Search Results (66)

Background/Objectives: Higher energy density (ED; kJ/g) and higher levels of processing of foods and beverages have been associated with childhood obesity and reduced diet quality. This study described and examined the distribution of ED and levels of processing of new food and beverage products intended for Australian children (0–4 years, 5–12 years). Methods: This study used 2013–2023 data from the Mintel Global New Products Database. Products were classified by ED (low ≦ 4.184 kJ/g, medium > 4.184 kJ/g and <12.552 kJ/g, or high ≧ 12.552 kJ/g) and level of processing (using the NOVA classification system; unprocessed/minimally processed foods; processed culinary ingredients; processed foods; ultra-processed foods (UPFs)). Non-parametric statistics were used to examine ED and level of processing by age and ‘Food’ and ‘Drink’ groups. Results: Of the 1770 products analysed, 56% were classified as high-ED and 81% as UPF. Among ‘Food’ products intended for children ‘5–12 years’, 93% were classified as UPFs. The differences in ED classification between non-UPFs and UPFs were significant for ‘Food’ products intended for children aged ‘0–4 years’ (p < 0.001) but not for children aged ‘5–12 years’ (p = 0.149). Conclusions: The prevalence of high-ED and UPFs in the Australian packaged food supply demonstrates the need to tighten regulations around products intended for children. The regulation of low-ED UPFs (i.e., recognised by Australian Dietary Guidelines as ‘healthy’) may also be required. Full article

Background/Objectives: The nutritional importance of grain-based foods (GBFs) and whole grains (WGs) is underscored by their central position in dietary guidance worldwide. Many jurisdictions recommend consumers increase WG intake because they are associated with multiple health benefits, with evidence quality rated as moderate to high. High intakes of ultra-processed foods (UPFs), as defined by NOVA that classifies food by level of processing, are associated with numerous negative health outcomes, with evidence less convincing than for WGs. Yet, some dietary guidance recommends consumers to avoid UPFs. This creates two divergent guidelines since NOVA designates most commonly eaten grain-based foods (GBFs) as UPFs. These contradictory guidelines fail to comply with recommended principles of dietary guidance and generate questions about underlying assumptions and definitions that classify WG staples and colas together. Methods: Definitions and assumptions for systems ostensibly categorizing foods by level of processing were evaluated for validity by various methods. Special attention was paid to the ability of different classifications to differentiate between WGs, RGs staples, and indulgent GBFs. Findings from meta-analyses associating high intakes of WGs with numerous health benefits were compared with those associating high intakes of UPFs. Menus and modeling studies were assessed for ability to meet recommendations for WGs and the grain food group with customary GBFs while avoiding UPFs. Advice to “avoid UPFs” was tested against principles for effective dietary guidance. Results: Definitions and categorizations of foods by levels of processing vary markedly. Assumptions for NOVA and other systems are questionable. While meta-analyses consistently show high intakes of UPFs are associated with adverse health outcomes, high intake of WG foods, nearly all designated as UPFs, are associated with better health outcomes, although evidence quality for the latter is rated stronger. These findings add to the body of evidence suggesting flawed assumptions behind categorizing WG staples in terms of level of processing. Conclusions: NOVA deems 90% of WGs as UPFs. Adding statements to dietary guidance to “Avoid UPFs”, while asking consumers to increase WG intakes, confuses. Further, it jeopardizes efforts to increase intake of fiber and WG foods because it excludes top sources of fiber and WG-based breads, rolls, tortillas, or cold cereals in Western diets. NOVA advice to avoid UPFs challenges principles for usable dietary guidance and the construction of culturally appropriate, healthy dietary patterns containing WG staples from all levels of processing. Full article

Introduction: Endovascular thrombectomy (EVT) is highly effective for ischemic stroke patients with a large vessel occlusion. EVT is typically only offered at urban hospitals; therefore, patients are transferred for EVT from hospitals that solely offer thrombolysis. There is uncertainly around patient selection for transfer, which results in a large number of futile transfers. Machine learning (ML) may be able to provide a model that better predicts patients to transfer for EVT. Objective: The objective of the study is to determine if ML can provide decision support to more accurately select patients to transfer for EVT. Methods: This is a retrospective study. Data from Nova Scotia, Canada from 1 January 2018 to 31 December 2022 was used. Four supervised binary classification ML algorithms were applied, as follows: logistic regression, decision tree, random forest, and support vector machine. We also applied an ensemble method using the results of these four classification algorithms. The data was split into 80% training and 20% testing, and five-fold cross-validation was employed. Missing data was accounted for by the k-nearest neighbour’s algorithm. Model performance was assessed using accuracy, the futile transfer rate, and the false negative rate. Results: A total of 5156 ischemic stroke patients were identified during the time period. After exclusions, a final dataset of 93 patients was obtained. The accuracy of logistic regression, decision tree, random forest, support vector machine, and ensemble models was 68%, 79%, 74%, 63%, and 68%, respectively. The futile transfer rate with random forest and decision tree was 0% and 18.9%, respectively, and the false negative rate was 5.37 and 4.3%, respectively Conclusions: ML models can potentially reduce futile transfer rates, but future studies with larger datasets are needed to validate this finding and generalize it to other systems. Full article

