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Study Says 61 Percent of Our Grocery Purchases Are Highly Processed Foods

Study Says 61 Percent of Our Grocery Purchases Are Highly Processed Foods


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A new study from the American Journal of Clinical Nutrition has linked American consumer habits with mostly processed foods

All of those trends in organic and locavore produce? We may just be fooling ourselves.

Although organic foods sales are on the rise, don’t fool yourself: We’re still loading up our shopping carts with chips and cookies. A new study from the American Journal of Clinical Nutrition has found that almost two-thirds — 61 percent — of American grocery purchases are highly processed foods. In addition, 77 percent of American grocery purchases consist of either moderately or highly processed foods. This means the average American consumes more than 1,000 calories of processed foods every day.

But don’t get too nervous and start cleaning out your pantry: The word processed, according to USDA standards, is defined as “a retail item derived from a covered commodity that has undergone specific processing resulting in a change in the character of the covered commodity.” By this definition, pasteurized dairy products, like milk, yogurt, and cheese, as well as frozen vegetables, are processed foods: not just your usual suspects like Oreos and Twinkies.

“Highly processed food purchases are a dominant, unshifting part of U.S. purchasing patterns yet may have higher saturated fat, sugar, and sodium content compared with less-processed foods,” the authors concluded. “Wide variation in nutrient content suggests food choices within categories may be important.”


Study Says 61 Percent of Our Grocery Purchases Are Highly Processed Foods - Recipes

To assess the prospective association between ultra-processed food consumption and all-cause mortality and to examine the effect of theoretical iso-caloric non-processed foods substitution.

Patients and Methods

A population-based cohort of 11,898 individuals (mean age 46.9 years, and 50.5% women) were selected from the ENRICA study, a representative sample of the noninstitutionalized Spanish population. Dietary information was collected by a validated computer-based dietary history and categorized according to their degree of processing using NOVA classification. Total mortality was obtained from the National Death Index. Follow-up lasted from baseline (2008-2010) to mortality date or December 31 th , 2016, whichever was first. The association between quartiles of consumption of ultra-processed food and mortality was analyzed by Cox models adjusted for the main confounders. Restricted cubic-splines were used to assess dose-response relationships when using iso-caloric substitutions.

Results

Average consumption of ultra-processed food was 385 g/d (24.4% of the total energy intake). After a mean follow-up of 7.7 years (93,599 person-years), 440 deaths occurred. The hazard ratio (and 95% CI) for mortality in the highest versus the lowest quartile of ultra-processed food consumption was 1.44 (95% CI, 1.01-2.07 P trend=.03) in percent of energy and 1.46 (95% CI, 1.04-2.05 P trend=.03) in grams per day per kilogram. Isocaloric substitution of ultra-processed food with unprocessed or minimally processed foods was associated with a significant nonlinear decrease in mortality.

Conclusion

A higher consumption of ultra-processed food was associated with higher mortality in the general population. Furthermore, the theoretical iso-caloric substitution ultra-processed food by unprocessed or minimally processed foods would suppose a reduction of the mortality risk. If confirmed, these findings support the necessity of the development of new nutritional policies and guides at the national and international level.


6 Ultra-Processed Foods to Throw Out Right Now

Plus healthier versions you can buy&mdashor make at home&mdashinstead.

An alarming study published in the journal BMJ Open revealed that 60% of calories in the average American&aposs daily diet come from "ultra-processed" foods, which are pretty much exactly what they sound like: processed foods that contain additives—like hydrogenated oils, artificial flavors, and emulsifiers—with long names you don&apost recognize.

The researchers also found that these ultra-processed foods account for 90% of the added sugar we consume, increasing our risk for obesity, type 2 diabetes, and heart disease. Yikes. In an interview with HealthDay News, lead study author਎uridice Martinez Steele stressed the importance of cleaning up our diets. "There is one relatively simple way to avoid excessive added sugar—not replacing real food with ultra-processed food and drink products," she said.

Luckily, creating homemade versions of your favorite treats is easier than you might think.ਊnd you don&apost need to swear off conveniently-packaged snacks altogether, says Health&aposs contributing nutrition editor Cynthia Sass, MPH, RD. You just need to read the labels carefully: "My take is, if the ingredient list looks like a recipe you could have made in your own kitchen, you&aposre on the right track."

Here, Sass points out the six worst ultra-processed foods in your pantry right now,ਊnd healthier versions you can਋uy—or make at home—instead.

Chips

The most notorious offenders, says Sass, are brands that contain artificial flavors, colors, and preservatives. (That means anything neon-orange is out.) Your best bet is a basic kettle chip with just three simple ingredients: potatoes, olive or sunflower oil, and salt. Other good options include organic blue corn chips and popcorn, which is low in calories, high in fiber, and packed with antioxidants. Or better yet, go the DIY route.ꂺked kale chips are easy to make, as are oven-roasted sweet potato chips. Follow the the step-by-step instructions in the video below.

Packaged snack cakes

Those plastic-wrapped cakes that seem to last for months years in your pantry are packed with sugar and preservatives (hence their longevity). Whipping up your own sweet treats is a better option, says Sass. You can use a nutrient-rich alternative to white flour, such as chickpea or almond flour, and also cut back on sugar and butter with healthier substitutions. Sass recommends replacing half of the sugar in the recipe with pureed fruit (mashed bananas and date paste both work well) and swapping each tablespoon of butter with a half tablespoon of avocado.

Craving a sweet fix, stat? "I love to take fresh fruit�rries, slices of pears, whatever is in season𠅊nd warm them in a skillet with a little lemon water," Sass says. "Then I&aposll make homemade crumble with almond butter, oats, and cinnamon and sprinkle it on top of the fruit."

Certain breads

You already know to avoid ultra-processed white bread in favor of fiber-rich whole grain breads that offer a slew of good-for-you perks. But picking the right loaf can be tricky because even healthy-seeming varieties can contain additives: "Bread is one of those foods where reading the ingredient list is really very important," Sass explains. In general, she recommends looking for a whole grain or gluten-free, or even grain-free bread that doesn&apost have any artificial additives or preservatives. When in doubt, check the frozen foods section, Sass says. It makes sense: Some of the healthiest breads "need to be frozen because they don&apost contain any preservatives," she explains.

Diet soda

Yes, you&aposve heard it before. But seriously, it&aposs time to ditch your diet soda stash once and for all. Besides the fact that diet soda has zero nutritional value, it contains artificial sweeteners like aspartame, saccharin, and sucralose, and has been linked to headaches, depression, and an increased risk of type 2 diabetes. If you can&apost get used to plain old H2O, opt for sparkling or flavored water. "Just be sure to choose one that contains only carbonated water and natural flavors," says Sass.

Frozen pizza

Sadly, there doesn&apost seem to be a minimally-processed version of pre-made pizza. The best alternative, says Sass, is making your own dough. She bakes a light, flaky crust from chopped up cauliflower that pleases even diehard pizza fans, and loads it up with veggies and fresh greens.

