Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses

SPS commentary:

It was reported that convincing evidence (class I) supported direct links between greater ultra-processed food exposure and higher risks of incident cardiovascular disease related mortality (risk ratio 1.50, 95% CI 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).

An editorial points out ultra-processed foods are not merely modified foods, but formulations of often chemically manipulated cheap ingredients such as modified starches, sugars, oils, fats, and protein isolates, with little if any whole food added, made palatable and attractive by using combinations of flavours, colours, emulsifiers, thickeners, and other additives. It adds they are engineered to be highly desirable, to maximise reward, and adding flavours that induce eating when not hungry. Furthermore, many are addictive, judged by the standards set for tobacco products, and aggressively marketed with meal deals, super sizing, and advertising. It discusses what can be done to control and reduce their production and consumption, which is rising worldwide. It notes that reformulation does not eliminate harm, profitability discourages manufacturers from switching to make nutritious foods, and the investment management companies that increasingly dominate corporate shareholdings would likely resist any such change. It calls for national dietary guidelines that recommend varieties of unprocessed or minimally processed foods and freshly prepared meals and avoidance of ultra-processed foods; institutional food procurement that aligns with these guidelines; front-of-pack labels that clearly identify ultra-processed foods; restricting advertising and prohibiting sales in or near schools and hospitals; and fiscal measures that make unprocessed or minimally processed foods and freshly prepared meals as accessible and available as, and cheaper than, ultra-processed foods.