Background: Ultra-processed foods (UPFs) represent a substantial part of modern diets, with a growing prevalence in food environments worldwide. Their unfavourable nutritional composition and adverse health effects present growing public health concerns. Methods: This study examines the prevalence of UPFs in the Slovenian food supply, their nutritional quality and the use of different food symbols and labelling schemes on food packaging. A cross-sectional analysis was conducted using the representative Slovenian branded foods database. A total of 23,173 prepacked foods and beverages were categorised into levels of processing according to the NOVA classification system. The nutritional composition of UPFs was compared to less processed products within 16 narrow subcategories. Additionally, the prevalence in the use of front-of-package nutrition labelling (FOPNL) and subjectively nutrition-related elements (SNREs) (such as EU Organic, Vegan labels etc.) were assessed across different food categories and processing levels. Results: Results show that UPFs represent 54.5% of the available products in the Slovenian food supply, with the highest prevalence in Confectionery (93%), Bread and bakery products (83%), Meat, meat products and alternatives (77%) and Convenience foods (74%). Comparison of nutritional composition indicated that UPFs had significantly poorer nutritional composition compared to less processed counterparts, including higher levels of sugar, salt and saturated fats, and a lower protein content. Breakfast cereals, Snack foods, Meat alternatives and Pre-prepared salads and sandwiches showed the most significant differences between UPFs and less processed counterparts. Analysis of the prevalence of symbols and labelling schemes revealed that 33.8% of products carried at least one FOPNL (15.0%) or SNRE (19.1%), with SNREs being more prevalent on less processed products and FOPNL predominantly used on UPFs (p < 0.05). The most prevalent SNRE was the EU Organic logo (12.7%), followed by the Vegan (4.7%) and Non-GMO (3.1%) logos, whereas the most frequent FOPNL was Reference Intakes (RI), presenting only energy value RI-Energy (12.5%), followed by nutrient-specific RI (1.6%), while other FOPNL were scarce and limited to certain categories. An additional comparison of visual presentation highlighted the potentially selective use of voluntary FOPNL to improve product framing. This raises concerns about their role in guiding consumer choices versus serving as marketing tools, especially when it comes to UPFs. Conclusions: Our findings highlight the need for monitoring UPFs in the food supply together with harmonised, mandatory labelling regulations to ensure transparency and empower consumers to make healthier choices. Full article

Background: Unhealthy food consumption in long-term care facilities (LTCFs) contributes to poor health outcomes among residents. This study aimed to assess its prevalence, identify demographic and physical risk factors, and propose targeted interventions. Methods: A mixed-methods study (2017–2021) analyzed data from 1000 Polish LTCF residents (aged 35–105 years). Anthropometric measurements, bioimpedance analyses, dietary assessments, and physical activity records were collected. Food items were classified as “healthy” or “unhealthy” using an AI-based Large Language Model (LLM), applying WHO guidelines and the NOVA classification system. Logistic regression and chi-square tests assessed associations between unhealthy food consumption and marital status, education level, mobility aid use, and portion control. Results: Unhealthy food consumption prevalence was 15.6%. Married residents had significantly higher rates than unmarried individuals (22.6% vs. 14.3%, p < 0.01). Lower educational attainment correlated with increased risk (partial primary education: 34.7% vs. tertiary education: 8.1%). Mobility aid users exhibited elevated consumption (cane: 34.6%; walker: 22.6%). Poor portion control showed the strongest association (OR = 3.2, 95% CI: 1.8–5.7). Conclusions: Marital status, educational disparities, mobility limitations, and portion control were key modifiable risk factors. Findings suggest the need for targeted nutrition programs, caregiver education, and policy reforms to improve dietary literacy and meal portioning. Future research should validate AI-based food classification methods, assess long-term intervention outcomes, and expand studies to diverse LTCF settings. These findings align with Poland’s National Health Programme and provide actionable insights for global LTCF populations. Full article

