Priscila Pereira Machado

We read with great interest the study by Chen et al.(1), which adds further robust evidence that dietary patterns based on ultra-processed products (UPP) increase the risk for incident type 2 diabetes (T2D). However, as for the attempt to investigate the associations of specific groups and subgroups of UPP with T2D, here we argue that methodological artifacts may explain the findings on putative protective associations of some UPP groups and subgroups with T2D. First, the multivariable models have ignored the evident multicollinearity between total UPP, UPP group, and UPP subgroup intake added to models, particularly in food frequency questionnaires studies (2). Multicollinearity can obscure true relationships between exposure and outcome variables. It can lead to unreliable estimates, making it difficult to adequately determine individual associations of each correlated exposure variable (eg, total UPP, UPP …

PurposeThis cross-sectional study aimed to assess the association between ultra-processed foods consumption and dietary diversity and micronutrient intake in Australia.MethodsAs part of the Nutrition and Physical Activity Survey (2011–2012), 12,153 participants aged 2 years and above were recruited and interviewed. Dietary intake data were collected by two 24-h dietary recalls using the Automated Multiple-Pass Method. The NOVA classification system was used to group the food items based on the extent and purpose of industrial food processing. The mean micronutrient contents were calculated for the total diet, and for two diet fractions; one made up entirely of ultra-processed foods (NOVA group 4) and the other consisting of all non-ultra-processed foods (aggregation of NOVA food groups 1 to 3). The mean micronutrient content in the ultra-processed and non-ultra-processed food diet fractions were …

ObjectiveThis study aims to determine whether ultra-processed foods (UPFs) are being discussed in news media in Australia and whether this terminology, as described in the NOVA system, is being applied accurately.DesignInterpretive content analysis of online and print media articles that mentioned UPFs from 2009 to 2023 in Australia.SettingAustralia.ParticipantsOnline and print media articles.ResultsA total of two hundred ninety-eight Australian media articles were captured. A substantial increase in the number of UPF articles was observed between 2017–2019 and 2021–2023. The UPF concept was inaccurately explained or defined in 32 % of the articles and was frequently used interchangeably with other descriptors, such as ‘highly or heavily processed food’, ‘junk food’, ‘unhealthy food’, ‘packaged food’ and ‘discretionary food’. Most of the articles had a health focus; however, sustainability interest …

Aims In 2019, the Australian Academy of Science in collaboration with the nutrition community published the decadal plan for the science of nutrition. This article aims to review progress towards each of its pillar goals (societal determinants, nutrition mechanisms, precision and personalised nutrition, and education and training) and two enabling platforms (a national data capability and a trusted voice for nutrition science), prioritise actions, and conceptualise program logic implementation models. This process also brought together public health nutrition researchers to reflect on societal determinants of health, and advise how the next 5 years of the decadal plan could reflect contemporary issues. Methods Two engagement events, in 2023, brought together experienced and mid‐ and early‐career nutrition professionals for co‐creation of implementation logic models. Results One hundred and nine early and mid …

Background Ultra-processed food (UPF) intake has increased in the past few decades, yet knowledge around the long-term effects on cardiovascular disease (CVD) risk is limited. Moreover, the magnitude of the impact of UPF intake on CVD in Australia has not been established. Objective To investigate the association of UPF intake with incident CVD and hypertension in a population-based cohort of middle-aged women. Methods Women aged 46-55 years were prospectively recruited into the Australian Longitudinal Study on Women’s Health and followed for 15 years. UPFs were defined according to the NOVA classification, and the contribution of these foods to total dietary intake was estimated. Outcomes were incident CVD (self-reported heart disease/stroke) and/or hypertension. Logistic regression models assessed the association between UFP intake …