Candy

First, the bad news on candy: Most of the movie theater brands you know and love contain high fructose corn syrup and artificial flavors. But the good news, is there are better options out there. "Seventy percent dark chocolate is a great alternative to candy," Sass says, noting that it&aposs a good source of magnesiumਊnd antioxidants, which can help lower blood pressure and cholesterol. For a bite-sized treat, she likes Dagoba Organic Chocolate Chocodrops ($8ਊmazon.com). "Some of my clients keep a bag in the freezer and grab a small handful of the frozen chips when they&aposre craving something sweet," she says. And if you prefer gummy candies, Sass recommends a German brand called Seitenbacher Gummi Fruit ($20 for a dozen 3-oz. bagsਊmazon.com). "Their sweetness comes from real fruit juices, such as apple and beetroot," she says.

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20 Healthy Processed Foods You Should Be Eating, According to Dietitians

Processed foods often get a bad rap as many of them are filled with sugar, sodium, and fat&mdashbut not all packaged noshes are created equal. While fresh, wholesome foods are always preferable, there are plenty of processed foods that are totally healthy, and you're missing out on their health-boosting nutrients and convenience if you decide to nix them from your diet.

The key is to read the nutrition and the ingredients labels carefully and look out for red flags, like added sugar, MSG, and unhealthy oils. Ideally, you want to eat packaged foods with minimal ingredients. For example, some store-bought breads have a generous amount of salt&mdashmore than you'd expect in a slice&mdashand if you enjoy more than one, the sodium can quickly add up. That said, you can be smart about choosing the processed foods you buy. From bean pasta to sauces to veggie burgers, here are the convenience foods dietitians always keep stocked in their kitchen.

It's a common misconception that prepping healthy meals means shopping only around the perimeter of the grocery store. But if you do that, you're missing out on many nutritious choices in the inner aisles, including the freezer section, where you'll find many high-fiber breads and frozen veggies and fruits.

&ldquoFrozen wild blueberries give us year-round access to these brain-protecting berries. They&rsquore picked at peak ripeness and their nutrient content is preserved better than fresh,&rdquo says Maggie Moon, MS, RD, author, The MIND Diet. &ldquoMost of the brain health research on blueberries has been conducted on wild blueberries, which are concentrated flavorful bursts of antioxidants,&rdquo she adds, so don&rsquot be afraid to dig into this packaged fruit. You may find that some frozen fruits are also cheaper than their fresh counterparts.

You won't find a bag of chia seeds in your produce aisle, but that doesn't mean it's any less deserving of a spot in your cart.

&ldquoChia seeds are high in plant-based omega-3 fatty acids and calcium, two important nutrients people don&rsquot get enough of. An ounce is also rich in fiber (11 grams)," says Moon. A 2019 study from the journal Lancet confirmed that eating 25 to 29 grams of fiber daily can help you live longer. You can add these to smoothies, yogurt or oatmeal bowls, or you can even make an overnight breakfast chia seed pudding.

Canned beans are often loaded with salt to help preserve them, but you can offset this by rinsing the beans under water before adding them to your dish. Moon says doing this cuts sodium by 40 percent.

&ldquoFor those nights when you just don&rsquot have it in you, canned beans are a lifesaver and a staple in my pantry. Chickpeas are one of my favorite plant proteins, and work especially well in Mediterranean- and Middle Eastern-inspired meals,&rdquo says Moon. They&rsquore a plant-based protein that doubles as an excellent source of fiber, too.

People are adding matcha to their smoothies, cookies, and overnight oats, and for a good reason. Matcha is a powdered tea that derives from finely grinding whole green tea leaves, which means you're taking in the benefits from the entire leaf. You can find matcha powder in the tea and coffee aisle of your grocery store, and some health food stores might also carry it.

&ldquoAll green tea has benefits for focus and memory, but matcha green tea powder leads to a greater concentration of the beneficial compounds in green tea," Moon says. A review of 49 human trials from the journal of Current Pharmaceutical Design suggests that phytochemicals like L-theanine and caffeine found in matcha improve mood, cognitive performance, and sharpness.

OK, so bean pasta might not be considered a whole food to some, but next to sliced whole-grain bread, it's one of the most nutritious packaged foods you can get. Bean pastas are higher in protein and fiber than traditional white noodles and even whole-grain varieties. Plus, they're gluten-free.

Moon's go-to is Banza's chickpea pasta, but there are other brands out there, like Explore Cuisine, Barilla, and Ancient Harvest, that feature beans and whole grains. &ldquoBanza chickpea pasta has a good texture and mouthfeel, making it a no-sacrifice swap for refined-grain pasta. Nutritionally, it has about twice the plant protein (25 grams) and more than four times the fiber (13 grams) of standard pasta,&rdquo says Moon.


Processed Foods and Health

Processed foods are generally thought to be inferior to unprocessed foods. They may bring to mind a packaged food item containing many ingredients, perhaps even artificial colors, flavors, or other chemical additives. Often referred to as convenience or pre-prepared foods, processed foods are suggested to be a contributor to the obesity epidemic and rising prevalence of chronic diseases like heart disease and diabetes. However, the definition of a processed food varies widely depending on the source:

  • The U.S. Department of Agriculture (USDA) defines a processed food as one that has undergone any changes to its natural state—that is, any raw agricultural commodity subjected to washing, cleaning, milling, cutting, chopping, heating, pasteurizing, blanching, cooking, canning, freezing, drying, dehydrating, mixing, packaging, or other procedures that alter the food from its natural state. The food may include the addition of other ingredients such as preservatives, flavors, nutrients and other food additives or substances approved for use in food products, such as salt, sugars, and fats.
  • The Institute of Food Technologists includes additional processing terms like storing, filtering, fermenting, extracting, concentrating, microwaving, and packaging. [1]

According to these standards, virtually all foods sold in the supermarket would be classified as “processed” to some degree. Because food begins to deteriorate and lose nutrients as soon as it is harvested, even the apples in the produce aisle undergo four or more processing steps before being sold to the consumer. That’s why in practice, it’s helpful to differentiate between the various degrees of food processing.

Types of food processing

A popular system to classify processed foods was introduced in 2009, called the NOVA classification. It lists four categories detailing the degree to which a food is processed: [2,3]

Unprocessed or minimally processed foods

Processed culinary ingredients

Processed foods

Ultra-processed foods

The NOVA system is recognized by the World Health Organization, Food and Agriculture Organization, and the Pan American Health Organization, but not currently in the U.S. by the Food and Drug Administration or USDA. NOVA has been criticized for being too general in its classification of certain foods, causing confusion. For example, yogurt may fall into more than one category: plain yogurt is minimally processed, but fruited yogurt with added sweeteners could be labeled either processed or ultra-processed depending on how much sweetener and other chemical additives are incorporated. NOVA also does not provide comprehensive lists of specific foods in each category, so the consumer is left to guess where each may fall.

Is processed food unhealthy?

There’s no doubt that at least some processed foods are found in most people’s kitchens. They can be time-savers when preparing meals, and some processed and fortified foods provide important nutrients that may not otherwise be obtained in a busy household or one that has a limited food budget. From a nutritional standpoint, processed and even ultra-processed foods can provide key nutrients. Some nutrients like protein are naturally retained throughout processing, and others like B vitamins and iron may be added back if they are lost during processing. Fruits and vegetables that are quickly frozen after harvesting can retain the majority of vitamin C.

