Ultraprocessed food and chronic noncommunicable diseases: A systematic review and meta-analysis of 43 observational studies

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2021 Mar;22(3):e13146.

doi: 10.1111/obr.13146.

Epub 2020 Nov 9.

Melissa M Lane   1 ,

Jessica A Davis   1 ,

Sally Beattie   2 ,

Clara Gomez-Donoso   3   4 ,

Amy Loughman   1 ,

Adrienne O'Neil   1 ,

Felice Jacka   1   5   6   7 ,

Michael Berk   1   8 ,

Richard Page   1   2   9 ,

Wolfgang Marx   1 ,

Tetyana Rocks   1

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Affiliations

1 The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food and Mood Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia.

2 The Barwon Centre of Orthopaedic Research and Education (B-CORE), Barwon Health and St John of God Hospital Geelong, Geelong, Victoria, Australia.

3 Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain.

4 CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain.

5 Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.

6 Black Dog Institute, Randwick, New South Wales, Australia.

7 College of Public Health, Medical & Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.

8 Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia.

9 School of Medicine, Deakin University, Geelong, Victoria, Australia.

PMID: 33167080

DOI: 10.1111/obr.13146

Melissa M Lane  et al.

Obes Rev .

2021 Mar .

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2021 Mar;22(3):e13146.

doi: 10.1111/obr.13146.

Epub 2020 Nov 9.

Authors

Melissa M Lane   1 ,

Jessica A Davis   1 ,

Sally Beattie   2 ,

Clara Gomez-Donoso   3   4 ,

Amy Loughman   1 ,

Adrienne O'Neil   1 ,

Felice Jacka   1   5   6   7 ,

Michael Berk   1   8 ,

Richard Page   1   2   9 ,

Wolfgang Marx   1 ,

Tetyana Rocks   1

Affiliations

1 The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food and Mood Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia.

2 The Barwon Centre of Orthopaedic Research and Education (B-CORE), Barwon Health and St John of God Hospital Geelong, Geelong, Victoria, Australia.

3 Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain.

4 CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain.

5 Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.

6 Black Dog Institute, Randwick, New South Wales, Australia.

7 College of Public Health, Medical & Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.

8 Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia.

9 School of Medicine, Deakin University, Geelong, Victoria, Australia.

PMID: 33167080

DOI: 10.1111/obr.13146

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Abstract

This systematic review and meta-analysis investigated the association between consumption of ultraprocessed food and noncommunicable disease risk, morbidity and mortality. Forty-three observational studies were included (N = 891,723): 21 cross-sectional, 19 prospective, two case-control and one conducted both a prospective and cross-sectional analysis. Meta-analysis demonstrated consumption of ultraprocessed food was associated with increased risk of overweight (odds ratio: 1.36; 95% confidence interval [CI], 1.23-1.51; P < 0.001), obesity (odds ratio: 1.51; 95% CI, 1.34-1.70; P < 0.001), abdominal obesity (odds ratio: 1.49; 95% CI, 1.34-1.66; P < 0.0001), all-cause mortality (hazard ratio: 1.28; 95% CI, 1.11-1.48; P = 0.001), metabolic syndrome (odds ratio: 1.81; 95% CI, 1.12-2.93; P = 0.015) and depression in adults (hazard ratio: 1.22; 95% CI, 1.16-1.28, P < 0.001) as well as wheezing (odds ratio: 1.40; 95% CI, 1.27-1.55; P < 0.001) but not asthma in adolescents (odds ratio: 1.20; 95% CI, 0.99-1.46; P = 0.065). In addition, consumption of ultraprocessed food was associated with cardiometabolic diseases, frailty, irritable bowel syndrome, functional dyspepsia and cancer (breast and overall) in adults while also being associated with metabolic syndrome in adolescents and dyslipidaemia in children. Although links between ultraprocessed food consumption and some intermediate risk factors in adults were also highlighted, further studies are required to more clearly define associations in children and adolescents. STUDY REGISTRATION: Prospero ID: CRD42020176752.

Keywords: NOVA; meta-analysis; noncommunicable disease; ultraprocessed food.

© 2020 World Obesity Federation.

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References

REFERENCES

Monteiro CA, Cannon G, Lawrence M, Costa Louzada ML, Pereira Machado P. Ultra-Processed Foods, Diet Quality, and Health Using the NOVA Classification System. Rome: FAO; 2019.