In the published article, the references “Davidou S, Christodoulou A, Fardet A, Frank K. The holistico-reductionist Siga classification according to the degree of food processing: an evaluation of ultra-processed foods in French supermarkets. Food Funct.(2020) 11: 2026–39. doi: 10.1039/c9fo02271f” and “Davidou S, Christodoulou A, Frank K, Fardet A. A study of ultra-processing marker profiles in 22,028 packaged ultra-processed foods using the Siga classification. J Food Comp Anal.(2021) 99: 103848. doi: 10.1016/j. jfca. 2021.103848” were not cited in the article. The citations have now been inserted as reference (43) and (44), in Section “2.1. Model development,” Sub-section “2.1. 5. Model 2,” paragraph 1 and should read:“The use of markers of ultra-processing (MUPs)(ie, processed food substances and cosmetic additives) to identify ultra-processed foods is a simple and effective way to capture the concept (43, 44).” In the published article, there was an error. Text was missing from the methods section. A correction has been made to Section “2.1. Model development,” Sub-section “2.1. 5. Model 2,” paragraph 1. This paragraph previously stated:“The use of markers of ultra-processing (MUPs)(ie, processed food substances and cosmetic additives) to identify ultra-processed foods is a simple and effective way to capture the concept. Ultra-processed foods are defined as “formulations of ingredients, mostly of exclusive industrial use, that result from a series of industrial processes”(9), and MUPs have been used as proxies to identify food ultra-processing. Another common characteristic of ultra-processed foods is the low presence or absence of …

BackgroundFew studies have tested longitudinal associations between ultra-processed food consumption and depressive outcomes. As such, further investigation and replication are necessary. The aim of this study is to examine associations of ultra-processed food intake with elevated psychological distress as an indicator of depression after 15 years.MethodData from the Melbourne Collaborative Cohort Study (MCCS) were analysed (n = 23,299). We applied the NOVA food classification system to a food frequency questionnaire (FFQ) to determine ultra-processed food intake at baseline. We categorised energy-adjusted ultra-processed food consumption into quartiles by using the distribution of the dataset. Psychological distress was measured by the ten-item Kessler Psychological Distress Scale (K10). We fitted unadjusted and adjusted logistic regression models to assess the association of ultra-processed …

BackgroundUltra-processed foods (UPFs) are becoming dominant in the global food and supply. Prospective cohort studies have found an association between UPF dietary pattern and increased risk of several non-communicable diseases and all-cause mortality. In this study, we (1) estimated the risk of all-cause mortality associated for each 10% increase in the share of UPF consumption in the total energy intake; (2) estimated the population attributable fractions (PAF) and the total number of premature deaths attributable to the consumption of UPF in adults (30-69 years) from 8 selected countries.MethodsFirst, we performed a dose-response meta-analysis of observational cohort studies assessing the association between UPFs dietary pattern and all-cause mortality. As we found evidence of linearity, we estimated the pooled RR (and its 95% CI) for all-cause mortality per each 10% increment in the % UPF. Then, we estimated the population attributable fraction (PAF) of premature all-cause mortality attributable to UPF in 8 selected countries with relatively low (Colombia and Brazil), intermediate (Chile and Mexico), and high (Australia, Canada, UK, and US) UPF consumption.ResultsWe found a linear dose-response association between UPF intake and all-cause mortality, with a 2.7% increased risk of all-cause mortality per 10% increase in the % UPF. Considering the magnitude of the association between UPFs intake and all-cause mortality, and the dietary share of UPF in each of the 8 selected countries, we estimated that 4% (Colombia) to 14% (United Kingdom and United States) of premature deaths were attributable to UPF intake …

Comprehensive metrics that provide a measure of dietary patterns at global and national levels are needed to inform and assess the effectiveness of policy actions that promote sustainable healthy diets. In 2019, the Food and Agriculture Organization of the United Nations and the World Health Organization reported 16 guiding principles of sustainable healthy diets, but it is still unknown how these principles are considered in dietary metrics. This scoping review aimed to explore how principles of sustainable healthy diets are considered in dietary metrics used worldwide. Forty-eight food-based, investigator-defined dietary pattern metrics assessing diet quality in free-living, healthy populations at the individual or household level were assessed against the 16 guiding principles of sustainable healthy diets, which was used as a theoretical framework. A strong adherence of the metrics to health-related guiding …

A nutrition classification scheme combining level of processing and nutrient profiling predicts increased intake of critical nutrients and obesity prevalence in Australia