Throughout history, foods fortified with specific nutrients have prevented deficiencies and their related health problems in certain populations. Examples include infant cereals fortified with iron and B vitamins to prevent anemia, milk fortified with vitamin D to prevent rickets, wheat flour fortified with folic acid to prevent birth defects, and iodine added to salt to prevent goiter.

Processing by certain methods like pasteurization, cooking, and drying can destroy or inhibit the growth of harmful bacteria. Additives such as emulsifiers preserve the texture of foods, such as preventing peanut butter from separating into solid and liquid parts. Other functions of processing include delaying the spoilage of food preserving desirable sensory qualities of food (flavor, texture, aroma, appearance) and increasing convenience in preparing a complete meal.

But food processing also has drawbacks. Depending on the degree of processing, many nutrients can be destroyed or removed. Peeling outer layers of fruits, vegetables, and whole grains may remove plant nutrients (phytochemicals) and fiber. Heating or drying foods can destroy certain vitamins and minerals. Although food manufacturers can add back some of the nutrients lost, it is impossible to recreate the food in its original form.

If you are deciding whether or not to include a highly processed food in your diet, it may be useful to evaluate its nutritional content and long-term effect on health. An ultra-processed food that contains an unevenly high ratio of calories to nutrients may be considered unhealthy. For example, research supports an association between a high intake of sugar-sweetened beverages and an increased risk of obesity, diabetes, and heart disease. But some processed foods that contain beneficial nutrients, such as olive oil or rolled oats, have been linked with lower rates of these chronic diseases.

Decoding the ingredients list on a food label

  • The ingredients are listed in order of quantity by weight. This means that the food ingredient that weighs the most will be listed first, and the ingredient that weighs the least is listed last. [5]
  • Some ingredients like sugar and salt may be listed by other names. For example, alternative terms for sugar are corn syrup, high-fructose corn syrup, honey, agave nectar, cane sugar, evaporated cane juice, coconut sugar, dextrose, malt syrup, molasses, or turbinado sugar. Other terms for sodium include monosodium glutamate or disodium phosphate.
  • If the food is highly processed, it may contain several food additives such as artificial colors, flavors, or preservatives. Their ingredient names may be less familiar. Some preservatives promote safety of the food by preventing growth of mold and bacteria. Others help prevent spoilage or “off” flavors from developing. Examples that you may see on the label include:
    • Preservatives—ascorbic acid, sodium benzoate, potassium sorbate, tocopherols
    • Emulsifiers that prevent separation of liquids and solids—soy lecithin, monoglycerides
    • Thickeners to add texture—xanthan gum, pectin, carrageenan, guar gum
    • Colors—artificial FD&C Yellow No. 6 or natural beta-carotene to add yellow hues

    Ingredients used widely in the production of highly/ultra-processed foods such as saturated fats, added sugar, and sodium have become markers of poor diet quality due to their effect on heart disease, obesity, and high blood pressure. [6,7] It is estimated that ultra-processed foods contribute about 90% of the total calories obtained from added sugars. [4]

    • In 2015, the World Health Organization categorized processed meats as cancer-causing to humans. They defined “processed meat” as meat that has been transformed through salting, curing, fermentation, smoking, or other processes to enhance flavor or improve preservation. The statement was made after 22 scientists from the International Agency for Research on Cancer Working Group evaluated more than 800 studies on the topic. The evidence on processed meats was strongest for colorectal cancer, followed by stomach cancer. [8]
    • An analysis of the Nurses’ Health Study and Health Professionals Follow-up Study found that a higher intake of ultra-processed foods like processed meats and potato chips was associated with weight gain over 4 years. [9] Other studies suggest that the more that ultra-processed foods are eaten, the greater the risk of a diet lacking in important nutrients. An evaluation of the dietary intakes of 9,317 U.S. participants in an NHANES cohort found that higher intakes of ultra-processed foods were linked with greater consumption of refined carbohydrate, added sugars, and saturated fat. At the same time, intakes of fiber, zinc, potassium, phosphorus, magnesium, calcium, and vitamins A, C, D, and E decreased. [10]
    • Another observational study among nearly 20,000 Spanish university graduates in the Seguimiento University of Navarra cohort found that higher consumption (more than 4 servings per day) of ultra-processed food was associated with a 62% increased risk of death from any cause compared with lower consumption (less than 2 servings per day). For each additional daily serving of ultra-processed food, there was an 18% increased risk of death. Based on their findings, the researchers noted the importance of policies that limit the proportion of ultra-processed foods in the diet and promote consumption of unprocessed or minimally processed foods to improve global public health. [11] Other cohort studies in France (NutriNet Santé) and the U.S. (NHANES) have also found that consumption of ultra-processed foods was directly associated with high all-cause mortality. [12,13]
    • In 2019, a randomized controlled trial looked at whether ultra-processed foods, as defined under the NOVA classification, might indeed cause people to eat more. Ten men and ten women were randomized to receive either an ultra-processed diet or unprocessed diet for 14 days, followed by 14 more days of the alternate diet. The diets were relatively equal in calories, sugar, fat, fiber, and other nutrients, and participants were allowed to eat as much or as little as they liked. The study found that participants ate about 500 calories more on the ultra-processed diet and also gained weight (about 2 pounds). [14] Most of the extra calories came from carbohydrate and fats, and the diet also increased their sodium intake. When the participants changed to the unprocessed diet, they ate fewer calories and lost the weight. According to appetite surveys, the diets did not differ in levels of hunger, fullness, and satisfaction, though participants tended to eat faster on the ultra-processed diet.

    The bottom line

    Food processing is a spectrum that ranges from basic technologies like freezing or milling, to the incorporation of additives that promote shelf stability or increase palatability. As a general rule, emphasizing unprocessed or minimally processed foods in the daily diet is optimal. That said, the use of processed foods is the choice of the consumer, and there are pros and cons that come with each type. The Nutrition Facts Label and ingredients list can be useful tools in deciding when to include a processed food in the diet. There is evidence showing an association with certain types of food processing and poor health outcomes (especially highly- or ultra-processed foods). This association applies mainly to ultra-processed foods that contain added sugars, excess sodium, and unhealthful fats.

