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Background: High consumption of ultraprocessed foods (UPFs) continues to draw significant public health interest because of the associated negative health outcomes. Metabolomics can contribute to the understanding of the biological mechanisms through which UPFs may influence health., Objectives: To investigate urine and plasma metabolomic biomarkers of UPF intake in adolescents and young adults., Methods: We used data from the Dortmund Nutritional and Anthropometric Longitudinally Designed study to investigate cross-sectional associations of UPF intake with concentrations of urine metabolites in adolescents using 3d weighed dietary records (3d-WDR) and 24-h urine samples (n = 339), and associations of repeatedly assessed UPF intake with concentrations of circulating plasma metabolites in young adults with 3-6 3d-WDRs within 5 y preceding blood measurement (n = 195). Urine and plasma samples were analyzed using mass spectrometry-based metabolomics. Biosample-specific metabolite patterns (MPs) were determined using robust sparse principal components analysis. Multivariable linear regression models were applied to assess the associations of UPF consumption (as a percentage of total food intake in g/d) with concentrations of individual metabolites and MP scores., Results: The median proportion of UPF intake was 22.0% [interquartile range (IQR): 12.3, 32.9] in adolescents and 23.2% (IQR: 16.0, 31.6) in young adults. We identified 42 and 6 UPF intake-associated metabolites in urine and plasma samples, respectively. One urinary MP, "xenobiotics and amino acids" [β = 0.042, 95% confidence interval (CI): 0.014, 0.070] and 1 plasma MP, "lipids, xenobiotics, and amino acids" (β = 0.074, 95% CI: 0.031, 0.117) showed positive association with UPF intake. Both patterns shared 29 metabolites, mostly of xenobiotic metabolism., Conclusions: We identified urine and plasma metabolites associated with UPF intake in adolescents and young adults, which may represent some of the biological mechanisms through which UPFs may influence metabolism and health., Competing Interests: Conflict of interest The authors report no conflicts of interest. Where authors are identified as personnel of the International Agency for Research on Cancer/WHO, the authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy, or views of the International Agency for Research on Cancer/WHO., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: This study aimed to investigate the association between consumption of ultra-processed foods (UPFs) and leucocyte telomere length (LTL)., Methods: This cross-sectional study utilized data from the UK Biobank, including a total of 64,690 participants. LTL was measured using Q-PCR with natural logarithmic conversion and Z-score normalization. Dietary data were collected through a 24-hour recall questionnaire from 2009 to 2010. UPFs were identified using the Nova food classification and analyzed as either a continuous or categorical variable respectively. Multiple linear regression models were employed to analyze the association between UPF consumption and LTL., Results: The included participants had an average age of 56.26 years, of whom 55.2% were female. After adjusting for sociodemographic, lifestyle-related and anthropometric variables, LTL exhibited a decrease of 0.005 (95% CI: -0.007, -0.002) with one UPF serving/day increase. Compared to participants consuming ≤ 3.5 servings/day, those consuming 3.5 to < 6, 6 to ≤ 8 and > 8 servings/day showed a shortening of LTL by 0.025 (95% CI: -0.047, -0.004), 0.034 (95% CI: -0.055, -0.012) and 0.038 (95% CI: -0.062, -0.015), respectively (P for trend = 0.001). Subgroup analyses by UPF subclasses revealed that consumption of ready-to-eat/heated food (β = -0.008, 95% CI: -0.014, -0.002), beans and potatoes (β = -0.024, 95% CI: -0.039, -0.009), animal-based products (β = -0.011, 95% CI: -0.019, -0.004), artificial sugar (β = -0.014, 95% CI: -0.025, -0.004), and beverages (β = -0.005, 95% CI: -0.009, -0.001) showed negative associations with LTL. Conversely, breakfast cereals (β = 0.020, 95% CI: 0.004, 0.036) and vegetarian alternatives (β = 0.057, 95% CI: 0.027, 0.086) showed positive correlations with LTL., Conclusions: Our study found that a higher consumption of total UPFs was associated with a shorter LTL. However, some subclass UPFs may be associated with longer LTL, depending on their nutritional composition., (Copyright © 2024. Published by Elsevier Inc.)

Background: Studies have shown that prolonged smartphone use is associated with dietary risk behaviors among adolescents. However, little is known about whether the exposure to food-related online media contents, such as mukbang (eating broadcast) and cookbang (cooking broadcast), is associated with unhealthy dietary behaviors, independent of overall duration of smartphone use., Objectives: This study investigated the associations between the frequency of mukbang/cookbang watching and dietary risk behaviors among Korean adolescents, using nationally representative survey data., Methods: In this cross-sectional study, we examined the data from 50,044 middle and high school students in the Korea Youth Risk Behavior Web-based Survey 2022. Participants reported their frequency of mukbang/cookbang watching, mean duration of smartphone use, frequency of breakfast eating, frequency of nighttime eating, and intakes of fast foods, sugar-sweetened beverages (SSBs), and high-caffeine drinks. We performed multivariable logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between mukbang/cookbang watching and dietary risk behaviors, accounting for complex survey sampling and adjusting for potential confounders., Results: Frequent mukbang/cookbang watching (≥5 times/wk compared with never) was positively associated with dietary risk behaviors, including frequent breakfast skipping (OR: 1.20; 95% CI: 1.13, 1.28), frequent nighttime eating (OR: 1.43; 95% CI: 1.33, 1.54), and frequent intakes of fast foods (OR: 1.69; 95% CI: 1.58, 1.80), SSBs (OR: 1.47; 95% CI: 1.30, 1.66), and high-caffeine drinks (OR: 1.41; 95% CI: 1.33, 1.50), adjusting for duration of smartphone use. All mukbang/cookbang viewers, including those who perceived that mukbang/cookbang videos had "no influence" on their dietary behavior, had higher prevalence of dietary risk behaviors than nonviewers (perceived "no influence" compared with nonviewers-OR: 1.18; 95% CI: 1.10, 1.26, breakfast skipping; OR: 1.15; 95% CI: 1.06, 1.24, nighttime eating; OR: 1.40; 95% CI: 1.30, 1.50, fast foods; OR: 1.22; 95% CI: 1.07, 1.38, SSBs; OR: 1.28; 95% CI: 1.20, 1.37, high-caffeine drinks)., Conclusions: Our findings suggest that frequent mukbang/cookbang watching may be associated with unhealthy dietary behaviors among Korean adolescents., (Copyright © 2024 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

Objective: Understand the correlates of ultra-processed food (UPF) intake and examine the association of UPF on body mass index in children aged 3-5 years., Design: Secondary analysis of a prospective cohort of 3-5-year-olds/parent, followed 1-year between March 2014 and October 2016. Usual UPF intake from 2 3-day food records completed 1 year apart, a standardized nutrient database customized with child-specific foods, and a NOVA food classification system was used. Child/parent characteristics and media use were measured via parent-reported surveys. Child weight/height objectively measured., Setting: New Hampshire community., Participants: Six hundred and sixty-seven parent-child dyads were screened, and 624 were enrolled with 90% follow-up., Main Outcome Measure(s): Primary outcome: identify correlates of UPF intake., Secondary Outcome: determine if UPF intake is associated with body mass index change., Analysis: Adjusted β linear regression, linear regression, P <0.05., Results: Ultra-processed food accounted for 67.6% of total caloric intake. In adjusted models, children's UPF intake was positively associated with increasing child age, greater hours watching television, and more frequent parent soda/fast-food intake. Ultra-processed food intake was negatively associated with higher parent education and reported race/ethnicity other than non-Hispanic White. There was no association between UPF intake and weight., Conclusions and Implications: There are several predictors of UPF intake in young children. Family-level interventions could be implemented to encourage the intake of minimally processed foods before and during preschool years., (Copyright © 2023 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Introduction. The availability of data on the consumption of ultra-processed foods among children is important for planning public policies. Objectives. To describe the prevalence of consumption of ultra-processed foods in children under 2 years of age and identify associated factors. To describe the proportion that ultra-processed foods represent out of the total number of foods consumed in a day. Methods. Secondary analysis of data from children aged 6-23 months with at least a 24-hour recall of food consumption based on the Second National Survey on Nutrition and Health of Argentina (2018). The following primary variables were studied: "consumption of ultra-processed foods" (according to the NOVA system) categorized into yes/no and "proportion of ultra-processed out of total foods consumed." The following associated factors were studied: breastfeeding, sex, age, and number of non-ultra-processed foods consumed. A multivariate logistic regression model was developed and an expansion factor was applied to weight the data. Results. A total of 4224 children were included (weighed: 908 104). The prevalence of ultra-processed food consumption was 90.8% (95% CI: 89.5-92) and was associated with an older age (OR: 3.21, 95% CI: 2.28-4.52) and the number of non-ultra-processed foods consumed (OR: 1.17, 95% CI: 1.13-1.23). Ultra-processed foods accounted for a median 20% (IQR: 12.5-28.6%) of all foods consumed in a day. Conclusions. This study highlights the high penetration of ultra-processed foods in complementary feeding., (Sociedad Argentina de Pediatría.)