The associations of micro/macronutrients and, more recently, whole-diet quality scores, with the development of inflammatory bowel disease in large, longitudinal prospective studies have yielded inconsistent results with a degree of ambiguity. 1 The exciting new development is the consistency of an association of the intake ultra-processed foods (UPFs) with development of Crohn’s disease (CD), but not ulcerative colitis (UC), across disparate cohorts, as convincingly outlined in the metaanalysis of over one million people globally by Narula and colleagues. 2 This adds CD to the list of UPF-associated non-communicable diseases, including all-cause mortality, cancer, cardiovascular disease, and obesity. 3 UPFs are defined according the NOVA classification system (Figure 1) 4 that has been widely used for retrospective assessments of UPF intake from food-frequency questionnaires, associating UPF as a …

The assignment of foods to one of four categories proposed by the Nova framework may be challenging in the absence of information on how these foods were prepared and their specific composition. A three-step iterative approach can make the categorization process more efficient and transparent, thereby increasing the accuracy of Nova estimates.

PurposeUltra-processed food (UPF) intake has increased in recent decades, yet limited knowledge of long-term effects on cardiovascular health persists and sex-specific data is scant. We determined the association of UPF intake with incident cardiovascular disease (CVD) and/or hypertension in a population-based cohort of women.MethodsIn the Australian Longitudinal Study on Women’s Health, women aged 50–55 years were prospectively followed (2001–2016). UPFs were identified using NOVA classification and contribution of these foods to total dietary intake by weight was estimated. Primary endpoint was incident CVD (self-reported heart disease/stroke). Secondary endpoints were self-reported hypertension, all-cause mortality, type 2 diabetes mellitus, and/or obesity. Logistic regression models assessed associations between UPF intake and incident CVD, adjusting for socio-demographic, medical …

BackgroundUltra-processed foods (UPF) are associated with adverse health outcomes. This study aimed to analyse the national trends in retail sales, consumer expenditure and nutritional quality of UPFs in Thailand.MethodsThe study used data from the Euromonitor Passport database for analysis of retail sales and consumer expenditure, and from the Mintel Global New Products Database for nutritional analysis using the WHO Southeast Asian Region nutrient profile model.ResultsThe study found the highest per capita sales volume and value of UPFs in 2021 were sauces, dressings & condiments (8.4 kg/capita) and carbonated soft drinks (27.1 L/capita), respectively. However, functional & flavoured water, ready-made meals and baked goods had the highest observed (2012–2021) and expected (2021–2026) sales growth. Supermarkets were responsible for most of the UPF sales since 2012, but convenience …

This study aimed to assess the nutritional quality of food and beverage products in Thailand by comparing four different food classification systems: the nutrient profiling-based food classification systems by the Department of Health (DOH), the WHO South-East Asia Region (WHO SEA) and the Healthier Choice Logo (HCL), and the food processing-based food classification system, NOVA. This study used secondary data from the Mintel Global New Products Database (N=17,414). Food subgroups were classified differently based on these four systems. The DOH classified food products into three groups: Group A - healthy pass or meeting standard; Group B - not meeting standard; and Group C – far below standard. The WHO SEA classified food products into two groups: marketing prohibited products; and marketing permitted products. The HCL classified food products into two groups: eligible products for the logo; and ineligible products for the logo. The NOVA classified food products into four groups: unprocessed or minimally processed foods (MP); processed culinary ingredients (PCI); processed foods (P); and ultra-processed foods (UPF). Descriptive statistics (percentage and frequency) were used for analysis. Agreement analysis was conducted using Cohen’s Kappa statistic between each pair of food classification systems. Of the total sample which could be classified by any of the four classification systems (n=10,486), the DOH, WHO SEA and HCL systems classified products as healthy (Group A, marketing permitted or eligible for HCL logo) at 10.4%, 11.1% and 10.9%, respectively. Only 5.6% were classified as minimally processed foods …

Objective The objective of this study was to examine the associations between ultra-processed food consumption and risk of obesity among UK adults. Methods Participants 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 …