    1. Weaver CM, Dwyer J, Fulgoni III VL, King JC, Leveille GA, MacDonald RS, Ordovas J, Schnakenberg D. Processed foods: contributions to nutrition. The American journal of clinical nutrition. 2014 Apr 2399(6):1525-42.
    2. Monteiro CA. Nutrition and health. The issue is not food, nor nutrients, so much as processing. Public health nutrition. 2009 May12(5):729-31.
    3. Monteiro CA, Cannon G, Moubarac JC, Levy RB, Louzada ML, Jaime PC. The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutrition. 2018 Jan21(1):5-17.
    4. Steele EM, Baraldi LG, da Costa Louzada ML, Moubarac JC, Mozaffarian D, Monteiro CA. Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study. BMJ open. 2016 Jan 16(3):e009892.
    5. U.S. Food and Drug Administration. Food Labeling Guide: Guidance for Industry. January 2013.
    6. Tapsell LC, Neale EP, Satija A, Hu FB. Foods, nutrients, and dietary patterns: interconnections and implications for dietary guidelines. Advances in Nutrition. 2016 May 97(3):445-54.
    7. Poti JM, Braga B, Qin B. Ultra-processed Food Intake and Obesity: What Really Matters for Health—Processing or Nutrient Content?. Current obesity reports. 2017 Dec 16(4):420-31.
    8. Bouvard V, Loomis D, Guyton KZ, Grosse Y, El Ghissassi F, Benbrahim-Tallaa L, Guha N, Mattock H, Straif K. Carcinogenicity of consumption of red and processed meat. The Lancet Oncology. 2015 Dec 116(16):1599-600.
    9. Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. Changes in diet and lifestyle and long-term weight gain in women and men. New England Journal of Medicine. 2011 Jun 23364(25):2392-404.
    10. Steele EM, Popkin BM, Swinburn B, Monteiro CA. The share of ultra-processed foods and the overall nutritional quality of diets in the US: evidence from a nationally representative cross-sectional study. Population health metrics. 2017 Dec15(1):6.
    11. Rico-Campà A, Martínez-González MA, Alvarez-Alvarez I, de Deus Mendonça R, de la Fuente-Arrillaga C, Gómez-Donoso C, Bes-Rastrollo M. Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study. BMJ. 2019 May 29365:l1949.
    12. Schnabel L, Kesse-Guyot E, Allès B, Touvier M, Srour B, Hercberg S, Buscail C, Julia C. Association Between Ultraprocessed Food Consumption and Risk of Mortality Among Middle-aged Adults in France. JAMA internal medicine. 2019 Feb 11.
    13. Kim H, Hu EA, Rebholz CM. Ultra-processed food intake and mortality in the USA: results from the Third National Health and Nutrition Examination Survey (NHANES III, 1988–1994). Public health nutrition. 2019 Feb 21:1-9.
    14. Hall KD, Ayuketah A, Brychta R, Cai H, Cassimatis T, Chen KY, Chung ST, Costa E, Courville A, Darcey V, Fletcher LA. Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake. Cell metabolism. 2019 May 16.

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    Discussion

    The application of a new food classification based on the extent and purpose of food processing, to data on food purchases collected in metropolitan areas of Brazil during the last three decades, shows that consumption of unprocessed or minimally processed foods (Group 1) and of processed culinary ingredients (Group 2) has been and is being steadily replaced by consumption of ready-to-eat or ready-to-heat ultra-processed food products (Group 3). This occurred in both lower- and upper-income groups. In the most recent survey, conducted in 2002–3, Group 3 foods represented more than one-quarter of total energy purchased by metropolitan Brazilian households, and more than one-third of that purchased by the upper income quintile.

    The present study also shows that a hypothetical meal prepared only with usual Group 3 items, compared with a meal prepared only with usual Group 1 and Group 2 items, would have one-third more added sugar, nearly one-quarter more saturated fat and sodium, less than half of the fibre content and two-thirds higher energy density. The meal prepared with only Group 3 items far exceeds the upper limits recommended for added sugar intake, sodium intake and energy density, it is close to the upper limit for saturated fat intake, and it is clearly insufficient in fibre ( 2 , 3 ) . The meal prepared with only Group 1 and Group 2 items exceeds in a lower degree the upper limits for added sugar, sodium and energy density and it is adequate in terms of saturated fat and fibre intake ( 2 , 3 ) .

    Limitations

    The present study has limitations. It considers household food availability and not diets. It is useful inasmuch as it can reasonably be said to apply to diets. Two limitations are that wasted food and also food eaten outside the home are not taken into account.

    The fact that food quantities were derived from expenses and average costs in the first survey and assessed directly in the second and third surveys makes the identified time trends more reliable in the second period (1995–6 to 2002–3) than in the first period (1987–8 to 1995–6). In any case, the increase in the share of Group 3 foods was seen in the two periods.

    With the use of household food availability data, a source of error with respect to diets is that some types of food, such as vegetable oils (Group 2) discarded after deep frying, and any fresh and perishable food (Group 1), may be wasted more than others. The latter is likely to be more important. Many if not most foods consumed outside the home, such as soft drinks and sweet and also savoury snacks, are Group 3 products. Taking into account the reduction in total purchased energy per person per day seen across the three surveys, which is likely to indicate a corresponding increase in consumption outside the home, it is practically certain that the replacement of Group 1 and Group 2 foods by Group 3 food products in Brazil has been substantially higher than we have estimated.

    Comparisons

    Household-level studies from economically developing economies also indicate increasing consumption of selected Group 3 food products. In Mexico, consumption of sweetened soft drinks more than doubled among adolescents between 1999 and 2006, and tripled for adult women ( Reference Barquera, Hernandez-Barrera and Tolentino 15 ) . An increase of Group 3 food products has also been reported in Santiago, Chile between 1988 and 1997, notably of ‘breakfast cereals’, pastries and baked goods, processed dairy products, beverages and juices, dressings and mayonnaise, and pre-cooked meals ( Reference Crovetto and Uauy 16 ) .

    In general, as more disposable income becomes available, the penetration of ultra-processed foods increases. Analysis of data collected by the market research organization Euromonitor shows that as national income increases, the share of retail sales of ultra-processed food products, such as ready meals and breakfast cereals, correspondingly increases, while the share of minimally processed foods, such as dried foods (mostly grains), and processed culinary ingredients, such as oils and fats, declines ( Reference Gehlhar and Regmi 4 ) .

    The Euromonitor data also show an explosive growth in the retail sales of ready meals and breakfast cereals, particularly in middle-income developing countries. In Brazil, between 1998 and 2003, the average annual growth rate for ready meals was 17·3 % and for cereal breakfasts was 8·9 %.

    The enormous growth potential for Group 3 food products in Brazil, and other lower-income countries, becomes evident when contrasted with their contribution to the food supplies of higher-income countries. For instance, breads, cakes, pastries, confectionery, biscuits, processed meats, cheeses and soft drinks, taken together, amounted to 45·3 % of the total energy purchased by families in the UK in 2008 ( 17 ) , a value twice as high as the 19·1 % for the same products in 2002–3 in Brazil. This dominance of Group 3 products in the diet is even more pronounced in the USA, where the five most commonly consumed foods are all Group 3 ultra-processed food products: ‘regular’ sugary soft drinks, cakes and pastries, burgers, pizza and potato chips ( Reference Block 18 ) .

    It is likely that the general increase in the consumption of these ultra-processed products in Brazil will have continued, given the continuous increases of purchasing power of all income groups after 2003 ( Reference Neri 19 ) . This will be testable when data from the new national household budget survey, conducted in 2008–9, become available.

    Human health significance

    What is the significance of the increased consumption of ultra-processed food products for health? Causal relationships between consumption of Group 3 food products and health have been indicated or established only for some products.

    Five systematic reviews have now concluded that there is an association between soft drink intake and increased energy intake, excess body weight and diabetes ( Reference Bachman, Baranowski and Nicklas 20 – 24 ) . Evidence on ‘fast’ foods and snacks and obesity points the same way, but so far is less conclusive ( 24 ) .

    A recent comprehensive report concludes that the evidence for a causal relationship between intake of processed meat and colorectal cancer is convincing ( 24 ) . This is particularly significant given the small number of studies that separate out processed meats as a category distinct from fresh meat. It is often assumed that consumption of all meat is increasing, whereas the study presented in the current paper shows that, in Brazil at least, the only meat whose consumption is rising is processed meat. Studies on meat consumption need to separate trends for fresh and for processed meat ( Reference Popkin 25 ) .