This study's purpose was to compare socioeconomic, dietary choice, and nutrition environment variables associated with food and nutrition security in USA households with and without children. Data were collected in 2021 and consisted of households at risk of or experiencing food insecurity. Multivariable logistic regression was used to identify significant explanatory variables for food and nutrition security by household type-with or without children (<18 years of age). Food insecurity rates were 74% and 64% in households with and without children, respectively. Nutrition insecurity rates were 38% and 30% in households with and without children, respectively. For both household types, greater dietary choice increased odds (4-15 times) of food and nutrition security. In households with children, more fast-food meals increased the odds (60%) of food security, while more processed meals and greater utilization barriers to healthful meals decreased the odds (40-50%). Greater utilization barriers also decreased the odds (20%) of food security in households without children. In households with children, higher income and greater healthfulness choice increased the odds (20% and 3 times) of nutrition security, while low (vs. high) perceived limited availability of foods doubled the odds in households without children. Dietary choice is an influential and crucial factor of food and nutrition security.

Excessive consumption of highly palatable foods rich in sugar and fat, often referred to as "junk" or "fast" foods, plays a central role in the development of obesity. The highly palatable characteristics of these foods activate hedonic and motivational mechanisms to promote food-seeking behavior and overeating, which is largely regulated by the brain reward system. Excessive junk food consumption can alter the functioning of this reward system, but exact mechanisms of these changes are still largely unknown. This study investigated whether long-term junk food consumption, in the form of Cafeteria (CAF) diet, can alter the reward system in adult, female Long-Evans rats, and whether different regimes of CAF diet influence the extent of these changes. To this end, rats were exposed to a 6-week diet with either standard chow, or ad libitum daily access to CAF diet, 30 % restricted but daily access to CAF diet, or one-day-a-week (intermittent) ad libitum access to CAF diet, after which c-Fos expression in the Nucleus Accumbens (NAc), Prefrontal Cortex (PFC), and Ventral Tegmental Area (VTA) following consumption of a CAF reward of choice was examined. We found that all CAF diet regimes decreased c-Fos expression in the NAc-shell when presented with a CAF reward, while no changes in c-Fos expression upon the different diet regimes were found in the PFC, and possibly the VTA. Our data suggests that long-term junk food exposure can affect the brain reward system, resulting in an attenuated activity of the NAc-shell., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

An increased consumption of ultra-processed foods (UPF) leads to a rising prevalence of chronic noncommunicable diseases. This study aims to characterise the nutrient profile of white-label pre-packaged foods and bakery products available in a market leader Portuguese food retail chain, according to the extent of processing proposed by NOVA classification system. The nutrient profile (energy, sugar, total fat, saturated fat and sodium) according to processing degree was analysed using non-parametric tests. UPF were the most energy dense (278 kcal/100 g, p  < .001) and the highest in sugar (15.9 g/100 g, p  < .001). Processed foods were the highest in sodium (538 mg/100 g, p  < .001). Processed and UPF showed significantly higher total (12.4 and 10.8 g/100 g, respectively) and saturated fat content (6.10 and 4.61 g/100 g, respectively) than unprocessed/minimally processed foods ( p  < .001). Regarding the variation of the nutritional value across the extent of processing, different results were observed for some categories suggesting the importance of a stratified analysis. The consumption of less processed foods and the manufacture of processed/UPF with better nutrient profile should be promoted.

Objective: Ultraprocessed foods (UPF), hyper-palatable foods (HPF), and high energy density (HED) foods may contribute to obesity risk. All have distinct definitions; however, it is unknown the degree to which they may identify overlapping or distinct foods. This study examined the availability of UPF, HPF, and HED foods in the US food system from 1988 to 2018 and the degree of distinction across definitions., Methods: Four data sets representing the US food system (1988, 2001, 2006, 2018) from the US Department of Agriculture were analyzed. UPF were identified based on the extent of industrialized processing. HPF were identified using the standardized definition that specifies palatability-inducing nutrient combinations. HED was characterized as >2.0 kcal/g., Results: Across years, 58% to 65% of foods were classified as UPF, 55% to 69% as HPF, and 37% to 47% as HED. Prevalence of UPF, HPF, and HED foods was higher in 2018 versus 1988 (p values < 0.001); HPF evidenced the largest increase (14%) and UPF evidenced the smallest (4%) over time. There was moderate to high overlap in foods (40%-70%) across definitions., Conclusions: Together, UPF, HPF, and HED foods comprise most foods in the US food supply. Changes in availability varied across definitions, with substantial increases in HPF and HED and relative stability of UPF., (© 2023 The Obesity Society.)

Objective: The primary objective of this study was to examine the socio-demographic and economic factors associated with the consumption of processed foods in South Africa., Study Design: This is an empirical study where secondary data analysis was performed from the South African Demographic and Health Survey VII., Methods: A nationally representative sample of 10,336 participants (aged ≥15 years) was included in the analysis. Using regression models, we studied the association between socio-demographic and economic predictors and the intake of processed foods., Results: The regression models found that the odds of consumption of any type of processed foods were significantly high in all South African provinces but specifically higher in urban settings, those with any level of education, and young adults. The odds of processed meat consumption were significantly higher among the coloured population, while that of fried food, fast food, and salty snacks was significant in the white population. The odds of consumption increased irrespective of marital status and were higher among males, specifically among those in the poorer and poorest wealth quintiles., Conclusion: These findings warrant advocacy and action for healthy food choices in the population. The role of industry, ethnic vulnerability, and gender stereotypes in food preparation are areas that need priority attention., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

A diet based on ultra-processed food (UPF) does not meet nutritional needs, especially during pregnancy. The aim of this study is to assess the change in UPF consumption from preconception to pregnancy and associated factors. Our hypothesis is that women tend to adopt a healthier eating pattern during pregnancy, decreasing the intake of UPF and increasing the intake of unprocessed/minimally processed foods. A prospective cohort study with 326 participants was carried out from 2016 to 2019 in 2 health units in Rio de Janeiro, Brazil. Pregestational food consumption assessed using the food frequency questionnaire in the prenatal interview in women up to 20 gestational weeks and gestational consumption in the interview 2 months after delivery. Food items classified according to the NOVA system. For the mean variation from preconception to gestational UPF consumption, we used the generalized estimating equations model with linear distribution. Control of confounding variables was based on the literature on factors associated with UPF consumption, using a 3-level hierarchical model. The proportion of UPF energy consumption was 28.9% in preconception and 33% during pregnancy. Older and more educated women had a lower mean variation in the consumption of UPF during the pregnancy. A higher average consumption of UPF observed among women physically inactive before pregnancy, who smoked during pregnancy, were multiparous, and with had a low pregestational weight. These results reflect similar behavior to that of the general population, aggravated by a significant increase during pregnancy. However, older and more educated women and those with healthy behaviors showed lower UPF intake in pregnancy., Competing Interests: Author Declarations The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Highly processed food (HPF) consumption is increasing globally and has become a prominent public health concern. However, the relationship between HPF consumption and food choice values and food literacy is unknown. This study aimed to examine the association of HPF consumption with food choice values and food literacy., Methods: This cross-sectional study used data from a nationwide questionnaire survey conducted in 2018 among 2232 Japanese adults aged 18-80 years. We assessed eight food choice values (accessibility, convenience, health/weight control, tradition, sensory appeal, organic, comfort, and safety) using a 25-item scale, and food literacy characterised by nutrition knowledge (using a validated 143-item questionnaire), cooking and food skills (using 14- and 19-item scales, respectively), and eight eating behaviours (hunger, food responsiveness, emotional overeating, enjoyment of food, satiety responsiveness, emotional undereating, food fussiness, and slowness in eating, using the 35-item Adult Eating Behavior Questionnaire). HPF consumption was estimated using a validated brief diet history questionnaire. The associations between HPF consumption and age, body mass index, energy intake, and each score on food choice values and food literacy were evaluated by multiple linear regression., Results: In males, one standard deviation increase in scores for cooking skill and satiety responsiveness was associated with an increase in HPF consumption by 22.1 g/4184 kJ (95% confidence interval (CI): 6.6 to 37.5) and 15.4 g/4184 kJ (95% CI: 6.0 to 24.7), respectively. In females, one standard deviation increase in age and scores for safety and nutrition knowledge corresponded to a decrease in HPF consumption by - 16.4 g/4184 kJ (95% CI: - 23.4 to - 9.3), - 9.9 g/4184 kJ (95% CI: - 19.1 to - 0.7), and - 11.1 g/4184 kJ (95% CI: - 17.0 to - 5.3), whereas one standard deviation increase in the satiety responsiveness score corresponded to an increase in HPF consumption by 13.1 g/4184 kJ (95% CI: 6.8 to 19.4)., Conclusions: This cross-sectional study suggests that several aspects of food choice values and food literacy were associated with HPF consumption in Japanese adults. Further studies are needed to confirm our findings in a broader context., (© 2023. The Author(s).)