Background In this secondary analysis of the Supporting the Modification of Lifestyle In Lowered Emotional States (SMILES) randomised controlled trial, we investigated if the beneficial effects of a dietary intervention on clinical depression were driven, in part, by reducing the consumption of foods classified as ultra-processed. Methods The SMILES trial enrolled 67 adults with major depressive disorder, randomly assigning them to either a 12-week modified Mediterranean dietary intervention or a social support control. Our analysis included 44 participants with non-missing dietary data and at least one valid Montgomery–Åsberg Depression Rating Scale (MADRS) assessment at 12 weeks of follow-up. The Nova food classification system was used to estimate the proportion of ultra-processed foods in the overall diet (percentage of grams) based on data from seven-day food diaries. We fitted linear regression models under blinded conditions to determine whether ultra-processed food intake-change from baseline to 12 weeks moderated the dietary intervention effects on depressive symptoms. We estimated mean differences in depressive symptoms along with ninety-five per cent confidence intervals (95% CIs). Results For participants in the dietary intervention, there was an additional 2.5-point improvement in MADRS scores for each 10% reduction in the dietary share of ultra-processed foods compared to participants in the control group (between-group mean differences in depressive symptoms:− 2.46, 95% CIs− 4.71 to− 0.20, p= 0.039, η p 2 of 0.10). Conclusions These preliminary findings suggest that the therapeutic benefit of a dietary …

Unhealthy diets are a leading risk factor for non-communicable diseases and negatively impact environmental sustainability. Policy actions recommended to address dietary risk factors, such as restrictions on marketing and front-of-pack labelling, are informed by nutrition classification schemes (NCSs). Ultra-processed foods are associated with adverse population and planetary health outcomes, yet the concept is rarely incorporated in nutrition classification schemes for policy actions. This study aims to develop a novel food processing-based nutrition classification scheme for guiding policy actions. A secondary aim is to validate the scheme by classifying food and beverage items in the Australian food supply (face validity) and comparing them to the classifications of existing NCSs (convergent validity). Two versions of a model were developed, classifying foods and beverages in two steps, first using the NOVA classification system and secondly by applying upper thresholds for added free sugars and sodium, producing a binary output of either healthy or unhealthy. All food and beverage items (n=7,322) in a dataset combining the Australian Food Composition Database (AUSNUT 2011-2013) and Mintel’s Global New Product Database (2014-2019) were classified using the two models. The same dataset was also classified by the Health Star Rating system (HSR), The Australian Dietary Guidelines (ADGs), The Pan American Health Organization’s Nutrient Profile Model (PAHO NPM), and the NOVA classification scheme, and pairwise agreement between all NCSs and the two models was determined (using Cohen’s Kappa coefficient). A higher …

ObjectiveTo examine how socio-demographic characteristics and diet quality vary with consumption of ultra-processed foods (UPF) in a cross-sectional nationally representative survey of Australian adults.DesignUsing a 24-h recall, this cross-sectional analysis of dietary and socio-demographic data classified food items using the NOVA system, estimated the percentage of total energy contributed by UPFs and assessed diet quality using the Dietary Guideline Index (DGI–2013 total and components). Linear regression models examined associations between socio-demographic characteristics and diet quality with percentage of energy from UPF.SettingAustralian Health Survey 2011–2013.ParticipantsAustralian adults aged ≥ 19 years (n 8209).ResultsConsumption of UPF was higher among younger adults (aged 19–30 years), adults born in Australia, those experiencing greatest area-level disadvantage, lower …

ABSTRACT OBJECTIVE To study the association between ultra-processed food consumption and carbon and water footprints of the Brazilian diet. METHODS Cross-sectional analysis on data collected in 2008–2009 on a probabilistic sample of the Brazilian population aged ≥ 10 years (n = 32,886). Individual food intake was assessed using two 24-hour food records, on non-consecutive days. The environmental impact of individual diets was calculated by multiplying the amount of each food by coefficients that quantify the atmospheric emissions of greenhouse gases in grams of carbon dioxide equivalent (carbon footprint) and freshwater use in liters (water footprint), both per gram or milliliter of food. The two coefficients consider the food life cycle ‘from farm to fork.’ Crude and adjusted linear regression models and tests for linear trends assessed the association between the ultra-processed food contribution to total energy intake (quintiles) and the diet carbon and water footprints. Potential confounders included age, sex, education, income, and region. Total energy intake was assessed as a potential mediation variable. RESULTS In the crude models, the dietary contribution of ultra-processed foods was linearly associated with the carbon and water footprints of the Brazilian diet. After adjustment for potential confounders, the association remained significant only regarding the diet water footprint, which increased by 10.1% between the lowest and highest quintile of the contribution of ultra-processed foods. Additional adjustment for total energy intake eliminated this association indicating that the dietary contribution of ultra-processed foods …