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      Ultra-processed foods and cardiometabolic health: public health policies to reduce consumption cannot wait

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          Abstract

          Incomplete understanding of the multiple mechanisms underlying the link between ultra-processed foods and cardiometabolic health should not be an excuse for inaction argue Mathilde Touvier and colleagues

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          Most cited references66

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          The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report

          Boyd Swinburn, Vivica I Kraak, Steven Allender … (2019)
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            Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake

            Kevin D. Hall, Alexis Ayuketah, Robert Brychta … (2019)
            We investigated whether ultra-processed foods affect energy intake in 20 weight-stable adults, aged (mean ± SE) 31.2 ± 1.6 years and BMI = 27 ± 1.5 kg/m2. Subjects were admitted to the NIH Clinical Center and randomized to receive either ultra-processed or unprocessed diets for 2 weeks immediately followed by the alternate diet for 2 weeks. Meals were designed to be matched for presented calories, energy density, macronutrients, sugar, sodium, and fiber. Subjects were instructed to consume as much or as little as desired. Energy intake was greater during the ultra-processed diet (508 ± 106 kcal/day; p = 0.0001), with increased consumption of carbohydrate (280 ± 54 kcal/day; p < 0.0001) and fat (230 ± 53 kcal/day; p = 0.0004), but not protein (-2 ± 12 kcal/day; p = 0.85). Weight changes were highly correlated with energy intake (r = 0.8, p < 0.0001), with participants gaining 0.9 ± 0.3 kg (p = 0.009) during the ultra-processed diet and losing 0.9 ± 0.3 kg (p = 0.007) during the unprocessed diet. Limiting consumption of ultra-processed foods may be an effective strategy for obesity prevention and treatment.
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              Ultra‐processed foods and the nutrition transition: Global, regional and national trends, food systems transformations and political economy drivers

              Phillip Baker, Priscila A. Machado, Thiago Santana Santos … (2020)
              Understanding the drivers and dynamics of global ultra-processed food (UPF) consumption is essential, given the evidence linking these foods with adverse health outcomes. In this synthesis review, we take two steps. First, we quantify per capita volumes and trends in UPF sales, and ingredients (sweeteners, fats, sodium and cosmetic additives) supplied by these foods, in countries classified by income and region. Second, we review the literature on food systems and political economy factors that likely explain the observed changes. We find evidence for a substantial expansion in the types and quantities of UPFs sold worldwide, representing a transition towards a more processed global diet but with wide variations between regions and countries. As countries grow richer, higher volumes and a wider variety of UPFs are sold. Sales are highest in Australasia, North America, Europe and Latin America but growing rapidly in Asia, the Middle East and Africa. These developments are closely linked with the industrialization of food systems, technological change and globalization, including growth in the market and political activities of transnational food corporations and inadequate policies to protect nutrition in these new contexts. The scale of dietary change underway, especially in highly populated middle-income countries, raises serious concern for global health.
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                Author and article information

                Contributors
                Mathilde Touvier: Role: researcher
                Maria Laura da Costa Louzada: Role: researcher
                Dariush Mozaffarian: Role: professor
                Phillip Baker: Role: researcher
                Filippa Juul: Role: faculty fellow
                Bernard Srour: Role: researcher
                Journal
                Journal ID (nlm-ta): BMJ
                Journal ID (iso-abbrev): BMJ
                Journal ID (publisher-id): BMJ-UK
                Journal ID (hwp): bmj
                Title: The BMJ
                Publisher: BMJ Publishing Group Ltd.
                ISSN (Print): 0959-8138
                ISSN (Electronic): 1756-1833
                Publication date Collection: 2023
                Publication date (Electronic): 10 October 2023
                Volume: 383
                Electronic Location Identifier: e075294
                Affiliations
                [1 ]Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Nutritional Epidemiology Research Team (EREN), Center of Research in Epidemiology and StatisticS (CRESS), Bobigny, France
                [2 ]Center for Epidemiological Research in Nutrition and Health, University of São Paulo, São Paulo, Brazil
                [3 ]Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
                [4 ]Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
                [5 ]Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY, USA
                Author notes
                Article
                Publisher ID: BMJ-2023-075294.r1 Publisher ID: toum075294
                DOI: 10.1136/bmj-2023-075294
                PMC ID: 10561017
                PubMed ID: 37813465
                SO-VID: 9142df8b-c23c-4ffa-873b-9834c74948a3
                Copyright © © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
                License:

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                Categories
                Subject: Analysis
                Series title: Food for Thought 2023

                ScienceOpen disciplines: Medicine
                Data availability:
                ScienceOpen disciplines: Medicine

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