    It is not yet possible to estimate or predict the impact of increased consumption of ultra-processed food products, taken all together, on human health. This is because as yet there are no studies relating ultra-processed foods as a group with health outcomes. It is high time that such studies were undertaken. These need not be complex they can simply involve re-examination of existing data. In the meantime, the known high energy density of food products in Group 3 and their negative overall nutrient profile, both confirmed by our exercise with ‘extreme’ food baskets, indicate it is safe to say that increased consumption of these ultra-processed products is increasing the risk and incidence of obesity and of other nutrition-related chronic diseases ( Reference Astrup, Dyerberg and Selleck 26 ) .

    Discussion on the effects of ultra-processed products on human health and the risk of disease almost always focuses on the nutrients in such products. As we have stated elsewhere ( Reference Monteiro 1 , Reference Monteiro 27 ) , while this approach is important it is narrow, and neglects or overlooks other factors likely to be at least as important as nutrient profiles.

    Many ultra-processed food products are accurately termed ‘fast’ foods or ‘convenience’ foods. Many have long or very long shelf-lives, often because they are relatively devoid of perishable nutrients, or are even practically imperishable, in contrast to all fresh foods. Ultra-processed foods are also typically sold ready-to-heat or ready-to-eat, in contrast to most fresh foods that need to be prepared and cooked. The problem is that the convenience and rapidity associated with these products favour patterns of consumption known to harm the mechanisms that regulate energy balance, which therefore leads to excess eating and obesity. Such unhealthy eating patterns include snacking instead of regular meals, eating while watching television and consuming a lot of energy in liquid form ( Reference De Graaf 28 – Reference Mattes 30 ) . These behaviours are all provoked and amplified by aggressive advertising and marketing of branded Group 3 products, many of which are produced by transnational and other very big manufacturers and caterers.

    Food and drink manufacturing, catering and allied industries concentrate their marketing investments on ‘value-added’ ultra-processed products, such as sugared breakfast cereals, burgers, sweet and savoury snacks, and soft drinks, and not on minimally processed foods and also not on oils, flours and sugar used in homes as culinary ingredients. Heavily marketed branded products are typically made up from the cheapest oils, starches and sugars available, whose price to the manufacturers is often further reduced by government subsidies. This, and the endless opportunities to formulate ‘new’ hyper-palatable Group 3 products using sophisticated combinations of cosmetic and other additives, explain why the industry concentrates its marketing investments on these products ( Reference Monteiro 1 ) .

    In modern societies, food accessibility and food advertisement are the key environmental cues which trigger automatic and uncontrollable responses leading to excess eating and obesity. The idea that eating and drinking behaviours are simply a matter of conscious choice that can be educated is fundamentally wrong ( Reference Cohen 31 ) .

    Wider significance

    Increased production and consumption of ultra-processed Group 3 products also can have negative social, cultural, environmental and other impacts. Thus, as the intensity of food processing increases, typically so also does the requirement for energy inputs, directly in the processing itself and indirectly in packaging and transportation ( Reference Beauman, Cannon and Elmadfa 32 , Reference Roberts 33 ) . Further, the replacement of meals prepared at home by uniform branded ready-to-heat and ready-to-eat dishes, snacks and soft drinks results in the weakening of traditional food cultures, the loss of culinary diversity and the decline of family life, among very many other adverse effects ( Reference Contreras Hernández and Gracia Arnáiz 34 ) .


    Food frequency questionnaire

    Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

    Tapsell LC, Neale EP, Satija A, Hu FB. Foods, nutrients, and dietary patterns: interconnections and implications for dietary guidelines. Adv Nutr. 20167(3):445–54. https://doi.org/10.3945/an.115.011718.

    Monteiro CA. Nutrition and health. The issue is not food, nor nutrients, so much as processing. Public Health Nutr. 200912(5):729–31. https://doi.org/10.1017/S1368980009005291.

    •• Moubarac JC, Parra DC, Cannon G, Monteiro C. Food classification systems based on food processing: significance and implications for policies and actions—a systematic literature review and assessment. Curr Obes Rep. 20143:256–72. This paper was the first systematic review to evaluate existing classification systems that categorize products by degree of food processing. Of the five identified systems, the NOVA food processing classification was rated highest in quality based on criteria for being a specific, coherent, clear, comprehensive, and workable system.

    • Monteiro CA, Cannon G, Moubarac JC, Levy RB, Louzada ML, Jaime PC. The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutr. 2017:1–13. doi:https://doi.org/10.1017/S1368980017000234. This commentary outlines the NOVA food processing classification and summarizes the use of NOVA in numerous studies to describe ultra-processed food consumption, examine the associations of ultra-processed foods with dietary quality and diet-related health outcomes, and inform dietary guidelines.

    Pan American Health Organization of the World Health Organization. Ultra-processed food and drink products in Latin America: trends, impact on obesity, policy implications. Washington, DC: Pan American Health Organization of the WHO 2015.

    Swinburn BA, Sacks G, Hall KD, McPherson K, Finegood DT, Moodie ML, et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet. 2011378(9793):804–14. https://doi.org/10.1016/S0140-6736(11)60813-1.

    Zobel EH, Hansen TW, Rossing P, von Scholten BJ. Global changes in food supply and the obesity epidemic. Curr Obes Rep. 20165(4):449–55. https://doi.org/10.1007/s13679-016-0233-8.

    Floros JD, Newsome R, Fisher W, Barbosa-Cánovas GV, Chen H, Dunne CP, et al. Feeding the world today and tomorrow: the importance of food science and technology. Compr Rev Food Sci Food Saf. 20109(5):572–99.

    Slimani N, Deharveng G, Southgate DA, Biessy C, Chajes V, van Bakel MM, et al. Contribution of highly industrially processed foods to the nutrient intakes and patterns of middle-aged populations in the European Prospective Investigation into Cancer and Nutrition study. Eur J Clin Nutr. 200963(Suppl 4):S206–25. https://doi.org/10.1038/ejcn.2009.82.

    Wahlqvist ML. Food structure is critical for optimal health. Food Funct. 20167(3):1245–50. https://doi.org/10.1039/c5fo01285f.

    van Boekel M, Fogliano V, Pellegrini N, Stanton C, Scholz G, Lalljie S, et al. A review on the beneficial aspects of food processing. Mol Nutr Food Res. 201054(9):1215–47. https://doi.org/10.1002/mnfr.200900608.

    FAO. Guidelines on the collection of information on food processing through food consumption surveys. Rome: Food and Agriculture Organization of the United Nations 2015.

    • Monteiro CA, Cannon G, Moubarac JC, Martins AP, Martins CA, Garzillo J, et al. Dietary guidelines to nourish humanity and the planet in the twenty-first century. A blueprint from Brazil. Public Health Nutr. 201518(13):2311–22. https://doi.org/10.1017/S1368980015002165. This paper discusses the development and aims of the Brazilian dietary guidelines released in 2014, which include recommendations to make minimally processed foods the basis of diet and to avoid consumption of ultra-processed foods. This is the first peer-reviewed paper by Monteiro and colleagues to describe the current NOVA classification for food processing.

    Monteiro CA, Levy RB, Claro RM, Castro IR, Cannon G. A new classification of foods based on the extent and purpose of their processing. Cad Saude Publica. 201026(11):2039–49.