Monteiro CA, Cannon G, Moubarac J-C, Levy RB, Louzada MLC, Jaime PC. The UN decade of nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutr. 2018;21(1):5-17. https://doi.org/10.1017/S1368980017000234

Monteiro CA, Levy RB, Claro RM, Castro IRR, Cannon G. A new classification of foods based on the extent and purpose of their processing. Cad Saude Publica. 2010;26(11):2039-2049.

Aguayo-Patron SV, Calderon de la Barca AM. Old fashioned vs. ultra-processed-based current diets: possible implication in the increased susceptibility to type 1 diabetes and celiac disease in childhood. Foods (Basel, Switzerland). 2017;6(11):100-116. https://doi.org/10.3390/foods6110100

Zinocker MK, Lindseth IA. The Western diet-microbiome-host interaction and its role in metabolic disease. Nutrients. 2018;10(3):365-379. https://doi.org/10.3390/nu10030365 [published Online First: 2018/03/23]

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Search in PubMed. Search in NLM Catalog. Add to Search. . 2021 Mar;22(3):e13146. doi: 10.1111/obr.13146. Epub 2020 Nov 9. Melissa M Lane   1 , Jessica A Davis   1 , Sally Beattie   2 , Clara Gomez-Donoso   3   4 , Amy Loughman   1 , Adrienne O'Neil   1 , Felice Jacka   1   5   6   7 , Michael Berk   1   8 , Richard Page   1   2   9 , Wolfgang Marx   1 , Tetyana Rocks   1. Expand. Affiliations. 1 The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food and Mood Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia. 2 The Barwon Centre of Orthopaedic Research and Education (B-CORE), Barwon Health and St John of God Hospital Geelong, Geelong, Victoria, Australia. 3 Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain. 4 CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain. 5 Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia. 6 Black Dog Institute, Randwick, New South Wales, Australia. 7 College of Public Health, Medical & Veterinary Sciences, James Cook University, Townsville, Queensland, Australia. 8 Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia. 9 School of Medicine, Deakin University, Geelong, Victoria, Australia. PMID: 33167080. DOI: 10.1111/obr.13146. Melissa M Lane  et al. Obes Rev . 2021 Mar . Show details. Display options. Format. Search in PubMed. Search in NLM Catalog. Add to Search. . 2021 Mar;22(3):e13146. doi: 10.1111/obr.13146. Epub 2020 Nov 9. Authors. Melissa M Lane   1 , Jessica A Davis   1 , Sally Beattie   2 , Clara Gomez-Donoso   3   4 , Amy Loughman   1 , Adrienne O'Neil   1 , Felice Jacka   1   5   6   7 , Michael Berk   1   8 , Richard Page   1   2   9 , Wolfgang Marx   1 , Tetyana Rocks   1. Affiliations. 1 The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food and Mood Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia. 2 The Barwon Centre of Orthopaedic Research and Education (B-CORE), Barwon Health and St John of God Hospital Geelong, Geelong, Victoria, Australia. 3 Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain. 4 CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain. 5 Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia. 6 Black Dog Institute, Randwick, New South Wales, Australia. 7 College of Public Health, Medical & Veterinary Sciences, James Cook University, Townsville, Queensland, Australia. 8 Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia. 9 School of Medicine, Deakin University, Geelong, Victoria, Australia. PMID: 33167080. DOI: 10.1111/obr.13146. Cite. Display options. Format. Abstract. This systematic review and meta-analysis investigated the association between consumption of ultraprocessed food and noncommunicable disease risk, morbidity and mortality. Forty-three observational studies were included (N = 891,723): 21 cross-sectional, 19 prospective, two case-control and one conducted both a prospective and cross-sectional analysis. Meta-analysis demonstrated consumption