Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses
Lane MM, Gamage E, Du S, Ashtree DN, McGuinness AJ, Gauci S, Baker P, Lawrence M, Rebholz CM, Srour B, Touvier M, Jacka FN, O'Neil A, Segasby T, Marx W
BMJ (Clinical research ed.) · 677 citations
How it was studied
- Design
- Systematic review (indexed by PubMed)
- Studied in
- People
- Main outcome
- Clinical events such as disease or death
- Intake measured by
- Not stated
Who paid for it
- Funding
- Independent funding
- Nonprofit
- Bloomberg Philanthropies
- Nonprofit
- Multiple Sclerosis Australia
- University or hospital
- Deakin University
- University or hospital
- Monash University
- University or hospital
- Dasman Diabetes Institute
- Nonprofit
- Barwon Health Foundation
- Unclassified
- MTPConnect
- Government
- Medical Research Council
- Government
- National Health and Medical Research Council
- Grants
- National Health and Medical Research Council (2008971); National Health and Medical Research Council (2009295)
Based on 9 listed funder(s).
Publication
- Published
- 2024-02-28 · BMJ · vol. 384 · p. e077310
- Cited
- 850 citations · more than 100% of similar papers · 325.3× the field average
- Impact
- Top 10% most cited in its field
- References
- 104 works
- Access
- Open access (hybrid journal) · CC-BY-NC
- Research areas
- Consumer Attitudes and Food Labeling · Biochemical Analysis and Sensing Techniques · Effects and risks of endocrine disrupting chemicals
- Keywords
- Medicine, MEDLINE, Confidence interval, Systematic review, Meta-analysis, Cochrane Library, Cohort study, PsycINFO, Relative risk, Environmental health, Internal medicine
- MeSH
- humans, cardiovascular diseases, meta-analysis as topic, food, processed
15 authors
From AU, US, FR, IE
- Melissa M. Lane · correspondingBarwon Health; Deakin University
- Elizabeth GamageBarwon Health; Deakin University
- Shutong DuJohns Hopkins University
- Deborah N AshtreeBarwon Health; Deakin University
- Amelia J. McGuinnessBarwon Health; Deakin University
- Sarah GauciBarwon Health; Deakin University; Monash University
Abstract
Objective
To evaluate the existing meta-analytic evidence of associations between exposure to ultra-processed foods, as defined by the Nova food classification system, and adverse health outcomes.
Design
Systematic umbrella review of existing meta-analyses.
Data sources
MEDLINE, PsycINFO, Embase, and the Cochrane Database of Systematic Reviews, as well as manual searches of reference lists from 2009 to June 2023.
Eligibility criteria for selecting studies
Systematic reviews and meta-analyses of cohort, case-control, and/or cross sectional study designs. To evaluate the credibility of evidence, pre-specified evidence classification criteria were applied, graded as convincing ("class I"), highly suggestive ("class II"), suggestive ("class III"), weak ("class IV"), or no evidence ("class V"). The quality of evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework, categorised as "high," "moderate," "low," or "very low" quality.
Results
The search identified 45 unique pooled analyses, including 13 dose-response associations and 32 non-dose-response associations (n=9 888 373). Overall, direct associations were found between exposure to ultra-processed foods and 32 (71%) health parameters spanning mortality, cancer, and mental, respiratory, cardiovascular, gastrointestinal, and metabolic health outcomes. Based on the pre-specified evidence classification criteria, convincing evidence (class I) supported direct associations between greater ultra-processed food exposure and higher risks of incident cardiovascular disease related mortality (risk ratio 1.50, 95% confidence interval 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). Highly suggestive (class II) evidence indicated that greater exposure to ultra-processed foods was directly associated with higher risks of incident all cause mortality (risk ratio 1.21, 1.15 to 1.27; low), heart disease related mortality (hazard ratio 1.66, 1.51 to 1.84; low), type 2 diabetes (odds ratio 1.40, 1.23 to 1.59; very low), and depressive outcomes (hazard ratio 1.22, 1.16 to 1.28; low), together with higher risks of prevalent adverse sleep related outcomes (odds ratio 1.41, 1.24 to 1.61; low), wheezing (risk ratio 1.40, 1.27 to 1.55; low), and obesity (odds ratio 1.55, 1.36 to 1.77; low). Of the remaining 34 pooled analyses, 21 were graded as suggestive or weak strength (class III-IV) and 13 were graded as no evidence (class V). Overall, using the GRADE framework, 22 pooled analyses were rated as low quality, with 19 rated as very low quality and four rated as moderate quality.
Conclusions
Greater exposure to ultra-processed food was associated with a higher risk of adverse health outcomes, especially cardiometabolic, common mental disorder, and mortality outcomes. These findings provide a rationale to develop and evaluate the effectiveness of using population based and public health measures to target and reduce dietary exposure to ultra-processed foods for improved human health. They also inform and provide support for urgent mechanistic research.
Systematic review registration
PROSPERO CRD42023412732.
Abstract via Europe PMC. Copyright remains with the authors or publisher (CC BY-NC).
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