    Moubarac JC, Claro RM, Baraldi LG, Levy RB, Martins AP, Cannon G, et al. International differences in cost and consumption of ready-to-consume food and drink products: United Kingdom and Brazil, 2008-2009. Glob Public Health. 20138(7):845–56. https://doi.org/10.1080/17441692.2013.796401.

    Crovetto MM, Uauy R, Martins AP, Moubarac JC, Monteiro C. Household availability of ready-to-consume food and drink products in Chile: impact on nutritional quality of the diet. Rev Med Chil. 2014142(7):850–8. https://doi.org/10.4067/S0034-98872014000700005.

    Monteiro CA, Levy RB, Claro RM, de Castro IR, Cannon G. Increasing consumption of ultra-processed foods and likely impact on human health: evidence from Brazil. Public Health Nutr. 201114(1):5–13. https://doi.org/10.1017/S1368980010003241.

    Moubarac JC, Martins AP, Claro RM, Levy RB, Cannon G, Monteiro CA. Consumption of ultra-processed foods and likely impact on human health. Evidence from Canada. Public Health Nutr. 2012:1–9. doi:https://doi.org/10.1017/S1368980012005009.

    Martinez Steele E, Baraldi LG, Louzada ML, Moubarac JC, Mozaffarian D, Monteiro CA. Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study. BMJ Open. 20166(3):e009892. https://doi.org/10.1136/bmjopen-2015-009892.

    Poti JM, Mendez MA, Ng SW, Popkin BM. Is the degree of food processing and convenience linked with the nutritional quality of foods purchased by US households? Am J Clin Nutr. 2015101(6):1251–62. https://doi.org/10.3945/ajcn.114.100925.

    Ludwig DS. Technology, diet, and the burden of chronic disease. JAMA. 2011305(13):1352–3. https://doi.org/10.1001/jama.2011.380.

    Fardet A, Rock E, Bassama J, Bohuon P, Prabhasankar P, Monteiro C, et al. Current food classifications in epidemiological studies do not enable solid nutritional recommendations for preventing diet-related chronic diseases: the impact of food processing. Adv Nutr. 20156(6):629–38. https://doi.org/10.3945/an.115.008789.

    Popkin BM. Relationship between shifts in food system dynamics and acceleration of the global nutrition transition. Nutr Rev. 201775(2):73–82. https://doi.org/10.1093/nutrit/nuw064.

    Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med. 2011364(25):2392–404. https://doi.org/10.1056/NEJMoa1014296.

    Malik VS, Pan A, Willett WC, Hu FB. Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis. Am J Clin Nutr. 201398(4):1084–102. https://doi.org/10.3945/ajcn.113.058362.

    Hu FB. Resolved: there is sufficient scientific evidence that decreasing sugar-sweetened beverage consumption will reduce the prevalence of obesity and obesity-related diseases. Obes Rev. 201314(8):606–19. https://doi.org/10.1111/obr.12040.

    Nago ES, Lachat CK, Dossa RA, Kolsteren PW. Association of out-of-home eating with anthropometric changes: a systematic review of prospective studies. Crit Rev Food Sci Nutr. 201454(9):1103–16. https://doi.org/10.1080/10408398.2011.627095.

    Bertoia ML, Mukamal KJ, Cahill LE, Hou T, Ludwig DS, Mozaffarian D, et al. Changes in intake of fruits and vegetables and weight change in United States men and women followed for up to 24 years: analysis from three prospective cohort studies. PLoS Med. 201512(9):e1001878. https://doi.org/10.1371/journal.pmed.1001878.

    Williams PG, Grafenauer SJ, O'Shea JE. Cereal grains, legumes, and weight management: a comprehensive review of the scientific evidence. Nutr Rev. 200866(4):171–82. https://doi.org/10.1111/j.1753-4887.2008.00022.x.

    Alinia S, Hels O, Tetens I. The potential association between fruit intake and body weight—a review. Obes Rev. 200910(6):639–47. https://doi.org/10.1111/j.1467-789X.2009.00582.x.

    Summerbell CD, Douthwaite W, Whittaker V, Ells LJ, Hillier F, Smith S, et al. The association between diet and physical activity and subsequent excess weight gain and obesity assessed at 5 years of age or older: a systematic review of the epidemiological evidence. Int J Obes. 200933(Suppl 3):S1–92. https://doi.org/10.1038/ijo.2009.80.

    Martins AP, Levy RB, Claro RM, Moubarac JC, Monteiro CA. Increased contribution of ultra-processed food products in the Brazilian diet (1987–2009). Rev Saude Publica. 201347(4):656–65. https://doi.org/10.1590/S0034-8910.2013047004968.

    Costa Louzada ML, Martins AP, Canella DS, Baraldi LG, Levy RB, Claro RM, et al. Ultra-processed foods and the nutritional dietary profile in Brazil. Rev Saude Publica. 201549:38. https://doi.org/10.1590/S0034-8910.2015049006132.

    Louzada ML, Martins AP, Canella DS, Baraldi LG, Levy RB, Claro RM, et al. Impact of ultra-processed foods on micronutrient content in the Brazilian diet. Rev Saude Publica. 201549:45. https://doi.org/10.1590/S0034-8910.2015049006211.

    Bielemann RM, Motta JV, Minten GC, Horta BL, Gigante DP. Consumption of ultra-processed foods and their impact on the diet of young adults. Rev Saude Publica. 201549:28.

    Cediel G, Reyes M, da Costa Louzada ML, Martinez Steele E, Monteiro CA, Corvalan C, et al. Ultra-processed foods and added sugars in the Chilean diet. Public Health Nutr. 20102017:1–9. https://doi.org/10.1017/S1368980017001161.

    Cornwell B, Villamor E, Mora-Plazas M, Marin C, Monteiro CA, Baylin A. Processed and ultra-processed foods are associated with lower-quality nutrient profiles in children from Colombia. Public Health Nutr. 2017:1–6. https://doi.org/10.1017/S1368980017000891.

    Setyowati D, Andarwulan N, Giriwono PE. Processed and ultraprocessed food consumption pattern in the Jakarta Individual Food Consumption Survey 2014. Asia Pac J Clin Nutr. 201727(4):1–15. https://doi.org/10.6133/apjcn.062017.01.

    Rischke R, Kimenju SC, Klasen S, Qaim M. Supermarkets and food consumption patterns: the case of small towns in Kenya. Food Policy. 201552:9–21.

    Monteiro CA, Moubarac JC, Levy RB, Canella DS, Louzada M, Cannon G. Household availability of ultra-processed foods and obesity in nineteen European countries. Public Health Nutr. 2017:1–9. https://doi.org/10.1017/S1368980017001379.

    Julia C, Martinez L, Alles B, Touvier M, Hercberg S, Mejean C, et al. Contribution of ultra-processed foods in the diet of adults from the French NutriNet-Sante study. Public Health Nutr. 2017:1–11. https://doi.org/10.1017/S1368980017001367.

    Solberg SL, Terragni L, Granheim SI. Ultra-processed food purchases in Norway: a quantitative study on a representative sample of food retailers. Public Health Nutr. 201619(11):1990–2001. https://doi.org/10.1017/S1368980015003523.