Emerging research suggests that modifying the presentation context of healthy food items can subtly 'nudge' individuals to make healthier choices. The present study aimed to investigate the effect of spatial separation between high and low nutritional value items on food and drink choices from an online fast-food menu. Participants (N = 210 women) were presented with one of three pictorial menus in which high nutritional value food and drink items were presented spatially mixed, grouped, or separate from low nutritional value items. Participants were asked to make one selection from each menu category (a main, drink, and dessert), and then completed a measure of dietary restraint. Overall, there was no main effect of menu condition. However, dietary restraint status moderated the effect of menu condition on healthy choices. In particular, women who scored low (but not those who scored high) on dietary restraint were positively influenced by the experimental manipulation, making approximately 14 % healthier selections when high nutritional value items were presented separately from low nutritional value items. This was principally the case for desserts, and to a lesser extent drinks. The findings have practical implications for the design of online fast-food menus to promote healthier food and drink selections., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To elucidate which markers of ultra-processing (MUP) and their combinations are best suited to detect ultra-processed food (UPF)., Design: The study was based on the 206 food and 32 beverage items of the Oxford WebQ which encompass all major foods consumed in the UK. For each Oxford WebQ question, ingredient lists of up to ten matching different commercial products ( n 2146) were researched online using data from the two market leaders of groceries in the UK sorted by relevance (Tesco) and by top sellers (Sainsbury's), respectively. According to the NOVA classification, sixty-five MUP were defined, and if the ingredient list of a food product was positive for at least one MUP, it was regarded as UPF. The percentage of UPF items containing specific MUP was calculated. In addition, all combinations of two to six different MUP were assessed concerning the percentage of identified UPF items., Setting: Cross-sectional analysis., Participants: None., Results: A total of 990 products contained at least one MUP and were, therefore, regarded as UPF. The most frequent MUP were flavour (578 items, 58·4 % of all UPF), emulsifiers (353 items, 35·7 % of all UPF) and colour (262 items, 26·5 % of all UPF). Combined, these three MUP detected 79·2 % of all UPF products. Detection rate increased to 88·4 % of all UPF if ingredient lists were analysed concerning three additional MUP, that is, fibre, dextrose and firming agent., Conclusions: Almost 90 % of all UPF items can be detected by six MUP.

Objective: We examined whether associations between the food environment, frequency of home cooking, diet quality and BMI were modified by the level of cooking skills., Design: Cross-sectional study using linear and modified Poisson regression models adjusted for age, sex, energy intake, education, income, household size and urbanisation. The frequency of home cooking was categorised into <6 and 6-7 d. Diet quality was based on a validated Dutch healthy diet index (0-150 points). Count of restaurants and food stores were determined by their count in a 1000m buffer around home and work. Cooking skills (score 1-5) were assessed using a validated questionnaire and added as interaction term., Setting: The Netherlands., Participants: 1461 adults aged 18-65 years., Results: Count of restaurants and food stores were not associated with the frequency of home cooking. A 10-unit higher count of food stores was associated with a higher diet quality ( β : 0·58 (95 % CI (0·04, 1·12)), and a 10-unit higher count of restaurants was associated with a lower BMI kg/m 2 ( β : -0·02 (95 % CI (-0·04, -0·004)). Better cooking skills were associated with a higher likelihood of cooking 6-7 d compared with <6 d (risk ratio: 1·24 (95 % CI (1·16, 1·31)) and a higher diet quality ( β : 4·45 (95 % CI (3·27, 5·63)) but not with BMI. We observed no interaction between the food environment and cooking skills ( P -for-interaction > 0·1)., Conclusions: Exposure to food stores was associated with a higher diet quality and exposure to restaurants with a lower BMI. Better cooking skills were associated with a higher frequency of home cooking and better diet quality but did not modify associations with the food environment. Future studies should explore different approaches to understand how individuals interact with their food environment.

Objective: To compare ultra-processing markers and nutrient composition in plant-based meat products (PBMP) with equivalent meat-based products (MBP)., Design: A total of 282 PBMP and 149 MBP within 18 product categories were assessed. Based on the NOVA classification, 33 ultra-processing markers were identified and six ultra-processing bullet categories were defined, that is flavour, flavour enhancer, sweetener, colour, other cosmetic additives and non-culinary ingredients. The ingredient lists were analysed concerning these ultra-processing markers and ultra-processing bullet categories, as well as nutrient composition, for all PBMP and MBP. Differences between PBMP and MBP were assessed using chi-square and Mann-Whitney U tests, respectively., Setting: Cross-sectional analysis., Participants: 282 PBMP and 149 MBP., Results: The percentage of ultra-processed food (UPF) items was significantly higher in PBMP (88 %) as compared to MBP (52 %) ( P < 0·0001). The proportion of UPF items was numerically higher in 15 out of 18 product categories with differences in six categories reaching statistical significance ( P < 0·05). Flavour, flavour enhancer, colour, other cosmetic additives and non-culinary ingredients were significantly more prevalent in PBMP as compared to MBP ( P < 0·0001). Concerning nutrient composition, median energy, total fat, saturated fat and protein content were significantly lower, whereas the amounts of carbohydrate, sugar, fibre and salt were significantly higher in PBMP ( P < 0·05)., Conclusions: Ultra-processing markers are significantly more prevalent in PBMP as compared to MBP. Since UPF intake has been convincingly linked to metabolic and CVD, substituting MBP with PBMP might have negative net health effects.

Sports foods are convenient alternatives to everyday foods to fuel performance. Strong scientific evidence supports their use; however, commercial sports foods are classified by the NOVA system as ultra-processed foods (UPF). Consumption of UPF has been associated with poor mental and physical health, but little is known about athletes' consumption of and attitudes towards sports foods as a source of UPF. The aim of this cross-sectional study was to assess Australian athletes' intake of and attitudes towards sports foods and UPF. Adult athletes were recruited to complete an anonymous online survey via social media between October 2021 and February 2022. Data were analysed using descriptive statistics, and Pearson's χ 2 test was used to assess potential relationships between categorical demographic variables and consumption of sports foods. One hundred forty Australian adults participating in recreational ( n 55), local/regional ( n 52), state ( n 11), national ( n 14) or international ( n 9) sports completed the survey. Ninety-five percent reported consuming sports foods within the past 12 months. Participants consumed sports drinks most commonly (73 %) and isolated protein supplements most frequently (40 % at least once per week). Participants reported everyday foods to be more affordable, taste better, present less risk of banned substances, but less convenient and greater risk of spoilage. Half (51 %) of participants reported concern about health effects of UPF. Participants reported regular UPF consumption despite taste and cost-related preferences for everyday foods and health concerns regarding UPF intake. Athletes may need support to identify and access safe, affordable, convenient, minimally processed alternatives to sports foods.

Improving diet quality is recognised as a double-duty action that can simultaneously address multiple forms of malnutrition. This study aimed to assess diet quality among non-pregnant non-lactating women of reproductive age (WRA) in Addis Ababa, Ethiopia. A 1-d quantitative 24 h recall was conducted among 653 non-pregnant/non-lactating women. Diet quality, assessed using the women dietary diversity score (WDDS), the Global Diet Quality Score (GDQS) and the Nova 4 classification reflecting consumption of ultra-processed foods (UPF), was compared. The proportion that meets the minimum dietary diversity for women (MDD-W) was estimated. The average MDD-W score was 2·6 (sd 0·9), with only 3 % of women meeting the MDD-W (≥ 5 food groups). Consumption of wholegrain and legumes was high, but UPF were also consumed by 9 % of the women. GDQS was positively associated with WDDS, age and skipping breakfast and was negatively associated with eating out of home and UPF consumption ( P < 0·05). The multivariate regression model showed that GDQS (total) was not associated with wealth but was significantly associated with both UPF and WDDS ( P < 0·001). Unlike UPF and WDDS alone, GDQS was able to predict both nutrient adequacy and unhealthy dietary practices. The diet quality of WRA in Addis Ababa is low in diversity, possibly exposing them to higher risk of nutrient inadequacy and non-communicable diseases as reflected by the low GDQS. Understanding what drives food and dietary choices in urban settings is urgently needed.