Objective: Our objective was to evaluate the association between ultra-processed food (UPF) consumption and body weight change after participating in nutritional intervention. Design: Our study was a 12-month follow-up of participants in a randomized controlled community trial. Setting: Brazilian Primary Health Care. Participants: The participants were health promotion services users. Users in the control group (CG) performed the service’s usual intervention, while those in the intervention group (IG) additionally participated for seven months in nutritional intervention. Socioeconomic data, self-health, perception of time spent in health promotion services, and weight loss attempts were investigated. Food consumption was obtained by 24 h food recall and categorizing these in quartiles according to the Nova system of food classification. Weight was measured and changes in the 12-month period were calculated by subtracting the weight at follow-up from the baseline measurement. Results: Of the participants, 88.1% were females aged 56.7 ± 11.8 with 19.7 ± 15.3 months of participation in the service. In the fourth quartile (highest UPF consumption), the % contribution of calories per consumption of UPFs was 47.7%, with no differences between the IG and CG (p = 0.406). Adjusted after 12 months, when comparing those with lower consumption of UPFs (first quartile), individuals from the second, third, and fourth quartiles had positive weight variation. Respectively, these variations were as follows: 0.363 kg (95% CI: 0.038; 0.689; p = 0.029); 0.467 kg (95% CI: 0.159; 0.776; p = 0.003); and 0.389 kg (95% CI: 0.061; 0.717; p = 0.020, with no differences between IG and CG). Conclusions: The percentage contribution of calories from UPFs was associated with positive weight change, which contributes to the growing evidence of the relationship between UPFs and obesity. Full article

Objective: This cross-sectional study aimed to investigate the association between processed food consumption and sleep quality among school-aged children. Methods: Our sample consisted of 137 children, with 52.6% being girls with a mean age of 7.9 ± 1.2 years. Moreover, 40.2% of children had overweight and 35.9% had experienced sleep problems. Dietary intake was evaluated using two non-consecutive 24 h recalls, and foods were categorized according to the NOVA classification system. The amount of sweet snacks consumed, in grams, was recorded for each meal and throughout the day. Sleep quality was assessed using the Portuguese Children’s Sleep Habits Questionnaire (CSHQ-PT). Results: The study found a significant and positive association between the sleep habits score and daily sweet snack consumption (B = 0.035; 95% CI: 0.011, 0.059). Additionally, there were higher odds of experiencing sleep problems in those children who consumed a higher percentage of energy from ultra-processed foods (OR: 1.043; 95% CI: 1.004, 1.084), higher total daily consumption of sweet snacks (OR: 1.016; 95% CI: 1.006, 1.026), particularly during morning and afternoon snack times (OR: 1.018; 95% CI: 1.002, 1.033). Conclusions: These findings underscore the importance of addressing dietary patterns on children’s sleep quality. Future interventions should account for reducing NOVA 4 and sweet snack consumption in order to improve sleep quality. Full article

The gut microbiota plays a vital role in various physical and physiological processes, including immune system regulation, neurotransmitter production, inflammatory response modulation, and the inhibition of pathogenic organisms. An imbalance in the microbial community, known as dysbiosis, has been associated with numerous health issues. Biological influences, health behaviors, socioeconomic determinants, and nutritional status can disrupt this balance. Objective: 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. Methods: 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. Results: 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. Conclusions: 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. Full article

Ultra-processed foods (UPFs) is a food category within the NOVA system. The key feature of UPFs are foods that have been highly processed and contain various additives, especially those that are industrially produced. It is claimed that UPFs are inherently unhealthy. The classification system is highly controversial. This paper critically evaluates the evidence. In stark contrast to conventional systems for food classification, the NOVA system disregards the nutritional values of foods. As a result, many foods generally considered to be healthy are included as UPFs, whereas many unhealthy foods are excluded. Epidemiological studies, mainly prospective cohort studies, have consistently reported an association between the intake of UPFs and risk of obesity, cardiovascular disease (CVD), type 2 diabetes, common mental disorders (especially depression), and all-cause mortality. A similar association has been reported for cancer and hypertension, but the supporting evidence is weaker. The most plausible explanation for this is that the associations are largely due to a limited number of unhealthy foods, such as processed meat and sugar-sweetened beverages. Studies of the relationship between UPFs and obesity present a different picture. There is much evidence that suggests that UPFs play a major causal role in obesity. The high contents of fat, sugar, carbohydrates, and sodium commonly present in UPFs makes these foods hyperpalatable. In addition, UPFs typically have a high energy density. As a result of these two features of UPFs, most people consume an excessive energy intake when presented with UPFs. Because UPFs include a wide range of foods, many of which are healthy, it is likely that while many UPFs are obesogenic, many others are not. Full article

