Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses
Lane MM, Gamage E, Du S, Ashtree DN, McGuinness AJ, Gauci S, Baker P, Lawrence M, Rebholz CM, Srour B, Touvier M, Jacka FN, O'Neil A, Segasby T, Marx W
BMJ (Clinical research ed.) · 677 citas
Cómo se estudió
- Diseño
- Revisión sistemática (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Eventos clínicos como enfermedad o muerte
- Consumo medido con
- No se indica
Quién lo pagó
- Financiación
- Financiación independiente
- Organización sin fines de lucro
- Bloomberg Philanthropies
- Organización sin fines de lucro
- Multiple Sclerosis Australia
- Universidad u hospital
- Deakin University
- Universidad u hospital
- Monash University
- Universidad u hospital
- Dasman Diabetes Institute
- Organización sin fines de lucro
- Barwon Health Foundation
- Sin clasificar
- MTPConnect
- Gobierno
- Medical Research Council
- Gobierno
- National Health and Medical Research Council
- Subvenciones
- National Health and Medical Research Council (2008971); National Health and Medical Research Council (2009295)
Según 9 financiadores declarados.
Publicación
- Publicado
- 2024-02-28 · BMJ · vol. 384 · pág. e077310
- Citado
- 850 citas · más que el 100% de estudios similares · 325.3× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 104 trabajos
- Acceso
- Acceso abierto (revista híbrida) · CC-BY-NC
- Áreas de investigación
- Consumer Attitudes and Food Labeling · Biochemical Analysis and Sensing Techniques · Effects and risks of endocrine disrupting chemicals
- Palabras clave
- Medicine, MEDLINE, Confidence interval, Systematic review, Meta-analysis, Cochrane Library, Cohort study, PsycINFO, Relative risk, Environmental health, Internal medicine
- MeSH
- humans, cardiovascular diseases, meta-analysis as topic, food, processed
15 autores
- Melissa M. Lane🇦🇺 · autor de correspondenciaBarwon Health; Deakin University
- Elizabeth Gamage🇦🇺Barwon Health; Deakin University
- Shutong Du🇺🇸Johns Hopkins University
- Deborah N Ashtree🇦🇺Barwon Health; Deakin University
- Amelia J. McGuinness🇦🇺Barwon Health; Deakin University
- Sarah Gauci🇦🇺Barwon Health; Deakin University; Monash University
- Phillip Baker🇦🇺The University of Sydney
- Mark Andrew Lawrence🇦🇺Deakin University
- Casey M. Rebholz🇺🇸Johns Hopkins University
- Bernard Srour🇫🇷Conservatoire National des Arts et Métiers; Inserm; Université Paris Cité; Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement; Université Sorbonne Paris Nord; Centre de Recherche Épidémiologie et Statistique
- Mathilde Touvier🇫🇷Conservatoire National des Arts et Métiers; Inserm; Université Paris Cité; Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement; Université Sorbonne Paris Nord; Centre de Recherche Épidémiologie et Statistique
- Felice Nellie Jacka🇦🇺Barwon Health; Deakin University; Murdoch Children's Research Institute; James Cook University
- Adrienne E O'Neil🇦🇺Barwon Health; Deakin University
- Toby Segasby🇮🇪Dublin City University
- Wolfgang Marx🇦🇺Barwon Health; Deakin University
Resumen
El texto original del estudio, en el idioma en que se publicó.
Objective
To evaluate the existing meta-analytic evidence of associations between exposure to ultra-processed foods, as defined by the Nova food classification system, and adverse health outcomes.
Design
Systematic umbrella review of existing meta-analyses.
Data sources
MEDLINE, PsycINFO, Embase, and the Cochrane Database of Systematic Reviews, as well as manual searches of reference lists from 2009 to June 2023.
Eligibility criteria for selecting studies
Systematic reviews and meta-analyses of cohort, case-control, and/or cross sectional study designs. To evaluate the credibility of evidence, pre-specified evidence classification criteria were applied, graded as convincing ("class I"), highly suggestive ("class II"), suggestive ("class III"), weak ("class IV"), or no evidence ("class V"). The quality of evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework, categorised as "high," "moderate," "low," or "very low" quality.
Results
The search identified 45 unique pooled analyses, including 13 dose-response associations and 32 non-dose-response associations (n=9 888 373). Overall, direct associations were found between exposure to ultra-processed foods and 32 (71%) health parameters spanning mortality, cancer, and mental, respiratory, cardiovascular, gastrointestinal, and metabolic health outcomes. Based on the pre-specified evidence classification criteria, convincing evidence (class I) supported direct associations between greater ultra-processed food exposure and higher risks of incident cardiovascular disease related mortality (risk ratio 1.50, 95% confidence interval 1.37 to 1.63; GRADE=very low) and type 2 diabetes (dose-response risk ratio 1.12, 1.11 to 1.13; moderate), as well as higher risks of prevalent anxiety outcomes (odds ratio 1.48, 1.37 to 1.59; low) and combined common mental disorder outcomes (odds ratio 1.53, 1.43 to 1.63; low). Highly suggestive (class II) evidence indicated that greater exposure to ultra-processed foods was directly associated with higher risks of incident all cause mortality (risk ratio 1.21, 1.15 to 1.27; low), heart disease related mortality (hazard ratio 1.66, 1.51 to 1.84; low), type 2 diabetes (odds ratio 1.40, 1.23 to 1.59; very low), and depressive outcomes (hazard ratio 1.22, 1.16 to 1.28; low), together with higher risks of prevalent adverse sleep related outcomes (odds ratio 1.41, 1.24 to 1.61; low), wheezing (risk ratio 1.40, 1.27 to 1.55; low), and obesity (odds ratio 1.55, 1.36 to 1.77; low). Of the remaining 34 pooled analyses, 21 were graded as suggestive or weak strength (class III-IV) and 13 were graded as no evidence (class V). Overall, using the GRADE framework, 22 pooled analyses were rated as low quality, with 19 rated as very low quality and four rated as moderate quality.
Conclusions
Greater exposure to ultra-processed food was associated with a higher risk of adverse health outcomes, especially cardiometabolic, common mental disorder, and mortality outcomes. These findings provide a rationale to develop and evaluate the effectiveness of using population based and public health measures to target and reduce dietary exposure to ultra-processed foods for improved human health. They also inform and provide support for urgent mechanistic research.
Systematic review registration
PROSPERO CRD42023412732.
Resumen vía Europe PMC. Los derechos de autor siguen siendo de los autores o la editorial (CC BY-NC).
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