Frequent ultra-processed food (UPF) consumption is consistently associated with poor health outcomes. Little is known about UPF intake during early childhood and its effects on growth. We assessed UPF in relation to child anthropometry, bone maturation, and their nutrition profiles in a rural Ecuadorian community. Covariate-adjusted regression models estimated relationships between UPF intake from a 24-hour Food Frequency Questionnaire and three outcomes: linear growth, weight status and bone maturation. Nutrient Profiling Models (NPM) evaluated a convenience sample of UPF ( n 28) consumed by children in the community. In this cohort ( n 125; mean age = 33·92 (sd 1·75) months), 92·8 % consumed some form of UPF the previous day. On average, children consuming UPF four to twelve times per day (highest tertile) had lower height-for-age z-scores than those with none or a single instance of UPF intake (lowest tertile) ( β = -0·43 [se 0·18]; P = 0·02). Adjusted stunting odds were significantly higher in the highest tertile relative to the lowest tertile (OR: 3·07, 95 % CI 1·11, 9·09). Children in the highest tertile had significantly higher bone age z-scores (BAZ) on average compared with the lowest tertile ( β = 0·58 [se 0·25]; P = 0·03). Intake of savoury UPF was negatively associated with weight-for-height z-scores ( β = -0·30 [se 0·14]; P = 0·04) but positively associated with BAZ ( β = 0·77 [se 0·23]; P < 0·001). NPM indicated the availability of unhealthy UPF to children, with excessive amounts of saturated fats, free sugars and sodium. Findings suggest that frequent UPF intake during early childhood may be linked to stunted growth (after controlling for bone age and additional covariates), despite paradoxical associations with bone maturation.

Purpose: The Brazilian Food Guide (BFG)'s messages are mostly qualitative and focused on food practices, such as meal planning, cooking, and eating modes. This study sough to investigate whether the adherence to these food practices is aligned with diet quality., Methods: A quota-based subsample of the NutriNet-Brasil Cohort (n = 2052) completed the Food Practices Brazil Scale (FPBr), a 24-item scale assessing the adherence to healthy eating practices recommended by the BFG. Four possible frequency-based answers are given and a score ranging from 0 to 72 is calculated by summing them (FPBr-score). Data from web-based 24-h recalls were used for calculating the usual percentage of energy intake (%energy) of ten food groups based on the level of food processing: plant-based unprocessed or minimally processed foods; processed foods; ultra-processed foods; fruits; vegetables; whole grains; beans and other legumes; nuts; red meat; and table sugar. The association between quartiles of the FPBr-score and food groups' %energy was analysed through crude and adjusted linear regression models., Results: Except for red meat, all the other food groups were linearly associated with the FPBr-score in the expected direction. For example, adjusted means for the %energy of plant-based unprocessed or minimally processed foods were 26.7% (CI95% 25.9-27.5) and 36.8% (CI95% 36.0-37.6) among those classified in the first and fourth quartiles of the FPBr-score, respectively. For ultra-processed foods, these percentages were 27.0 (CI95% 26.3-27.8) against 17.5 (CI95% 16.7-18.3)., Conclusions: These results support the use of messages based on practices and behaviors in Food-Based Dietary Guidelines. At the same time, they call attention to the importance of policies that enable people to adopt healthier food practices., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objectives: The goal of the present study was to evaluate the association between depression and ultra-processed food (UPF) consumption as risk factors for developing type 2 diabetes (T2D)., Design: A prospective community study., Setting: Baseline data (2009-2010) from CARTaGENE community health study from Quebec, Canada, were used. Food and drink consumption was assessed using the Canadian-Diet History Questionnaire II and grouped according to their degree of processing by the NOVA classification, and participants were categorised into tertiles of UPF (g/d). Depression was defined using either a validated cut-off score on the Patient Health Questionnaire-9 or antidepressant use. The outcome was the incidence of T2D, examined in 3880 participants by linking survey data with administrative health insurance data. Cox regression models estimated the associations between UPF, depression and incident T2D., Participants: 40-69-year-old individuals at baseline., Results: In total, 263 (6·8 %) individuals developed T2D. Participants with high depressive symptoms and high UPF consumption showed the highest risk for T2D (adjusted hazard ratios (aHR) = 1·58, 95 % CI (0·98, 2·68)), compared to those with low depressive symptoms and low UPF consumption. The risk for T2D was similar when high depressive symptoms and antidepressant use were combined with high UPF (aHR 1·62, 95 % CI (1·02, 2·57))., Conclusions: This study shows that co-occurring depression and high UPF consumption were associated with a higher risk for T2D. Early management and monitoring of both risk factors might be essential for diabetes prevention.

Objective: To assess the association between child ultra-processed food (UPF) consumption and home-school learning environment characteristics during school closures due to the COVID-19 pandemic in schoolchildren with low- and middle income in Chile., Design: Cross-sectional. UPF consumption was collected using the Nova screener. We apply the structured days hypothesis (SDH) to assess home-school learning environment characteristics with three constructs that summarised school preparedness for online teaching and learning, school closure difficulties for caregivers and child routine. We explored associations between child UPF consumption and home-school environment characteristics using multivariate linear regression analyses after controlling for child demographic and school characteristics., Setting: Low- and middle-income neighbourhoods in southeastern Santiago, Chile., Participants: Children from the Food Environment Chilean Cohort ( n 428, 8-10 years old)., Results: Based on the Nova score, child mean consumption of UPF was 4·3 (sd 1·9) groups. We found a statistically significant negative association between child routine for eating, play and study and child UPF consumption when we adjusted for child sociodemographic (model 1: β = -0·19, (95 % CI -0·40, 0·02)) and school characteristics (model 2: β = -0·20, (95 % CI -0·41, 0·00)). Associations between school preparedness for online teaching or school closure difficulties and UPF were not statistically significant., Conclusions: Variations in child routines during the COVID-19 pandemic were negatively associated with UPF intake in schoolchildren with low- and middle income. Our findings are consistent with the SDH, suggesting the school environment helps regulate eating behaviours. Future research should evaluate what happens when children return to in-person classes at school.

Objective: This paper describes the first web-based self-completed 24-h recall designed to categorise food intake according to Nova groups - Nova24h - and its agreement with a reference tool in estimating the dietary relative contribution of the four Nova food groups (% of total energy intake)., Design: Comparisons of estimates of dietary relative contributions of Nova groups obtained by Nova24h and one standard interviewer-led 24-h recall., Setting: Nationwide adult cohort study in Brazil., Participants: The subjects were 186 participants of the NutriNet Brasil Cohort Study ( n 186)., Results: No statistically significant differences were observed between the Nova24h and the reference tool mean contributions of unprocessed or minimally processed foods (52·3 % v . 52·6 %), processed culinary ingredients (11·6 % v . 11·9 %), processed foods (17·1 % v . 14·7 %) and ultra-processed foods (19·0 % v . 20·9 %). Intraclass correlation coefficients between individual estimates obtained for each Nova group showed moderate to good agreement (0·54-0·78). Substantial or almost perfect agreement between the tools was seen regarding the ability to rank participants according to quintiles of contribution of each Nova group (PABAK 0·69-0·81)., Conclusions: Nova24h is a suitable tool for estimating the dietary relative energy contribution of Nova food groups in the NutriNet Brasil cohort. New studies are necessary to verify its adequacy in other populations.

The consumption and availability of ultra-processed foods (UPFs), which are associated with an increased risk of noncommunicable diseases, have increased in most countries. While many countries have or are planning to incorporate UPF recommendations in their national dietary guidelines, the classification of food processing levels relies on expertise-based manual categorization, which is labor-intensive and time-consuming. Our study utilized transformer-based language models to automate the classification of food processing levels according to the NOVA classification system in the Canada, Argentina, and US national food databases. We showed that fine-tuned language models using the ingredient list text found on food labels as inputs achieved a high overall accuracy (F1 score of 0.979) in predicting the food processing levels of Canadian food products, outperforming traditional machine learning models using structured nutrient data and bag-of-words. Most of the food categories reached a prediction accuracy of 0.98 using a fined-tuned language model, especially for predicting processed foods and ultra-processed foods. Our automation strategy was also effective and generalizable for classifying food products in the Argentina and US databases, providing a cost-effective approach for policymakers to monitor and regulate the UPFs in the global food supply.