of ultraprocessed food was associated with increased risk of overweight (odds ratio: 1.36; 95% confidence interval [CI], 1.23-1.51; P < 0.001), obesity (odds ratio: 1.51; 95% CI, 1.34-1.70; P < 0.001), abdominal obesity (odds ratio: 1.49; 95% CI, 1.34-1.66; P < 0.0001), all-cause mortality (hazard ratio: 1.28; 95% CI, 1.11-1.48; P = 0.001), metabolic syndrome (odds ratio: 1.81; 95% CI, 1.12-2.93; P = 0.015) and depression in adults (hazard ratio: 1.22; 95% CI, 1.16-1.28, P < 0.001) as well as wheezing (odds ratio: 1.40; 95% CI, 1.27-1.55; P < 0.001) but not asthma in adolescents (odds ratio: 1.20; 95% CI, 0.99-1.46; P = 0.065). In addition, consumption of ultraprocessed food was associated with cardiometabolic diseases, frailty, irritable bowel syndrome, functional dyspepsia and cancer (breast and overall) in adults while also being associated with metabolic syndrome in adolescents and dyslipidaemia in children. Although links between ultraprocessed food consumption and some intermediate risk factors in adults were also highlighted, further studies are required to more clearly define associations in children and adolescents. STUDY REGISTRATION: Prospero ID: CRD42020176752. Keywords: NOVA; meta-analysis; noncommunicable disease; ultraprocessed food. © 2020 World Obesity Federation. Similar articles. Association Between Ultraprocessed Food Consumption and Risk of Mortality Among Middle-aged Adults in France. Schnabel L, Kesse-Guyot E, Alles B, Touvier M, Srour B, Hercberg S, Buscail C, Julia C. Schnabel L, et al. JAMA Intern Med. 2019 Apr 1;179(4):490-498. doi: 10.1001/jamainternmed.2018.7289. JAMA Intern Med. 2019. PMID: 30742202 Free PMC article. Ultraprocessed Food Consumption is Strongly and Dose-Dependently Associated with Excess Body Weight in Swiss Women. Pestoni G, Habib L, Reber E, Rohrmann S, Staub K, Stanga Z, Faeh D. Pestoni G, et al. Obesity (Silver Spring). 2021 Mar;29(3):601-609. doi: 10.1002/oby.23091. Obesity (Silver Spring). 2021. PMID: 33624439. Ultraprocessed food consumption and dietary nutrient profiles associated with obesity: A multicountry study of children and adolescents. Neri D, Steele EM, Khandpur N, Cediel G, Zapata ME, Rauber F, Marron-Ponce JA, Machado P, da Costa Louzada ML, Andrade GC, Batis C, Babio N, Salas-Salvado J, Millett C, Monteiro CA, Levy RB; NOVA Multi-Country Study Group on Ultra-Processed Foods, Diet Quality and Human Health. Neri D, et al. Obes Rev. 2022 Jan;23 Suppl 1:e13387. doi: 10.1111/obr.13387. Epub 2021 Dec 9. Obes Rev. 2022. PMID: 34889015. Consumption of ultra-processed foods and health outcomes: a systematic review of epidemiological studies. Chen X, Zhang Z, Yang H, Qiu P, Wang H, Wang F, Zhao Q, Fang J, Nie J. Chen X, et al. Nutr J. 2020 Aug 20;19(1):86. doi: 10.1186/s12937-020-00604-1. Nutr J. 2020. PMID: 32819372 Free PMC article. Review. Behavioral and Pharmacotherapy Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults: An Updated Systematic Review for the U.S. Preventive Services Task Force [Internet]. LeBlanc EL, Patnode CD, Webber EM, Redmond N, Rushkin M, O’Connor EA. LeBlanc EL, et al. Rockville (MD): Agency for Healthcare Research and Quality (US); 2018 Sep. Report No.: 18-05239-EF-1. Rockville (MD): Agency for Healthcare Research and Quality (US); 2018 Sep. Report No.: 18-05239-EF-1. PMID: 30354042 Free Books & Documents. Review. See all similar articles. Cited by. Ultra-Processed Food Intakes Are Associated with Depression in the General Population: The Korea National Health and Nutrition Examination Survey. Lee S, Choi M. Lee S, et al. Nutrients. 2023 May 1;15(9):2169. doi: 10.3390/nu15092169. Nutrients. 