Mapping ultra-processed foods (UPFs) in India: a formative research study.

Increased consumption of ultra-processed foods (UPFs) which have additives such as artificial colours, flavours and are usually high in salt, sugar, fats and specific preservatives, are associated with diet-related non-communicable diseases (NCDs). In India, there are no standard criteria for identifying UPFs using a classification system based on extent and purpose of industrial processing. Scientific literature on dietary intake of foods among Indian consumers classifies foods as unhealthy based on presence of excessive amounts of specific nutrients which makes it difficult to distinguish UPFs from other commercially available processed foods. A literature review followed by an online grocery retailer scan for food label reading was conducted to map the types of UPFs in Indian food market and scrutinize their ingredient list for the presence of ultra-processed ingredients. All UPFs identified were randomly listed and then grouped into categories, followed by saliency analysis to understand preferred UPFs by consumers. Indian UPF categories were then finalized to inform a UPF screener. A lack of application of a uniform definition for UPFs in India was observed; hence descriptors such as junk-foods, fast-foods, ready-to-eat foods, instant-foods, processed-foods, packaged-foods, high-fat-sugar-and-salt foods were used for denoting UPFs. After initial scanning of such foods reported in literature based on standard definition of UPFs, an online grocery retailer scan of food labels for 375 brands (atleast 3 brands for each food item) confirmed 81 food items as UPFs. A range of packaged traditional recipes were also found to have UPF ingredients. Twenty three categories of UPFs were then developed and subjected to saliency analysis. Breads, chips and sugar-sweetened beverages (e.g. sodas and cold-drinks) were the most preferred UPFs while frozen ready-to-eat/cook foods (e.g. chicken nuggets and frozen kebabs) were least preferred. India needs to systematically apply a food classification system and define Indian food categories based on the level of industrial processing. Mapping of UPFs is the first step towards development of a quick screener that would generate UPF consumption data to inform clear policy guidelines and regulations around UPFs and address their impact on NCDs.

Ghosh-Jerath S ，Khandpur N ，Kumar G ，Kohli S ，Singh M ，Bhamra IK ，Marrocos-Leite FH ，Reddy KS ... -  《BMC PUBLIC HEALTH》

Erratum: Eyestalk Ablation to Increase Ovarian Maturation in Mud Crabs.

《Jove-Journal of Visualized Experiments》

Characterization of the degree of food processing in the European Prospective Investigation into Cancer and Nutrition: Application of the Nova classification and validation using selected biomarkers of food processing.

Epidemiological studies have demonstrated an association between the degree of food processing in our diet and the risk of various chronic diseases. Much of this evidence is based on the international Nova classification system, which classifies food into four groups based on the type of processing: (1) Unprocessed and minimally processed foods, (2) Processed culinary ingredients, (3) Processed foods, and (4) "Ultra-processed" foods (UPF). The ability of the Nova classification to accurately characterise the degree of food processing across consumption patterns in various European populations has not been investigated so far. Therefore, we applied the Nova coding to data from the European Prospective Investigation into Cancer and Nutrition (EPIC) in order to characterize the degree of food processing in our diet across European populations with diverse cultural and socio-economic backgrounds and to validate this Nova classification through comparison with objective biomarker measurements. After grouping foods in the EPIC dataset according to the Nova classification, a total of 476,768 participants in the EPIC cohort (71.5% women; mean age 51 [standard deviation (SD) 9.93]; median age 52 [percentile (p)25-p75: 58-66] years) were included in the cross-sectional analysis that characterised consumption patterns based on the Nova classification. The consumption of food products classified as different Nova categories were compared to relevant circulating biomarkers denoting food processing, measured in various subsamples (N between 417 and 9,460) within the EPIC cohort via (partial) correlation analyses (unadjusted and adjusted by sex, age, BMI and country). These biomarkers included an industrial transfatty acid (ITFA) isomer (elaidic acid; exogenous fatty acid generated during oil hydrogenation and heating) and urinary 4-methyl syringol sulfate (an indicator for the consumption of smoked food and a component of liquid smoke used in UPF). Contributions of UPF intake to the overall diet in % grams/day varied across countries from 7% (France) to 23% (Norway) and their contributions to overall % energy intake from 16% (Spain and Italy) to >45% (in the UK and Norway). Differences were also found between sociodemographic groups; participants in the highest fourth of UPF consumption tended to be younger, taller, less educated, current smokers, more physically active, have a higher reported intake of energy and lower reported intake of alcohol. The UPF pattern as defined based on the Nova classification (group 4;% kcal/day) was positively associated with blood levels of industrial elaidic acid (r = 0.54) and 4-methyl syringol sulfate (r = 0.43). Associations for the other 3 Nova groups with these food processing biomarkers were either inverse or non-significant (e.g., for unprocessed and minimally processed foods these correlations were -0.07 and -0.37 for elaidic acid and 4-methyl syringol sulfate, respectively). These results, based on a large pan-European cohort, demonstrate sociodemographic and geographical differences in the consumption of UPF. Furthermore, these results suggest that the Nova classification can accurately capture consumption of UPF, reflected by stronger correlations with circulating levels of industrial elaidic acid and a syringol metabolite compared to diets high in minimally processed foods.