Background: Few 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., Method: Data 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 food consumption (exposure) with elevated psychological distress (outcome and defined as K10 ≥ 20). We fitted additional logistic regression models to determine whether these associations were modified by sex, age and body mass index., Results: After adjusting for sociodemographic characteristics and lifestyle and health-related behaviours, participants with the highest relative intake of ultra-processed food were at increased odds of elevated psychological distress compared to participants with the lowest intake (aOR: 1.23; 95%CI: 1.10, 1.38, p for trend = 0.001). We found no evidence for an interaction of sex, age and body mass index with ultra-processed food intake., Conclusion: Higher ultra-processed food intake at baseline was associated with subsequent elevated psychological distress as an indicator of depression at follow-up. Further prospective and intervention studies are necessary to identify possible underlying pathways, specify the precise attributes of ultra-processed food that confer harm, and optimise nutrition-related and public health strategies for common mental disorders., Competing Interests: Declaration of competing interest The Food & Mood Centre has received Grant/Research support from Fernwood Foundation, Wilson Foundation, the A2 Milk Company, and Be Fit Foods. MML is supported by a Deakin University Scholarship and has received research funding support from Be Fit Foods. ML is currently funded by an Alfred Deakin Postdoctoral Research Fellowship. MF is supported by a Deakin University Scholarship and has received grants and fellowships from Avant Mutual, the Royal Australian and New Zealand College of Psychiatrists (RANZCP) and the National Health and Medical Research Council (NHMRC). TR has received grants, fellowships and research support from University of the Sunshine Coast, Australian Postgraduate Awards, Fernwood Foundation, Roberts Family Foundation and Be Fit Food. TR received consultancy, honoraria and travel funds from Oxford University Press, the University of Melbourne, the University of Sydney, Bond University, University of Southern Queensland, Dietitians Association of Australia, Nutrition Society of Australia, The Royal Australian and New Zealand College of Psychiatrists, Academy of Nutrition and Dietetics, Black Dog Institute, Australian Rotary Health, Australian Disease Management Association, Department of Health and Human Services, Primary Health Networks, Barwon Health, West Gippsland Healthcare Group, Central West Gippsland Primary Care Partnership, Parkdale College, City of Greater Geelong and Global Age. AO is supported by an NHMRC Emerging Leader 2 Fellowship (2009295). She has received research funding from National Health & Medical Research Council, Australian Research Council, University of Melbourne, Deakin University, Sanofi, Meat and Livestock Australia and Woolworths Limited and Honoraria from Novartis. FNJ has received Grant/Research support from the Brain and Behaviour Research Institute, the National Health and Medical Research Council (NHMRC), Australian Rotary Health, the Geelong Medical Research Foundation, the Ian Potter Foundation, Eli Lilly, Meat and Livestock Australia, Woolworths Limited, the Fernwood Foundation, Wilson Foundation, the A2 Milk Company, Be Fit Foods, and The University of Melbourne, and has received speakers honoraria from Sanofi-Synthelabo, Janssen Cilag, Servier, Pfizer, Health Ed, Network Nutrition, Angelini Farmaceutica, Eli Lilly and Metagenics. FNJ has written two books for commercial publication and has a personal belief that good diet quality is important for mental and brain health. DNA is supported by funds from an NHMRC Emerging Leader 2 Fellowship (2009295). WM is currently funded by an Alfred Deakin Postdoctoral Research Fellowship and a Multiple Sclerosis Research Australia early-career fellowship. WM has previously received funding from the Cancer Council Queensland and university grants/fellowships from La Trobe University, Deakin University, University of Queensland, and Bond University. WM has received industry funding and has attended events funded by Cobram Estate Pty. Ltd. WM has received travel funding from Nutrition Society of Australia. WM has received consultancy funding from Nutrition Research Australia and ParachuteBH. WM has received speakers' honoraria from The Cancer Council Queensland and the Princess Alexandra Research Foundation., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: High unprocessed and minimally processed food (UMP) intake has been associated with high-quality diets, whereas the opposite has been shown for ultraprocessed food (UPF). Nevertheless, the association between UMP and UPF consumption and diet quality over the long-term warrants further examination., Objective: This study aimed to assess whether UMP and UPF intake are associated with three diet-quality metrics in female and male health professionals from two US cohorts over 3 decades of follow-up., Design: This was a cohort study, including data from the Nurses' Health Study (NHS), from 1986 to 2010 (N = 51,956) and the Health Professionals Follow-up Study (HPFS) from 1986 to 2006 (n = 31,307)., Participants and Setting: Participants were invited in 1976 (NHS) and 1986 (HPFS) to respond to mailed questionnaires every 2 to 4 years and diet was assessed with a semi-quantitative food frequency questionnaire every 4 years., Main Exposure Measures: UMP and UPF intake were calculated using the NOVA classification., Statistical Analyses: Generalized estimating equations for marginal means and repeated cross-sectional associations between diet-quality metrics and quintiles of UMP and UPF. Diets were assessed every 4 years from 1986 to 2010., Results: With increasing quintiles of UMP intakes, the Alternate Healthy Eating Index-2010 increased 7.1% (3.80 points, 95% CI 3.66 to 3.93) in the NHS and 10.1% (5.75 points, 95% CI 5.52 to 5.98) in the HPFS; the Mediterranean diet index increased 11.7% (0.50 points, 95% CI 0.47 to 0.52) in the NHS and 14.0% (0.64 points, 95% CI 0.60 to 0.68) in the HPFS; and the Dietary Approaches To Stop Hypertension diet score increased 7.5% (1.81 points, 95% CI 1.76 to 1.87) in the NHS and 10.6% (2.66 points, 95% CI 2.57 to 2.76) in the HPFS. In the fifth quintile of UPF intake compared with the first, the Alternate Healthy Eating Index-2010 was -9.3% (-4.60 points, 95% CI -4.73 to -4.47) lower in the NHS and -13.7% (-6.89 points, 95% CI -7.12 to -6.66) lower in the HPFS; the Mediterranean diet index was -14.7% (-0.55 points, 95% CI -0.57 to -0.53) lower in the NHS, and -19.0% (-0.74 points, 95% CI -0.78 to -0.70) lower in the HPFS; and the Dietary Approaches To Stop Hypertension diet score was -8.1% (-1.81 points, 95% CI -1.86 to -1.76) lower in the NHS and -12.8% (-2.84 points, 95% CI -2.93 to -2.74) lower in the HPFS., Conclusions: Consumption of UMP was associated with better dietary quality, whereas consumption of UPF was associated with poorer dietary quality., (Copyright © 2023 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background: A proposed topic for the 2025 Dietary Guidelines for Americans (DGA) Scientific Advisory Committee to address is the relationship between dietary patterns with ultra-processed foods (UPF) and body composition and weight status. Implementing the NOVA system, the most commonly applied framework for determining whether a food is "ultra-processed," in dietary guidance could omit several nutrient-dense foods from recommended healthy diets in the DGA., Objective: The purpose of this proof-of-concept study was to determine the feasibility of building a menu that aligns with recommendations for a healthy dietary pattern from the 2020 DGA and includes ≥80% kcal from UPF as defined by NOVA., Design: To accomplish this objective, we first developed a list of foods that fit NOVA criteria for UPF, fit within dietary patterns in the 2020 DGA, and are commonly consumed by Americans. We then used these foods to develop a 7-d, 2000 kcal menu modeled on MyPyramid sample menus and assessed this menu for nutrient content as well as for diet quality using the Healthy Eating Index-2015 (HEI-2015)., Results: In the ultra-processed DGA menu that was created, 91% of kcal were from UPF, or NOVA category 4. The HEI-2015 score was 86 out of a possible 100 points. This sample menu did not achieve a perfect score due primarily to excess sodium and an insufficient amount of whole grains. This menu provided adequate amounts of all macro- and micronutrients except vitamin D, vitamin E, and choline., Conclusions: Healthy dietary patterns can include most of their energy from UPF, still receive a high diet quality score, and contain adequate amounts of most macro- and micronutrients., (Published by Elsevier Inc.)

Background: Objective markers of ultraprocessed foods (UPF) may improve the assessment of UPF intake and provide insight into how UPF influences health., Objectives: To identify metabolites that differed between dietary patterns (DPs) high in or void of UPF according to Nova classification., Methods: In a randomized, crossover, controlled-feeding trial (clinicaltrials.govNCT03407053), 20 domiciled healthy participants (mean ± standard deviation: age 31 ± 7 y, body mass index [kg/m 2 ] 22 ± 11.6) consumed ad libitum a UPF-DP (80% UPF) and an unprocessed DP (UN-DP; 0% UPF) for 2 wk each. Metabolites were measured using liquid chromatography with tandem mass spectrometry in ethylenediaminetetraacetic acid plasma, collected at week 2 and 24-h, and spot urine, collected at weeks 1 and 2, of each DP. Linear mixed models, adjusted for energy intake, were used to identify metabolites that differed between DPs., Results: After multiple comparisons correction, 257 out of 993 plasma and 606 out of 1279 24-h urine metabolites differed between UPF-DP and UN-DP. Overall, 21 known and 9 unknown metabolites differed between DPs across all time points and biospecimen types. Six metabolites were higher (4-hydroxy-L-glutamic acid, N-acetylaminooctanoic acid, 2-methoxyhydroquinone sulfate, 4-ethylphenylsulfate, 4-vinylphenol sulfate, and acesulfame) and 14 were lower following the UPF-DP; pimelic acid, was lower in plasma but higher in urine following the UPF-DP., Conclusions: Consuming a DP high in, compared with 1 void of, UPF has a measurable impact on the short-term human metabolome. Observed differential metabolites could serve as candidate biomarkers of UPF intake or metabolic response in larger samples with varying UPF-DPs. This trial was registered at clinicaltrials.gov as NCT03407053 and NCT03878108., (Published by Elsevier Inc.)