    Djupegot IL, Nenseth CB, Bere E, Bjornara HBT, Helland SH, Overby NC, et al. The association between time scarcity, sociodemographic correlates and consumption of ultra-processed foods among parents in Norway: a cross-sectional study. BMC Public Health. 201717(1):447. https://doi.org/10.1186/s12889-017-4408-3.

    Juul F, Hemmingsson E. Trends in consumption of ultra-processed foods and obesity in Sweden between 1960 and 2010. Public Health Nutr. 201518(17):3096–107. https://doi.org/10.1017/S1368980015000506.

    O'Halloran SA, Lacy KE, Grimes CA, Woods J, Campbell KJ, Nowson CA. A novel processed food classification system applied to Australian food composition databases. J Hum Nutr Diet. 2017 https://doi.org/10.1111/jhn.12445.

    Venn D, Banwell C, Dixon J. Australia’s evolving food practices: a risky mix of continuity and change. Public Health Nutr. 2016:1–10. https://doi.org/10.1017/S136898001600255X.

    Luiten CM, Steenhuis IH, Eyles H, Ni Mhurchu C, Waterlander WE. Ultra-processed foods have the worst nutrient profile, yet they are the most available packaged products in a sample of New Zealand supermarkets. Public Health Nutr. 2015:1–9. https://doi.org/10.1017/S1368980015002177.

    Poti JM, Mendez MA, Ng SW, Popkin BM. Highly processed and ready-to-eat packaged food and beverage purchases differ by race/ethnicity among US households. J Nutr. 2016146(9):1722–30. https://doi.org/10.3945/jn.116.230441.

    Martinez Steele E, Popkin BM, Swinburn B, Monteiro CA. The share of ultra-processed foods and the overall nutritional quality of diets in the US: evidence from a nationally representative cross-sectional study. Popul Health Metrics. 201715(1):6. https://doi.org/10.1186/s12963-017-0119-3.

    Moubarac JC, Batal M, Martins AP, Claro R, Levy RB, Cannon G, et al. Processed and ultra-processed food products: consumption trends in Canada from 1938 to 2011. Can J Diet Pract Res. 201475(1):15–21.

    Moubarac JC, Batal M, Louzada ML, Martinez Steele E, Monteiro CA. Consumption of ultra-processed foods predicts diet quality in Canada. Appetite. 2017108:512–20. https://doi.org/10.1016/j.appet.2016.11.006.

    • Adams J, White M. Characterisation of UK diets according to degree of food processing and associations with socio-demographics and obesity: cross-sectional analysis of UK National Diet and Nutrition Survey (2008–12). Int J Behav Nutr Phys Act. 201512:160. https://doi.org/10.1186/s12966-015-0317-y. This cross-sectional study found that higher consumption of processed/ultra-processed food among adults in the UK was not associated with BMI or the likelihood of being overweight/obese or being obese.

    Asfaw A. Does consumption of processed foods explain disparities in the body weight of individuals? The case of Guatemala. Health Econ. 201120(2):184–95. https://doi.org/10.1002/hec.1579.

    • Canella DS, Levy RB, Martins AP, Claro RM, Moubarac JC, Baraldi LG, et al. Ultra-processed food products and obesity in Brazilian households (2008–2009). PLoS One. 20149(3):e92752. https://doi.org/10.1371/journal.pone.0092752. This cross-sectional study found that, in a nationally representative sample of Brazilians, the prevalence of obesity was 3.7 percentage points higher among children and adults living in household strata in the highest compared with lowest quartile of ultra-processed food purchases.

    •• Louzada ML, Baraldi LG, Steele EM, Martins AP, Canella DS, Moubarac JC, et al. Consumption of ultra-processed foods and obesity in Brazilian adolescents and adults. Prev Med. 201581:9–15. https://doi.org/10.1016/j.ypmed.2015.07.018. This cross-sectional study was the first to assess the relationship between ultra-processed food consumption and obesity using dietary intake rather than food purchases. In a nationally representative sample, Brazilians in the highest quintile of ultra-processed food consumption had 0.94 kg/m 2 higher BMI and were 26% more likely to be obese compared with those in the lowest quintile.

    •• Mendonca RD, Pimenta AM, Gea A, de la Fuente-Arrillaga C, Martinez-Gonzalez MA, Lopes AC, et al. Ultraprocessed food consumption and risk of overweight and obesity: the University of Navarra Follow-Up (SUN) cohort study. Am J Clin Nutr. 2016104(5):1433–40. https://doi.org/10.3945/ajcn.116.135004. This investigation is the first prospective cohort to examine the association between ultra-processed food consumption and incident overweight/obesity. Highly educated middle-aged Spanish adults in the highest quartile of ultra-processed food intake at baseline had a 26% higher risk of developing overweight/obesity over a mean of 9 years of follow-up than those in the lowest quartile.

    Tavares LF, Fonseca SC, Garcia Rosa ML, Yokoo EM. Relationship between ultra-processed foods and metabolic syndrome in adolescents from a Brazilian Family Doctor Program. Public Health Nutr. 201215(1):82–7. https://doi.org/10.1017/S1368980011001571.

    •• Rauber F, Campagnolo PD, Hoffman DJ, Vitolo MR. Consumption of ultra-processed food products and its effects on children’s lipid profiles: a longitudinal study. Nutr Metab Cardiovasc Dis. 201525(1):116–22. https://doi.org/10.1016/j.numecd.2014.08.001. This study is the first prospective investigation to examine the association between ultra-processed food intake and changes in lipid profiles. Higher ultra-processed food intake among Brazilian preschoolers was associated with greater increases in total and LDL cholesterol between ages 3–4 and 7–8 years.

    • Rinaldi AE, Gabriel GF, Moreto F, Corrente JE, KC ML, Burini RC. Dietary factors associated with metabolic syndrome and its components in overweight and obese Brazilian schoolchildren: a cross-sectional study. Diabetol Metab Syndr. 20168(1):58. https://doi.org/10.1186/s13098-016-0178-9. This cross-sectional examination found that higher processed industrialized food intake was associated with higher fasting glucose, but was not associated with waist circumference, blood pressure, HDL cholesterol, triglycerides, or metabolic syndrome among school-aged children with overweight/obesity in Brazil.

    • Lavigne-Robichaud M, Moubarac JC, Lantagne-Lopez S, Johnson-Down L, Batal M, Laouan Sidi EA et al. Diet quality indices in relation to metabolic syndrome in an Indigenous Cree (Eeyouch) population in northern Quebec, Canada. Public Health Nutr. 2017:1–9. doi:https://doi.org/10.1017/S136898001700115X. This cross-sectional study found that higher consumption of ultra-processed food was associated with increased likelihood of having metabolic syndrome among Eeyouch adults in Quebec, Canada.

    •• Mendonca RD, Lopes AC, Pimenta AM, Gea A, Martinez-Gonzalez MA, Bes-Rastrollo M. Ultra-processed food consumption and the incidence of hypertension in a Mediterranean cohort: the Seguimiento Universidad de Navarra Project. Am J Hypertens. 201730(4):358–66. https://doi.org/10.1093/ajh/hpw137. This paper presents the first prospective cohort study to evaluate the association between ultra-processed food consumption and risk of hypertension. Highly educated middle-aged Spanish adults in the highest tertile of ultra-processed food consumption had a 21% higher risk of developing hypertension over a mean of 9 years of follow-up compared with those in the lowest tertile.