Background/Objectives: Prostate cancer is the second leading cause of cancer death among American men, following lung cancer. While diet and exercise have been extensively studied in relation to prostate cancer prevention, the evidence remains inconclusive. Methods: A comprehensive literature search was performed to identify observational studies investigating the association between ultra-processed food (UPF) consumption and prostate cancer risk and mortality, determined by the NOVA classification system. In addition, we conducted subgroup analyses to assess the association based on study design, age, and data collection methods. Results: Six studies were identified, including four cohort studies and two case–control studies. No significant association was found between high UPF consumption and increased risk of prostate cancer [RR = 1.02, 95% confidence interval (CI) = 0.96–1.08, n = 5]. However, there was a slight increase in mortality (RR = 1.15, 95% CI = 0.99–1.35, n = 2). A subgroup analysis by the dietary assessment method revealed an RR of 1.01 (95% CI = 0.93–1.09) for studies using the food frequency questionnaire (FFQ) and 1.04 (95% CI = 0.93–1.16) for studies using 24-h recalls. There was no significant heterogeneity among the studies (I² = 0, p = 0.82). Conclusions: This meta-analysis suggests no significant association between high UPF consumption and prostate cancer risk. Given the known associations with other chronic diseases, the potential public health implications of reducing UPF consumption remain important. Further research with the use of more robust food assignment systems and more precise dietary assessments is needed to clarify the role of UPF in prostate cancer development. Full article

Background: Over time, there have been significant changes in the dietary patterns of the Chinese population with the emergence of ultra-processed foods (UPFs). Methods: To ascertain the changes in UPFs intake among adults in southern China, over the past two decades, the study included residents aged 18 years and older who participated in the China National Nutrition Surveys in Guangdong province in 2002, 2012, and 2022. Dietary intake data were collected via three-day 24 h dietary recalls and weighing household foods and condiments. The recorded dietary data were classified according to the NOVA classification system, and the percentage of total energy derived from each food group was calculated. Results: From 2002 to 2022, there was a notable increase in the consumption of UPFs among adults in Guangdong Province, with the percentage of UPFs intake rising from 0.88% to 8.52% (p-value < 0.001). This growth was especially pronounced among specific population groups, including the young, the better educated, and those living in highly urbanized areas. The largest increase in energy intake from UPFs was observed among students, from 0.42% to 17.26% (p-value < 0.001). The nutrient contents of UPFs in Guangdong in 2022 were found to contain a markedly higher calculated percentage of calories provided by carbohydrates in comparison to minimally processed foods (56.6% vs. 43.8%) as well as in sodium (749 mg/100 kcal vs. 29 mg/100 kcal). Conclusions: Given the increasing consumption of UPFs and the growing evidence linking these products to chronic diseases, it is important to promote healthy food intake and balanced diets through active nutritional education campaigns to prevent potential health risks that may arise. Full article

Objective: To analyze the association between ultra-processed food (UPF) consumption and cardiometabolic, biochemical, and inflammatory risk factors in children in a metropolis in Northeast Brazil. Methods: A cross-sectional study using baseline data from a community-based controlled trial was carried out with 151 children from public schools in João Pessoa, Paraíba, Brazil aged 7 to 10 years. Dietary consumption was assessed using 24 h food recall, and UPF consumption was estimated using the NOVA classification system. Anthropometry (BMI for age), blood pressure, biochemical parameters (ALT, AST, GGT, cholesterol, LDL-c, HDL-c, triglycerides, fasting glucose, HbA1c, HOMA-IR, creatinine, urea, hs-CRP), and cytokines (IL-2, IL-4, IL-6, IL-10, IL-17a, IFN-γ, and TNF-α) were also assessed. Results: Children in the third tertile (highest UPF consumption) had higher serum concentrations of LDL-c (p-value = 0.04) and ALT (p-value = 0.01), with a trend towards higher AST (p-value = 0.06). Total energy (p-value = 0.01), trans fatty acid (p-value = 0.02), and sodium (p-value = 0.04) intakes were higher in the highest tertile, whereas protein (p-value < 0.01) and fiber (p-value < 0.01) intakes were lower. Concentrations of IL-17A (p-value = 0.01) and IL-10 (p-value = 0.04) were significantly higher in the second tertile. Multiple linear regression showed that UPF consumption was significantly associated with increased LDL-c, ALT, and AST concentrations. Conclusions: High intake of UPFs was associated with dyslipidemia, elevated liver enzymes, and inflammatory changes in children. Dietary interventions are needed to reduce UPF consumption and prevent cardiometabolic and liver disease in childhood. Full article