This study aims to compare the classification of foods available in the Portuguese market using Nutri-Score and NOVA classifications and to analyse their ability to discriminate the fat, saturated fat, sugar, and salt content of foods. A sample of 2682 food products was collected. The nutritional quality of foods was established using the Nutri-Score, classifying them into five categories (from A to E). The NOVA classification was used to classify foods according to the degree of food processing into unprocessed/minimally processed foods, processed culinary ingredients, processed foods, and ultra-processed foods (UPF). The nutritional content of food products was classified using a Multiple Traffic Light label system. It was observed that 73.7% of UPF were classified as Nutri-Score C, D, and E, 10.1% as Nutri-Score A, and 16.2% as Nutri-Score B. Nutri-Score was positively correlated with NOVA classification (ρ = 0.140, p < 0.001) and with the Multiple Traffic Lights system (ρ Total Fat = 0.572, ρ Saturated Fat = 0.668, ρ Sugar = 0.215, ρ Salt = 0.321, p < 0.001). NOVA classification negatively correlated with the Multiple Traffic Lights system for total fat (ρ = -0.064, p < 0.001). Our findings indicate the presence of many UPFs in all Nutri-Score categories. Since food processing and nutritional quality are complementary, both should be considered in labelling.

There is a growing interest in the study of the degree of food processing and both health and nutritional outcomes. To that end, several definitions of the degree of processing have been proposed. However, when each of these is used on a common database of nutritional, clinical and anthropometric variables, the observed effect of high intakes of highly processed food, varies considerably.. Moreover, assigning a given food by nutritional experts, to its appropriate level of processing, has been shown to be variable. Thus, the subjective definitions of the degree of food processing and the coding of foods according to these classifications is prone to error is prone to error. Another issue that need resolution is the relative importance of the degree of food processing and the formulation of a processed food. Although correlational studies linking processed food and obesity abound, there is a need for more investigative studies.

Modern nutrition science began approximately 100 years ago in the context of nutrient deficiency diseases. Nutrition research and policy activities were framed mostly within a reductionist paradigm in which foods were analysed as being a collection of their constituent nutrients. Today, nutrition problems extend to all forms of malnutrition as well as environmental sustainability considerations and are associated with food and dietary pattern exposures. In 2009, researchers investigating the nutrition transition in Brazil proposed that industrial food processing was a key determinant of nutrition problems. The NOVA food classification system which is based on the nature, extent and purposes of food processing was developed to operationalise this proposition. The ultra-processed food (UPF) concept within NOVA is receiving much attention in relation to nutrition research and policy activities. This commentary describes the UPF concept as being fit-for-purpose in providing guidance to inform policy activities to tackle unhealthy and unsustainable diets. There is now a substantial body of evidence linking UPF exposure with adverse population and planetary health outcomes. The UPF concept is increasingly being used in the development of food-based dietary guidelines and nutrition policy actions. It challenges many conventional nutrition research and policy activities as well as the political economy of the industrial food system. Inevitably, there are politicised debates associated with UPF and it is apparent a disproportionate number of articles claiming the concept is controversial originate from a small number of researchers with declared associations with UPF manufacturers. Prominent examples of these claims are assessed.

Ultra-processed foods' (UPFs') consumption has been positively linked to the presence of allergic symptoms, but it is yet unknown whether this is linked to their nutritional composition or allergen load. This study used the ingredient lists available in the Greek Branded Food Composition Database, HelTH, to classify foods ( n = 4587) into four grades of food processing (NOVA1-4) according to the NOVA System. Associations between NOVA grades and the presence of allergens (as an ingredient or trace) were studied. Overall, UPFs (NOVA4) were more likely to contain allergens than unprocessed foods, NOVA1 (76.1% vs. 58.0%). However, nested analyses among similar foods showed that in >90% of cases, processing degree was not linked to allergens' presence. Recipe/matrix complexity was more strongly linked to allergens' presence with NOVA4 foods declaring 1.3 allergenic ingredients vs. 0.4 allergenic ingredients in NOVA1 foods ( p < 0.01). Exposure to trace allergens was more common for NOVA4 than NOVA1 foods (45.4% vs. 28.7%), but the extent of contamination was similar (2.3 vs. 2.8 trace allergens). Overall, UPFs are more complex mixtures with higher numbers of allergens per food and are more prone to cross-contamination. However, indicating a food's degree of processing is not sufficient to help identify allergen-free choices within the same subcategory.

The aim of this study is to describe how individuals use different food retailers and how food retail usage varies according to socio-demographic and diet-related characteristics. A cross-sectional survey among Dutch adults (N = 1784) was used. Results from the Two-step cluster analysis indicated that there were five clusters of food retail users. Use of discount supermarkets, organic supermarkets, fast-food outlets, and restaurants contributed to clustering, but use of regular supermarkets, local food shops and whether food retailers were close to home or further from home did not. The clusters included mixed food outlet users, discount supermarket and restaurant users, fast-food and restaurant users, predominant discount supermarket users and supermarkets, fast-food and restaurant users. Participants in each cluster had their own characteristics especially in terms of socio-economic position and diet quality. Future studies need to consider further how food retail selection links physical exposure to the food environment and diet., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Despite the accumulating evidence that increased consumption of ultra-processed food has adverse health implications, it remains difficult to decide what constitutes processed food. Indeed, the current processing-based classification of food has limited coverage and does not differentiate between degrees of processing, hindering consumer choices and slowing research on the health implications of processed food. Here we introduce a machine learning algorithm that accurately predicts the degree of processing for any food, indicating that over 73% of the US food supply is ultra-processed. We show that the increased reliance of an individual's diet on ultra-processed food correlates with higher risk of metabolic syndrome, diabetes, angina, elevated blood pressure and biological age, and reduces the bio-availability of vitamins. Finally, we find that replacing foods with less processed alternatives can significantly reduce the health implications of ultra-processed food, suggesting that access to information on the degree of processing, currently unavailable to consumers, could improve population health., (© 2023. The Author(s).)

This cross-sectional study assessed highly processed food (HPF) consumption and its association with individual characteristics in a nationwide sample of Japanese adults. Eight-day weighed dietary records were obtained from 2742 free-living adults aged 18-79 years across Japan. HPFs were identified based on a classification method developed by researchers at the University of North Carolina at Chapel Hill. The basic characteristics of the participants were assessed using a questionnaire. On average, HPF contributed to 27.9% of daily energy intake. The contribution of HPF to the daily intake of 31 nutrients ranged from 5.7% for vitamin C to 99.8% for alcohol (median, 19.9%). Cereals and starchy foods were the main food groups that contributed to the total energy intake of HPF. Multiple regression analysis showed that the older group (60-79 years) had a lower HPF energy contribution than the younger group (18-39 y) (regression coefficient (β) = -3.55, p < 0.0001). Compared to current smokers, past and never-smokers had lower HPF energy contributions (β = -1.41, p < 0.02; and -4.20, p < 0.0001, respectively). In conclusion, HPFs account for approximately one-third of energy intake in Japan. Younger age and current smoking status should be considered in future intervention strategies to reduce HPF consumption.

Background: Both the nutritional quality of the foods consumed (as nutrient composition) and their ultra-processed nature have been linked to health risks. However, the respective contribution of each of these correlated dimensions or their synergy to the overall diet quality has been rarely explored., Objective: To identify the respective effects of the nutritional quality of the foods consumed, the ultra-processed nature of foods and their cross-effect contributing to the overall quality of the diet., Design: Cross-sectional observational study., Setting: Web-based French NutriNet-Santé cohort study., Participants: Participants in the NutriNet-Santé cohort study with at least three available 24 h records as baseline dietary data (N = 98 454 participants)., Main Outcome Measures: The overall quality of the diet (qualified using the adherence to the 2017 French national nutrition and health dietary recommendations dietary score PNNS-GS2) was broken down into: (1) an effect of the nutritional quality of the foods consumed (qualified using the modified Foods Standards Agency nutrient profile model (underlying the Nutri-Score) dietary index FSAm-NPS DI); (2) an effect of the ultra-processed nature of the foods consumed (qualified using the proportion of ultra-processed foods consumed UPFp using the NOVA classification), and (3) a cross-effect of both dimensions., Results: The overall effect from the 'nutritional quality of the foods consumed' (FSAm-NPS DI) was 1.10, corresponding to 26% of the total effect; the overall effect from ultra-processed foods consumption was 1.29, corresponding to 30% of the total effect; and cross-effect between nutritional quality of the foods consumed and ultra-processing was at 1.91, corresponding to 44% of total effects., Conclusions: Our study provides support to the postulate that nutritional quality and ultra-processing should be considered as two correlated but distinct and complementary dimensions of the diet., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Oral nutrition supplements (ONS) are widely recommended for the management of unintentional weight loss in patient populations, long-term care residents, and community-dwelling older adults. Most marketed ONS are ultra-processed, with precision nutrition and aseptic composition, as well as convenience and availability, driving their selection. However, therapeutic effectiveness is mixed and the potential health risks of consuming ultra-processed ONS long-term in lieu of less-processed foods have received little attention. A diverse and balanced microbiota supporting immunity and wellness is maintained by a diet rich in plant-sourced foods. The implications of ultra-processed ONS displacing plant-sourced foods, and specifically the potential for undesirable impacts on the gut microbiota, require consideration. Most ONS are either devoid of fiber or are supplemented with isolated or purified fibers that may contribute to adverse gastrointestinal symptoms and appetite suppression. In contrast, the diversity of microbial-available, nondigestible carbohydrates, together with the array of phytochemicals found in plant-sourced foods, support microbial diversity and its resiliency. This review outlines the clinical dilemma of recommending commercial ultra-processed ONS vs nutritionally adequate (eg, high-energy/high-protein) foods and beverages that contribute to diet quality, maintenance of a diverse and stable gut microbiota composition, and support nutrition status and health. Ultra-processed ONS may fall short of expected health benefits, and overreliance may potentially contribute to the risk for patient and older adult populations because of the displacement of a variety of healthful foods., (© 2022 The Authors. Nutrition in Clinical Practice published by Wiley Periodicals LLC on behalf of American Society for Parenteral and Enteral Nutrition.)