    Perez-Escamilla R, Obbagy JE, Altman JM, Essery EV, McGrane MM, Wong YP, et al. Dietary energy density and body weight in adults and children: a systematic review. J Acad Nutr Diet. 2012112(5):671–84. https://doi.org/10.1016/j.jand.2012.01.020.

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    Schulte EM, Avena NM, Gearhardt AN. Which foods may be addictive? The roles of processing, fat content, and glycemic load. PLoS One. 201510(2):e0117959. https://doi.org/10.1371/journal.pone.0117959.

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    Introduction

    Increasing policy attention has focused on added sugars, including by the WHO,1 the UK National Health System,2 the Canadian Heart and Stroke Foundation,3 the American Heart Association (AHA)4 and the US Dietary Guidelines Advisory Committee (USDGAC).5

    These reports concluded that a high intake of added sugars increases the risk of weight gain,1 , 4 , 5 excess body weight5 and obesity3 , 5 type 2 diabetes mellitus3 , 5 higher serum triglycerides5 and high blood cholesterol3 higher blood pressure5 and hypertension5 stroke3 , 5 coronary heart disease3 , 5 cancer3 and dental caries.1 , 3 , 5 Moreover, foods higher in added sugars are often a source of empty calories with minimum essential nutrients or dietary fibre,6–8 which displace more nutrient-dense foods9 and lead, in turn, to simultaneously overfed and undernourished individuals.

    All reports recommended limiting intake of added sugars.1 , 3–5 In the USA, the USDGAC recommended limiting added sugars to no more than 10% of total calories. This is a challenge, as recent consumption of added sugars in the USA amounted to almost 15% of total calories in 2005–2010.10 , 11

    To design and implement effective measures to reduce added sugars, their dietary sources must be clearly identified. Added sugars can be consumed either as ingredients of dishes or drinks prepared from scratch by consumers or a cook, or as ingredients of food products manufactured by the food industry. According to market disappearance data from 2014, more than three-quarters of the sugar and high fructose corn syrup available for human consumption in the USA were used by the food industry.12 This suggests that food products manufactured by the industry could have an important role in the excess added sugars consumption in the USA. However, to assess this role, it is essential to consider the contribution of manufactured food products to both total energy intake and the energy intake from added sugars, and, more relevantly, to quantify the relationship between their consumption and the total dietary content of added sugars. To address these questions, we performed an investigation utilising the 2009–2010 National Health and Nutrition Examination Survey (NHANES).


    INDUSTRIAL SOUPS

    Most commercial soup bases and sauces contain artificial meat-like flavors that mimic those we used to get from natural, gelatin-rich broth. These kinds of short cuts mean that consumers are shortchanged. When the homemade stocks were pushed out by the cheap substitutes, an important source of minerals disappeared from the American diet. The thickening effects of gelatin could be mimicked with emulsifiers, but, of course, the health benefits were lost. Gelatin is a very healthy thing to have in your diet. It helps you digest proteins properly and is supportive of digestive health overall.

    Research on gelatin and natural broths came to an end in the 1950s when food companies discovered how to induce maillard reactions–the process of creating flavor compounds by mixing reduced sugars and amino acids under increased temperatures–and produce meat-like flavors in the laboratory. In a General Foods Company report issued in 1947, chemists predicted that almost all natural flavors would soon be chemically synthesized. 15 Following the Second World War, American food companies discovered monosodium glutamate, a food ingredient the Japanese had invented in 1908 to enhance food flavors, including meat-like flavors. Humans actually have receptors on the tongue for glutamate—it is the protein in food that the human body recognizes as meat–but the glutamate in MSG has a different configuration, which cannot be assimilated properly by the body. Any protein can be hydrolyzed (broken down into its component amino acids) to produce a base containing MSG. When the industry learned how to synthesize the flavor of meat in the laboratory, using inexpensive proteins from grains and legumes, the door was opened to a flood of new products, including boullion cubes, dehydrated soup mixes, sauce mixes, TV dinners, and condiments with a meaty taste.

    The fast food industry could not exist without MSG and artificial meat flavors, which beguile the consumer into eating bland and tasteless food. The sauces in many commercially processed foods contain MSG, water, thickeners, emulsifiers and caramel coloring. Your tongue is tricked into thinking that you are consuming something nutritious, when in fact it is getting nothing at all except some very toxic substances. Even dressings, Worcestershire sauce, rice mixes, flavored tofu, and many meat products have MSG in them. Almost all canned soups and stews contain MSG, and the “hydrolyzed protein” bases often contain MSG in very large amounts.

    So-called homemade soups in most restaurants are usually made by mixing water with a powdered soup base made of hydrolyzed protein and artificial flavors, and then adding chopped vegetables and other ingredients. Even things like lobster bisque and fish sauces in most seafood restaurants are prepared using these powdered bases full of artificial flavors.

    The industry even thinks it is too costly to just use a little onion and garlic for flavoring–they use artificial garlic and onion flavors instead. It’s all profit based with no thought for the health of the consumer.

    Unfortunately, most of the processed vegetarian foods are loaded with these flavorings, as well. The list of ingredients in vegetarian hamburgers, hot dogs, bacon, baloney, etc., may include hydrolyzed protein and “natural” flavors, all sources of MSG. Soy foods are loaded with MSG.

    Food manufacturers get around the labeling requirements by putting MSG in the spice mixes if the mix is less than fifty percent MSG, they don’t have to indicate MSG on the label. You may have noticed that the phrase “No MSG” has actually disappeared. The industry doesn’t use it anymore because they found out that there was MSG in all the spice mixes even Bragg’s amino acids had to take “No MSG” off the label.


    Are They Really Healthy?

    Lean Cuisine products are better than a lot of lunch and dinners out there, like fast food, for example. When you compare a serving of Lean Cuisine Pepperoni Pizza to a slice of pepperoni pizza from Pizza Hut, you'll find that the frozen meal is the healthier option.

    The single serving of Lean Cuisine pizza (6 ounces or 170 grams) is 410 calories with 10 grams of fat, 3 grams of fiber, 21 grams of protein, 59 grams of carbohydrates and 870 milligrams of sodium.

    One slice of a large hand-tossed pepperoni pizza weighs 123 grams, making it slightly smaller than the Lean Cuisine. It contains 330 calories, 14 grams of fat, 15 grams of protein, 38 grams of carbohydrates and 990 milligrams of sodium.

    However, the majority of these meals fall between 250 and 300 calories which doesn't satisfy the recommended calorie intake for one meal. While there are vegetables, there needs to be more of them to qualify as a serving. Many of the meals are made with refined pasta, so that's why it's important to go beyond Lean Cuisine nutrition and look closely at the ingredient list before deciding which ones to purchase.

    A May 2019 small-scale study with 20 participants conducted by researchers at the National Institutes of Health's National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), was the first of its kind to study the effects of processed foods. They discovered people who eat ultra processed foods eat more calories and gained more weight compared to those who ate a minimally processed diet.

    If you're cutting back calories to lose weight, some of the meals provide enough calories to qualify as a meal. The refined ingredients and sodium are enough reason to avoid them when and where possible. Opt for whole foods for the best nutrition.



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