Background/Objectives: Food insecurity (FI) is defined as the lack of consistent access to enough food for an active and healthy life. FI affects over 30 million Americans and is associated with poor clinical outcomes and impaired quality of life and drives significant health inequities. Despite the rising prevalence of FI and the federal focus on improving access to healthy food, there is a paucity of research on FI in patients with inflammatory bowel disease (IBD). Therefore, the goal of this study was to define FI in a cohort of IBD patients and determine whether FI was associated with changes in dietary patterns, including specifically an increase in ultra-processed food (UPF) consumption in this high-risk patient population. Methods: This was a single-center, retrospective cohort study of patients with a diagnosis of IBD who were 18 years of age or older and who were seen in a nutrition focused clinic. Patients were screened for FI using the Hunger Vital Sign™, a 2-question validated FI screening tool and underwent a 24-h dietary recall. The degree of food processing was assessed using the NOVA Food Classification System. Results: Among 128 patients with IBD, we observed that FI is increasingly prevalent, with 45% of patients reporting difficulty with sufficient grocery access at least “sometimes” in the last 12 months and 10% reporting decreased food access “often” in the prior year. In addition, the patients at high-risk for FI were significantly more likely to eat NOVA 4 UPFs (54% vs. 27%, p = 0.001) and were significantly less likely to eat NOVA 1 unprocessed foods (32% vs. 61%, p = 0.001) as compared to those not at risk for FI. Finally, only a small percentage of those at highest risk for FI were enrolled in a federal food assistance program for grocery support. Conclusions: The prevalence of FI is increasing in patients with IBD and is associated with reduced dietary quality. Full article

Background/Objectives: We investigated the effects of ultraprocessed food (UPF) consumption on metabolic disorders (e.g., adiposity, metabolic associated steatotic liver disease [MASLD], and insulin resistance) in children and adolescents with obesity to improve dietary guidelines and public health strategies. Methods: The dietary intake of 149 participants (aged 8–17 years) was assessed with food diaries. The NOVA classification system was used to classify food according to the degree of processing. Metabolic outcomes, including the fat mass index (FMI), hepatic fat percentage, and insulin resistance, were measured via dual-energy X-ray absorptiometry (DXA), magnetic resonance imaging proton density fat fraction (MRI-PDFF), and biochemical analysis, respectively. Results: Greater UPF consumption from baseline to the 6-month follow-up was significantly associated with increased insulin and decreased total cholesterol and LDL-cholesterol. UPF consumption was positively associated with the prevalence of MASLD (liver MRI-PDFF ≥ 5%; odds ratio _{T3 vs. T1} = 1.75; 95% confidence interval [CI] 1.03, 3.00), moderate-to-severe MASLD (liver MRI-PDFF ≥ 10%; OR _{T3 vs. T1} = 4.19; 95% CI 1.72, 10.22), and insulin resistance (OR _{T3 vs. T1} = 2.44; 95% CI 1.33, 4.48), after adjusting for covariates. A linear dose-response relationship was observed between UPF consumption and the odds of moderate-to-severe MASLD and insulin resistance. Conclusions: Greater UPF consumption was strongly associated with MASLD and insulin resistance in children and adolescents with obesity, underscoring the importance of reducing UPF consumption through dietary guidelines and public health interventions to mitigate the risk of obesity-related metabolic conditions in young populations. Full article

Background: Eating habits established during the preschool stage may last a lifetime, underlining the importance of choosing and purchasing healthy foods for proper nutrition. Aim: To assess the associations between place of food purchase and dietary intake and quality in Spanish preschool children. Methods: A cross-sectional analysis was carried out within the framework of the SEguimiento del Niño para un Desarrollo Óptimo (SENDO) project. Data were collected using (1) the food frequency questionnaire (FFQ), from which dietary nutrient intake and diet quality (NOVA System classification and KIDMED index) were analysed, and (2) the baseline food habits questionnaire, which asked about the food purchase outlet. Data were analysed by logistic regression, considering the intra-group correlation between siblings and using the type of food purchase outlet as a grouping variable. Results: Children from families shopping in hypermarkets consumed fewer nutrients, less minimally processed foods, as well as less fruit and vegetables than children from families shopping in specialised shops. Conclusions: Food shopping in specialised outlets can improve the quality of children’s diets, promoting healthier habits such as greater adherence to the Mediterranean Diet and increasing the consumption of minimally processed foods. This has a positive impact on children’s long-term health. Full article