There is a need for conceptual and methodological innovation in food environment-health research. We compared different operationalizations of survey-derived activity space exposures to fast food outlets (FFOs) in associations with use of FFO, diet quality and body mass index (BMI). FFO exposure was determined for home, work and a maximum of sixteen other locations reported by 1728 Dutch adults. Considerable differences in count of FFO between locations were found. Adjusted linear regression analyses resulted in small, unexpected associations with use of FFO, diet quality and BMI, whereby the strength of associations differed between exposure measures. Using home and work areas may be a cost-efficient compromise to capture large parts of the exposure to FFOs., Competing Interests: Declaration of competing interest None., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: The current study aimed to characterise the food profile of Yanomami indigenous children according to the degree of food processing and its associated factors., Design: This is a cross-sectional study with Yanomami indigenous children aged 6 to 59 months. Socio-demographic, maternal and infant data were collected through a standardised questionnaire. The food profile was obtained by using a list of thirty-four foods to verify the child's consumption of these foods on the day preceding the interview. Foods were classified according to the degree of processing based on the NOVA system (in natura or minimally processed, processed culinary ingredients, processed and ultra-processed). In natura and minimally processed foods were subdivided into 'regional' and 'urban' foods. Poisson regression analysis was applied to estimate the associated factors according to the 90 % CI., Setting: Three villages (Auaris, Maturacá and Ariabú) in the Yanomami indigenous territory, in the Brazilian Amazon., Participants: In total, 251 Yanomami children aged 6 to 59 months were evaluated., Results: The prevalence of consumption of 'regional' and 'urban' in natura or minimally processed foods was 93 % and 56 %, respectively, and consumption of ultra-processed foods was 32 %. Ultra-processed food consumption was 11·6 times higher in children of Maturacá and 9·2 times higher in Ariabú when compared with the children of Auaris and 31 % lower in children who had mothers with shorter stature., Conclusion: Despite the high frequency of consumption of in natura and minimally processed foods, the consumption of ultra-processed foods was substantial and was associated with demographic and maternal factors in Yanomani indigenous children under 5 years of age.

Background: The degree of food processing may be an important dimension of diet in how it relates to health outcomes. A major challenge is standardizing food processing classification systems for commonly used datasets., Objectives: To standardize and increase transparency in its application, we describe the approach used to classify foods and beverages according to the Nova food processing classification in the 24-h dietary recalls from the 2001-2018 cycles of What We Eat in America (WWEIA), NHANES, and investigate variability and potential for Nova misclassification within WWEIA, NHANES 2017-2018 data via various sensitivity analyses., Methods: First, we described how the Nova classification system was applied to the 2001-2018 WWEIA, NHANES data using the reference approach. Second, we calculated the percentage energy from Nova groups [1: unprocessed or minimally processed foods, 2: processed culinary ingredients, 3: processed foods, and 4: ultraprocessed foods (UPFs)] for the reference approach using day 1 dietary recall data from non-breastfed participants aged ≥1 y from the 2017-2018 WWEIA, NHANES. We then conducted 4 sensitivity analyses comparing potential alternative approaches (e.g., opting for more vs. less degree of processing for ambiguous items) to the reference approach, to assess how estimates differed., Results: The energy contribution of UPFs using the reference approach was 58.2% ± 0.9% of the total energy; unprocessed or minimally processed foods contributed 27.6% ± 0.7%, processed culinary ingredients contributed 5.2% ± 0.1%, and processed foods contributed 9.0% ± 0.3%. In sensitivity analyses, the dietary energy contribution of UPFs ranged from 53.4% ± 0.8% to 60.1% ± 0.8% across alternative approaches., Conclusions: We present a reference approach for applying the Nova classification system to WWEIA, NHANES 2001-2018 data to promote standardization and comparability of future research. Alternative approaches are also described, with total energy from UPFs differing by ∼6% between approaches for 2017-2018 WWEIA, NHANES., (Copyright © 2022 American Society for Nutrition. All rights reserved.)

Excessive consumption of ultra-processed foods is associated with the development of metabolic changes in children and adolescents. However, the consumption of total sugars, monosaccharides and disaccharides present in these ultra-processed foods and other food groups and its association with anthropometric indicators must be evaluated. Therefore, this study aimed at analysing the influence of sugar consumption from foods with different degrees of processing on anthropometric indicators of children and adolescents after 18 months of follow-up. This cohort study was conducted among 492 children and adolescents aged 7-15 years. Information on food consumption and anthropometry was collected during three follow-up stages. NOVA classification was used for food categorisation. The influence of sugar consumption on the variation of anthropometric measurements over time was evaluated using generalised estimation equation models. During the analysis period, for each increase of 1 g/d in the consumption of total sugars and monosaccharides from ultra-processed foods, there was an increase of 0·002 kg/m 2 ( P = 0·030) and 0·001 kg/m 2 ( P = 0·019) in BMI/Age; increase of 0·073 ( P < 0·001), 0·032 ( P < 0·001) and 0·100 ( P < 0·001) in the BMI/Age z -score; and increase of 0·001 cm ( P = 0·001), 0·001 cm ( P = 0·003) and 0·003 cm ( P < 0·001) in waist circumference, with the consumption of total sugars, monosaccharides and disaccharides, respectively. Our study findings support the evidence that the consumption of total sugars, monosaccharides and disaccharides from ultra-processed foods is associated with weight gain and abdominal fat in children and adolescents, which may represent an important risk factor for excess weight in this age group.

Few studies have investigated which types of food are least reported among underreporters of energy intake (EI). This study assessed the association between the underreporting of EI and the consumption report of food groups according to NOVA classification in women in social vulnerability. EI was measured through three 24-h dietary recalls administered by the research team. Total energy expenditure (TEE) was evaluated using the doubly labelled water method. The percentage of EI arising from each NOVA group food classification (unprocessed/minimally processed foods, culinary ingredients, processed foods and ultra-processed foods [UPF]) was calculated. The agreement between the EI and the TEE was assessed using the ratio EI:TEE. Associations were assessed with Pearson's correlation and multivariable linear regression, adjusted for age, education and body fat. The sample (63 women, age: 30.8 years, Body Mass Index: 27.6 kg/m 2 ) reported an EI of 1849 kcal and a TEE of 2223 kcal, with a mean EI:TEE of 0.85. There were no significant correlations between the EI:TEE and the reported food intake according to NOVA classifications. Multivariable linear regression also did not show any significant associations (UPF: 8.47, 95% CI: [-3.65; 20.60] %kcal; Processed: -6.85, [-19.21; 7.71] %kcal; Culinary ingredients: 1.30 [-5.10; 7.71] %kcal; Unprocessed/minimally processed: -2.92 [-10.98; 5.13] %kcal). In conclusion, socially vulnerable women that underreport their EI do not report a lower intake of any specific group of foods according to NOVA classification., (© 2022 British Nutrition Foundation.)