2023. PMID: 37432323 Free PMC article. Efficacy of front-of-pack warning label system versus guideline for daily amount on healthfulness perception, purchase intention and objective understanding of nutrient content of food products in Guatemala: a cross-over cluster randomized controlled experiment. Kroker-Lobos MF, Morales-Juarez A, Perez W, Kanda T, Gomes FS, Ramirez-Zea M, Siu-Bermudez C. Kroker-Lobos MF, et al. Arch Public Health. 2023 Jun 16;81(1):108. doi: 10.1186/s13690-023-01124-0. Arch Public Health. 2023. PMID: 37328782 Free PMC article. Position statement on nutrition therapy for overweight and obesity: nutrition department of the Brazilian association for the study of obesity and metabolic syndrome (ABESO-2022). Pepe RB, Lottenberg AM, Fujiwara CTH, Beyruti M, Cintra DE, Machado RM, Rodrigues A, Jensen NSO, Caldas APS, Fernandes AE, Rossoni C, Mattos F, Motarelli JHF, Bressan J, Saldanha J, Beda LMM, Lavrador MSF, Del Bosco M, Cruz P, Correia PE, Maximino P, Pereira S, Faria SL, Piovacari SMF. Pepe RB, et al. Diabetol Metab Syndr. 2023 Jun 9;15(1):124. doi: 10.1186/s13098-023-01037-6. Diabetol Metab Syndr. 2023. PMID: 37296485 Free PMC article. Review. Ultra-Processed Food Intake Is Associated with Non-Alcoholic Fatty Liver Disease in Adults: A Systematic Review and Meta-Analysis. Henney AE, Gillespie CS, Alam U, Hydes TJ, Cuthbertson DJ. Henney AE, et al. Nutrients. 2023 May 10;15(10):2266. doi: 10.3390/nu15102266. Nutrients. 2023. PMID: 37242149 Free PMC article. Review. Ultra-Processed Food, Reward System and Childhood Obesity. Calcaterra V, Cena H, Rossi V, Santero S, Bianchi A, Zuccotti G. Calcaterra V, et al. Children (Basel). 2023 Apr 29;10(5):804. doi: 10.3390/children10050804. Children (Basel). 2023. PMID: 37238352 Free PMC article. Review. See all "Cited by" articles. References. REFERENCES. Monteiro CA, Cannon G, Lawrence M, Costa Louzada ML, Pereira Machado P. Ultra-Processed Foods, Diet Quality, and Health Using the NOVA Classification System. Rome: FAO; 2019. Monteiro CA, Cannon G, Moubarac J-C, Levy RB, Louzada MLC, Jaime PC. The UN decade of nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutr. 2018;21(1):5-17. https://doi.org/10.1017/S1368980017000234. Monteiro CA, Levy RB, Claro RM, Castro IRR, Cannon G. A new classification of foods based on the extent and purpose of their processing. Cad Saude Publica. 2010;26(11):2039-2049. Aguayo-Patron SV, Calderon de la Barca AM. Old fashioned vs. ultra-processed-based current diets: possible implication in the increased susceptibility to type 1 diabetes and celiac disease in childhood. Foods (Basel, Switzerland). 2017;6(11):100-116. https://doi.org/10.3390/foods6110100. Zinocker MK, Lindseth IA. The Western diet-microbiome-host interaction and its role in metabolic disease. Nutrients. 2018;10(3):365-379. https://doi.org/10.3390/nu10030365 [published Online First: 2018/03/23] Publication types. Meta-Analysis Actions Search in PubMed Search in MeSH Add to Search. Research Support, Non-U.S. Gov't Actions Search in PubMed Search in MeSH Add to Search. Review Actions Search in PubMed Search in MeSH Add to Search. Systematic Review Actions Search in PubMed Search in MeSH Add to Search. MeSH terms. Adolescent Actions Search in PubMed Search in MeSH Add to Search. Adult Actions Search in PubMed Search in MeSH Add to Search. Child Actions Search in PubMed Search in MeSH Add to Search. Cross-Sectional Studies Actions Search in PubMed Search in MeSH Add to Search. Food / adverse effects* Actions Search in PubMed Search in MeSH Add to Search. Food Handling* Actions Search in PubMed Search in MeSH Add to Search. Humans Actions Search in PubMed Search in MeSH Add to Search. Noncommunicable Diseases* / epidemiology Actions Search in PubMed Search in MeSH Add to Search. Observational Studies as Topic Actions Search in PubMed Search in MeSH Add to Search. Prospective Studies Actions Search in PubMed Search in MeSH Add to Search. Related information. Cited in Books. MedGen. LinkOut - more resources. Full Text Sources Ovid Technologies, Inc. Wiley.