture-specific nature of foods constituting this group.