Background: Intake of unhealthy foods is linked to the onset of obesity and diet-related non-communicable diseases (NCDs). Availability of unhealthy (nutritionally poor) foods can influence preference, purchasing and consumption of such foods. This study determined the healthiness of foods sold at modern retail outlets- supermarkets and mini-marts in the Greater Accra Region of Ghana., Methods: All modern retail outlets located in six districts of Greater Accra were eligible. Those < 200 m 2 of floor area and with permanent structures were categorized as mini-marts; and those ≥200 m 2 as supermarkets. Shelf length of all available foods were measured. Healthiness of food was determined using two criteria - the NOVA classification and energy density of foods. Thus, ultra-processed foods or food items with >225 kcal/100 g were classified as unhealthy. The ratio of the area occupied by unhealthy to healthy foods was used to determine the healthiness of modern retail outlets., Results: Of 67 retail outlets assessed, 86.6% were mini-marts. 85.0% of the total SHELF area was occupied by foods categorized as unhealthy (ranging from 9,262 m 2 in Ashiaman Municipality to 41,892 m 2 in Accra Metropolis). Refined grains/grain products were the most available, occupying 30.0% of the total food shelf space, followed by sugar-sweetened beverages (20.1% of total shelf space). The least available food group-unprocessed staples, was found in only one high income district, and occupied 0.1% of the total food shelf space. Retail outlets in two districts did not sell fresh fruits or fresh/unsalted canned vegetables. About two-thirds of food products available ( n = 3,952) were ultra-processed. Overall, the ratio of ultra-processed-to-unprocessed foods ranged from 3 to 7 with an average (SD) of 5(2). Thus, for every healthy food, there were five ultra-processed ones in the studied retail outlets., Conclusion: This study reveals widespread availability of ultra-processed foods in modern retail outlets within the selected districts. Toward a healthier food retail environment, public health and food regulators, in partnership with other stakeholders need to institute measures that improve availability of healthy foods within supermarkets and mini-marts., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Adjei, Amevinya, Quarpong, Tandoh, Aryeetey, Holdsworth, Agyemang, Zotor, Laar, Mensah, Addo, Laryea, Asiki, Sellen, Vandevijvere and Laar.)

Exploring potentially addictive foods and food components is a recent research focus. Few studies have evaluated this based on level of food processing using the NOVA classification system. This study compared intakes of ultra-processed foods in young adults with and without food addiction. Secondary analysis of online cross-sectional survey data was conducted. The sample included 735 young Australian adults (18-35 years). Dietary intake was assessed by food frequency questionnaire and coded using NOVA to determine percentage energy (%E) from each of the four NOVA categories (unprocessed; processed culinary ingredients; processed; ultra-processed). Food addiction was assessed using the Yale Food Addiction Scale (YFAS). Linear regression models, adjusted for age, gender and body mass index (BMI), were developed to examine the association between %E from NOVA categories with food addiction status and number of symptoms. Sample mean age was 24.7 ± 4.2 years, 85% were female, 67% within healthy weight BMI range, and 20% classified as food addicted. Participants consumed 34.3 ± 13.4 %E from ultra-processed foods. Young adults classified as food addicted consumed a higher %E from ultra-processed foods (β = 3.954, p = 0.002) and a lower %E from unprocessed foods (β = -2.743, p = 0.010) than those classified as not food addicted. For each additional food addiction symptom reported, the %E from ultra-processed foods was higher (β = 1.693, p < 0.001) and %E from unprocessed foods was lower (β = -1.238, p < 0.001). Results demonstrate an association between YFAS assessed food addiction and higher intakes of ultra-processed foods, providing an important new perspective on the relationship between self-reported diet and food addiction in young adults. Future research should evaluate the relationship between food addiction, ultra-processed food intakes and health in longitudinal studies in order to inform potential treatment approaches., Competing Interests: Declaration of competing interest The authors certify that there are no conflicts of interest to declare. All authors have reviewed and approved the final manuscript and accept full responsibility for all aspects of the work described., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Studies indicate that eating locations can influence food choices. However, the relationship with ultra-processed foods has been little explored. The objective was to assess the association between eating locations and ultra-processed foods consumption in the UK in 2014-2016. Data from 2,449 individuals aged 4 years or older from the NDNS were analysed cross-sectionally. Food consumption information was collected through 4-day food diaries. Recorded foods were classified into NOVA system. The eating locations were grouped into nine categories (home, institutional places, sit-down restaurants, on the go, coffee shops, leisure and sports clubs, fast food, friends and relatives' house, and other places). Linear regression models were carried out. The coefficients represent the increment in the contribution of ultra-processed foods to total energy intake for each percentage point increase in the contribution of each eating location to total energy intake. Among children, consumption at home was inversely associated with ultra-processed foods consumption (β: -0.10; 95% CI -0.17, -0.03), while in leisure and sports places (0.47; 0.20, 0.73) directly associated. For adolescents, eating at home (-0.12; -0.19, -0.05) was inversely associated with the consumption of ultra-processed foods, as well as sit-down restaurants (-0.21; -0.38, -0.03). Fast food (0.29; 0.12, 0.47) were directly associated with the consumption of ultra-processed foods for adolescents. Finally, for adults, sit-down restaurants (-0.13; -0.22, -0.03) showed to be inversely associated with the consumption of ultra-processed foods while in fast food restaurants (0.77; 0.38, 1.17) it was directly associated. Our results showed that the eating locations have different impacts on diet quality.

Affordable nutrient density is provided by low-cost and nutrient-rich foods. We explored nutrient density, cost, and NOVA category assignments within and across food groups in Brazil. The nutrient density of the foods ( n = 591) was assessed using the Nutrient Rich Food Index (NRF9.3) based on protein, fiber, vitamin A (RAE), vitamin C, vitamin E (mg), Ca, Fe, K and Mg; and NRF6.3 score for priority nutrients: Ca, Fe, Zn, vitamin A, vitamin B12, and folate. Nutrients to limit (LIM) were saturated fat, added sugar, and sodium. Affordability was defined as the ratio of energy and/or nutrient density of foods and retail price per 100 kcal. Foods were classified as minimally processed ( n = 106), processed ( n = 188), ultra-processed ( n = 286), and culinary ingredients ( n = 11). Nutrient density was positively linked to per 100 kcal food cost. Ultra-processed foods (UPF) contained more energy, fat, sugar, and salt and had lower NRF scores compared to minimally processed (MPF) foods. UPF was also less expensive than MPF foods. Nutrient-rich foods below the median per 100 kcal costs included MPF foods, but also processed foods (PF) and UPF. Affordable nutrient-rich foods can be found in the different categories of the NOVA classification.

NOVA classification distinguishes foods by level of processing, with evidence suggesting that a high intake of ultra-processed foods (UPFs, NOVA category 4) leads to obesity. The Australian Dietary Guidelines, in contrast, discourage excess consumption of “discretionary foods” (DFs), defined according to their composition. Here, we (i) compare the classification of Australian foods under the two systems, (ii) evaluate their performance in predicting energy intakes and body mass index (BMI) in free-living Australians, and (iii) relate these outcomes to the protein leverage hypothesis of obesity. Secondary analysis of the Australian National Nutrition and Physical Activity Survey was conducted. Non-protein energy intake increased by 2.1 MJ (p < 0.001) between lowest and highest tertiles of DF intake, which was significantly higher than UPF (0.6 MJ, p < 0.001). This demonstrates that, for Australia, the DF classification better distinguishes foods associated with high energy intakes than does the NOVA system. BMI was positively associated with both DFs (−1. 0, p = 0.0001) and UPFs (−1.1, p = 0.0001) consumption, with no difference in strength of association. For both classifications, macronutrient and energy intakes conformed closely to the predictions of protein leverage. We account for the similarities and differences in performance of the two systems in an analysis of Australian foods.

Young adults are frequent consumers of food prepared outside the home (FOH). In a cross-sectional survey, the MYMeals study, we showed FOH provided one-third of meals and snacks for young Australian adults, yet it contributed higher proportions of energy and nutrients of concern, such as saturated fat and sodium. This study aimed to determine the detailed proportional contribution of nutrients of concern from the nine food outlet types captured in the MYMeals study. Young adults residing in New South Wales (NSW), Australia, ( n = 1001) used a validated smartphone app to report all types and amounts of food and beverages consumed for three consecutive days, as well as their preparation location. The proportions of daily energy, macronutrients, sodium, total sugars, and saturated fat were calculated for each of the nine following outlet types: bakeries or patisseries, coffee chains, cold-drink chains, fast-food chains, ice creamery or frozen yoghurt outlets, independent cafes or restaurants, pubs (hotels) and clubs, service stations or convenience stores, and others not fitting the above categories. Of all FOH outlet types, independent cafes or restaurants contributed the most energy (17.5%), sodium (20.0%) and saturated fat (17.8%) to the total diet, followed by fast-food chains (12.0% energy, 15.8% sodium, and 12.0% saturated fat) and other outlets, with smaller proportions. For males, the proportion of energy and nutrients contributed by fast-food outlets was higher than for females (14.8% versus 9.8% energy). Menu labelling at independent cafes and restaurants is recommended, comprising, in addition to the energy labels already in use in fast-food restaurants, the labelling of nutrients of concern. The feasibility of this recommendation warrants further exploration.