Ultraprocessed food consumption associated with cardiometabolic risk factors in children

1.  Preschool-aged children in the top tertile of unprocessed food (UPF) consumption had significantly higher body-mass index (BMI), waist circumference, adiposity, fasting plasma glucose, and lower HDL levels than those who consumed the least amount of UPFs.

Evidence Rating Level: 2 (Good)        

Study Rundown: Modifiable risk factors including diet and physical activity are thought to contribute to one’s risk for cardiovascular disease (CVD), and increasing literature demonstrates that these risk factors are modifiable starting in childhood. The affordability and high availability of ultraprocessed foods (UPFs), food products that undergo extensive industrial processing prior to consumption, have made them frequent staples in modern diets. Their nutritional profiles, rich in sugars, saturated fats, and sodium, are associated with poorer cardiometabolic health in adults. However, the research representing associations between UPF consumption in childhood to abnormal cardiometabolic risk factors is limited. This cross-sectional study investigated the above association in Spanish children aged three to six years old. It found that children in the highest tertile of daily energy-adjusted UPF consumption, when compared to those in the lowest tertile, had significantly higher body-mass indexes (BMI), waist circumferences, adiposity, and fasting plasma glucose, as well as lower high-density lipoprotein (HDL) levels. Substituting 100g of UPFs with 100g of minimally or nonprocessed foods was also found to decease BMI and fasting glucose levels in children. These results highlight the role of UPF consumption, even in early childhood, but signal the need for longitudinal research to investigate long-term effects of UPF consumption starting in childhood.

Click to read the study in JAMA Network Open

Relevant Reading: Food classification systems based on food processing: significance and implications for policies and actions: a systematic literature review and assessment

In-Depth [cross-sectional study]: Cardiovascular diseases (CVD) is the leading cause of death around the globe. Despite the existence of genetic factors that impact an individual’s risk for heart disease, modifiable risk factors represent an opportunity to mitigate a portion of one’s overall risk. The overconsumption of UPFs has become more widespread as a result of globalization and increased access and affordability to these products, but there is little research investigating the association between UPF consumption and the development of abnormal cardiometabolic risk factors in childhood. The current large cross-sectional study sought to elucidate this possible association. Data from the prospective multicentre Childhood Obesity Risk Assessment Longitudinal Study (CORALS) was used, with results of 1426 eligible children from seven schools included in the analysis (mean [SD] age, of 5.8 [1.1] years; 698 boys [49.0%] and 728 girls [51.0%]). Data collected included a face-to-face visit and several specialized questionnaires assessing 3-day food consumption, participant and family demographics, and physical activity levels. At health care centres, measurements of adiposity and waist circumference, as well as cardiometabolic risk factor assessments were completed. Blood pressure measurements, plasma and eight-hour fasting glucose, low- and high-density lipoprotein (LDL and HDL) levels, triglycerides, and insulin concentrations were obtained. 

Patients were categorized into tertiles based on reported energy-adjusted UPF consumption by trained dieticians. Children in the highest tertile of daily energy-adjusted UPF consumption, compared to those in the lowest tertile, had higher BMIs (β = 0.20; 95% CI, 0.05-0.35, p < .05), waist circumferences (β = 0.20; 95% CI, 0.05-0.35, p < .05), fat mass indexes (β = 0.17; 95% CI, 0.00-0.32, p < .05), and fasting plasma glucose levels (β = 0.22; 95% CI, 0.06-0.37, p < .05). There was an inverse correlation between high-density lipoprotein (HDL) levels and UPF consumption (β = −0.19; 95% CI, −0.36 to −0.02, p < .05). Substituting 100g of UPFs with 100g of minimally or nonprocessed foods was also found to decrease BMI and fasting glucose levels in children. The baseline cross-sectional analysis found associations between those in the highest UPF consumption tertile and higher total consumption of calories, carbohydrates, dairy products, candy, and sugary beverages than their lower-tertile counterparts. They were also the least likely to consume healthy amounts of protein, monounsaturated and polyunsaturated fatty acids, fiber, milk, cheese, oil, white meat, unprocessed red meat, eggs, fish, vegetables, fruits, and legumes (ps < .05). Mothers of high-UPF children were younger, of lower socioeconomic status (SES), lower education levels, were less likely to have exclusively breastfed their child, and were more likely to be overweight and obese themselves. The most commonly consumed UPFs were pastries, sweet beverages, cookies, and candies. This is the first study to find that UPF consumption was associated with increased fasting glucose, BMI, adiposity, waist circumference, and lower HDL levels.

Image: PD

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