Huybrechts I ，Rauber F ，Nicolas G ，Casagrande C ，Kliemann N ，Wedekind R ，Biessy C ，Scalbert A ，Touvier M ，Aleksandrova K ，Jakszyn P ，Skeie G ，Bajracharya R ，Boer JMA ，Borné Y ，Chajes V ，Dahm CC ，Dansero L ，Guevara M ，Heath AK ，Ibsen DB ，Papier K ，Katzke V ，Kyrø C ，Masala G ，Molina-Montes E ，Robinson OJK ，Santiuste de Pablos C ，Schulze MB ，Simeon V ，Sonestedt E ，Tjønneland A ，Tumino R ，van der Schouw YT ，Verschuren WMM ，Vozar B ，Winkvist A ，Gunter MJ ，Monteiro CA ，Millett C ，Levy RB ... -  《Frontiers in Nutrition》

Decoding diets: insights on ultra-processed food consumption among Lebanese adults from the updated LEBANese natiONal food consumption survey (LEBANON-FCS).

Ultra-processed foods are evident to play a role in the development of nutrition-related non-communicable diseases (NR-NCDs). There's a scarcity of data in the Eastern Mediterranean Region (EMR) regarding ultra-processed food consumption, which highlights the need for such data in this region that is witnessing a nutrition transition. This study was conducted to assess the dietary pattern of Lebanese adults according to different degrees of food processing. A cross-sectional study involving a nationally representative sample (n = 444) of Lebanese adults (18-64 years) was conducted over the course of 5 months. A validated food frequency questionnaire and two non-consecutive 24-h recalls were used to collect the dietary intake. Sociodemographic and medical characteristics were collected using a validated questionnaire. Anthropometric measurements were taken by trained dietitians. Food items were classified according to the NOVA food classification system, and the percent contribution of every type of processing to the energy intake was calculated. Ultra-processed foods contributed to the highest percent of energy intake in the sample (46.7%), followed by unprocessed and minimally processed foods (39.6%). Being male, and younger increased the odds of higher ultra-processed food intake; being employed and food secure increased the odds of a higher NOVA-UPF score. Compared with participants in Beirut, participants residing in North Lebanon and Akkar had higher odds of having a high UPF intake and lower odds of having a high NOVA-UPF score. The three most contributing food items to energy intake were ultra-processed (breads and breakfast cereals, fast foods, sweets and desserts). Compared to the unprocessed and minimally processed food diet fraction, the ultra-processed food diet fraction was significantly higher in sodium and thiamin and lower in proteins, fiber, and essential vitamins and minerals such as vitamins A, D, B12, folate, iron, calcium, and magnesium. UPF intake was the main contributor to TEI, and the intake was considerably higher among those who reported having renal disease, younger adults, and males. In comparison to the minimally processed diet fraction, the UPF diet fraction was found to have considerably greater levels of sodium and thiamin and lower levels of proteins, fiber, and essential vitamins and minerals. The study findings call for public health policies and interventions to encourage the consumption of minimally processed foods and decrease the consumption of ultra-processed foods, especially sweets and sweetened beverages, which are especially problematic.

Khattar M ，Tzenios N ，Antar E ，Malli D ，Adults-Lebanon-FCS Group ，Hoteit M ... -  《Frontiers in Nutrition》

Defining the optimum strategy for identifying adults and children with coeliac disease: systematic review and economic modelling.

Elwenspoek MM ，Thom H ，Sheppard AL ，Keeney E ，O'Donnell R ，Jackson J ，Roadevin C ，Dawson S ，Lane D ，Stubbs J ，Everitt H ，Watson JC ，Hay AD ，Gillett P ，Robins G ，Jones HE ，Mallett S ，Whiting PF ... -  《-》