Ultra-processed food intake in association with BMI change and risk of overweight and obesity: A prospective analysis of the French NutriNet-Santé cohort
Beslay M, Srour B, Méjean C, Allès B, Fiolet T, Debras C, Chazelas E, Deschasaux M, Wendeu-Foyet MG, Hercberg S, Galan P, Monteiro CA, Deschamps V, Calixto Andrade G, Kesse-Guyot E, Julia C, Touvier M
PLoS medicine · 221 citations
How it was studied
- Design
- Cohort study (indexed by PubMed)
- Studied in
- People
- Main outcome
- Health markers and function
- Intake measured by
- Food diaries or recalls
Who paid for it
- Funding
- Independent funding
- Government
- Institut National de la Santé et de la Recherche Médicale
- Nonprofit
- Fondation pour la Recherche Médicale
- Government
- Institut National Du Cancer
- Government
- Institut National de la Recherche Agronomique
- University or hospital
- Conservatoire National des Arts et Métiers
- Government
- Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement
- Nonprofit
- World Cancer Research Fund
- Government
- National Cancer Institute
- Government
- French National Cancer Institute
- University or hospital
- Université Sorbonne Paris-Nord - Galilée Doctoral School
- Government
- Ministère de la Santé (solidarites-sante.gouv.fr),
- Government
- Santé Publique France
- University or hospital
- Université Sorbonne Paris-Nord
- Government
- Insitut National de la Santé et de la Recherche Médicale
Based on 14 listed funder(s) and full-text disclosure statement.
Publication
- Published
- 2020-08-27 · PLoS Med · vol. 17 · issue 8 · p. e1003256
- Publisher
- Public Library of Science
- Cited
- 292 citations · more than 100% of similar papers · 25.1× the field average
- Impact
- Top 10% most cited in its field
- References
- 82 works
- Access
- Open access (journal) · CC-BY
- Research areas
- Consumer Attitudes and Food Labeling · Nutrition, Genetics, and Disease · Nutritional Studies and Diet
- Keywords
- Medicine, Overweight, Body mass index, Obesity, Prospective cohort study, Hazard ratio, Population, Cohort, Cohort study, Demography, Environmental health, Confidence interval, Internal medicine
- MeSH
- humans, obesity, body mass index, nutrition surveys, risk factors, cohort studies, follow-up studies, prospective studies, energy intake, nutritive value, adult, middle aged, female, male, overweight, fast foods
17 authors
From FR, BR
- Marie BeslayInserm; Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement; Université Sorbonne Paris Nord; Sorbonne Paris Cité; Equipe de Recherche en Epidémiologie Nutritionnelle; Centre de Recherche Épidémiologie et Statistique
- Bernard Srour · correspondingInserm; Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement; Université Sorbonne Paris Nord; Sorbonne Paris Cité; Equipe de Recherche en Epidémiologie Nutritionnelle; Centre de Recherche Épidémiologie et Statistique
- Caroline MéjeanCentre de Coopération Internationale en Recherche Agronomique pour le Développement; Université de Montpellier; Institut Agro Montpellier; Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement; Institut Agronomique Méditerranéen de Montpellier; Montpellier Interdisciplinary center on Sustainable Agri-food systems: social and nutritional sciences; Centre International deHautes Etudes Agronomiques Méditerranéennes
- Benjamin AllèsInserm; Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement; Université Sorbonne Paris Nord; Sorbonne Paris Cité; Equipe de Recherche en Epidémiologie Nutritionnelle; Centre de Recherche Épidémiologie et Statistique
- Thibault FioletInserm; Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement; Université Sorbonne Paris Nord; Sorbonne Paris Cité; Equipe de Recherche en Epidémiologie Nutritionnelle; Centre de Recherche Épidémiologie et Statistique
- Charlotte DebrasInserm; Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement; Université Sorbonne Paris Nord; Sorbonne Paris Cité; Equipe de Recherche en Epidémiologie Nutritionnelle; Centre de Recherche Épidémiologie et Statistique
Abstract
Background
Ultra-processed food (UPF) consumption has increased drastically worldwide and already represents 50%-60% of total daily energy intake in several high-income countries. In the meantime, the prevalence of overweight and obesity has risen continuously during the last century. The objective of this study was to investigate the associations between UPF consumption and the risk of overweight and obesity, as well as change in body mass index (BMI), in a large French cohort.
Methods and findings
A total of 110,260 adult participants (≥18 years old, mean baseline age = 43.1 [SD 14.6] years; 78.2% women) from the French prospective population-based NutriNet-Santé cohort (2009-2019) were included. Dietary intakes were collected at baseline using repeated and validated 24-hour dietary records linked to a food composition database that included >3,500 different food items, each categorized according to their degree of processing by the NOVA classification. Associations between the proportion of UPF in the diet and BMI change during follow-up were assessed using linear mixed models. Associations with risk of overweight and obesity were assessed using Cox proportional hazard models. After adjusting for age, sex, educational level, marital status, physical activity, smoking status, alcohol intake, number of 24-hour dietary records, and energy intake, we observed a positive association between UPF intake and gain in BMI (β Time × UPF = 0.02 for an absolute increment of 10 in the percentage of UPF in the diet, P < 0.001). UPF intake was associated with a higher risk of overweight (n = 7,063 overweight participants; hazard ratio (HR) for an absolute increase of 10% of UPFs in the diet = 1.11, 95% CI: 1.08-1.14; P < 0.001) and obesity (n = 3,066 incident obese participants; HR10% = 1.09 (1.05-1.13); P < 0.001). These results remained statistically significant after adjustment for the nutritional quality of the diet and energy intake. Study limitations include possible selection bias, potential residual confounding due to the observational design, and a possible item misclassification according to the level of processing. Nonetheless, robustness was tested and verified using a large panel of sensitivity analyses.
Conclusions
In this large observational prospective study, higher consumption of UPF was associated with gain in BMI and higher risks of overweight and obesity. Public health authorities in several countries recently started to recommend privileging unprocessed/minimally processed foods and limiting UPF consumption.
Trial registration
ClinicalTrials.gov NCT03335644 (https://clinicaltrials.gov/ct2/show/NCT03335644).
Abstract via Europe PMC. Copyright remains with the authors or publisher (CC BY).
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