Ultra-processed Foods Linked To 32 Health Issues – Expert Reaction

A new research review reports links between greater
consumption of ultra-processed foods and an increased risk
of 32 damaging health outcomes, with the most convincing
evidence pointing to higher risks of cardiovascular disease,
type 2 diabetes, and common mental health
disorders.

The study published in The
BMJ conducted a high-level evidence summary, or
“umbrella review,” of 45 previously conducted
meta-analyses from 14 review articles linking
ultra-processed foods with adverse health outcomes. The
review articles were all published in the past three years
and involved almost 10 million participants.

The SMC
asked experts to comment.

Dr Andrew Reynolds,
Department of Medicine, University of Otago,
comments:

“Is this something new? While this
study is impressively well conducted and in a prestigious
journal, it is the latest in a series of similar reviews.
The last one was published less
than a fortnight ago. All reviews to date have looked at
the same observational associations while calling for
mechanistic studies and trials to be done.

“Is
this topic important? Undoubtedly. Absolutely. Yes. What
we eat is incredibly important to our health. But is
ultra-processing the right lens to look at the health of
what we eat? This publication relies on the NOVA
classification system, which ignores much of what we
understand about nutrients, food groups, and dietary
patterns to classify a food into one of four categories.
Pound-for-pound, every food in the same category is
considered equal. This means that frozen peas with mint and
a sugar-coated doughnut are the same, they are both
ultra-processed. Except they aren’t the same? One is a
vegetable with a flavour added, the other is an occasional
food, or something to be enjoyed in moderation. This new
publication recognises that ‘diets rich in ultra-processed
foods are associated with markers of poor diet quality, with
higher levels of added sugars, saturated fat, and sodium;
higher energy density; and lower fibre, protein, and
micronutrients’ but does not control for these factors in
its analysis.

“What should happen next? It
would be really useful to understand the health effects of
different food processing techniques, then how they work in
combination, and then build a classification system that is
based on that new knowledge and the existing knowledge of
nutrients, foods, and dietary patterns. Alternatively, what
we already know about healthy kai should be used to improve
the food environment around us. Healthy kai is not the
cheapest kai, nor is it equitably available to all New
Zealanders. We could remove the barriers to healthy kai
first, rather than seek new ways to identify unhealthy
foods?”

Conflict of interest statement: “I am a
Senior Research Fellow funded by the Heart Foundation of New
Zealand. One of my research interests is the effects of food
processing on cardiometabolic health.”

Dr
Kathryn Bradbury, Senior Heart Foundation Fellow, Senior
Research Fellow, Department of Epidemiology and
Biostatistics, School of Population Health, University of
Auckland, comments:

“This umbrella review looked at
studies which had systematically reviewed all the available
evidence on ultraprocessed food consumption and health
outcomes.

“The authors of the umbrella review found
that there was moderate quality evidence that eating higher
amounts of ultraprocessed food increases the risk of death,
type 2 diabetes, and being overweight or obese, and does not
affect the risk of prostate cancer. They also found low
quality evidence that eating higher amounts of
ultraprocessed food may increase the risk of death from
cardiovascular diseases, as well as anxiety.

“More
evidence is needed to confirm these findings, and to confirm
the direction of some of the relationships. For example, it
is possible that having anxiety leads to eating more
ultraprocessed foods, and not the other way around. We also
need further research into the mechanisms of how
ultraprocessed foods might influence health
outcomes.

“The ultraprocessed foods category is very
broad but usually includes foods and drinks that are high in
calories, sugar, fat or salt. Foods like chips and fizzy
drinks are classified as ultraprocessed, but packaged,
sliced wholegrain bread is also technically ultraprocessed,
and bread is a major source of fibre in Aotearoa New
Zealand. Of course, as a population we should be cutting
down on fizzy drinks but wholegrain bread and some of the
other foods which are categorised as ultraprocessed are
actually ones we recommend in our dietary
guidelines.”

No conflict of
interest.

Professor Emeritus Elaine Rush, Auckland
University of Technology, Riddet Institute,
comments:

“Ultra-processed foods consist of
combinations of ingredients that are put together using a
series of industrial techniques and processes. Ingredients
include sugar, fat and salt and these ingredients may be
chemically modified and include additives that make the
product tastier, more palatable and more attractive. The
ingredients are usually cheap and have a long shelf-life.
Food based dietary guidelines for health and the planet do
not include ultra processed foods which are also often
labelled as treat or occasional (once a week)
foods.

“Evidence is accumulating that some food
additives may cause harm – both to human function and the
health of the microbes that live in the gut which in turn
affect our health and well being.

“This timely and
very large umbrella review pulls together evidence and
analysis of many studies with around 10 million people
showing that the more ultra-processed foods eaten the higher
the risk of nutrition related chronic disease and loss of
quality of life. It is very clear – ultra-processed foods
are not good for human health. The more that are consumed
the associated harm is greater. While the authors recommend
population-based measures to reduce dietary exposure to
ultra-processed foods, i.e. eat less ultra-processed food,
they do not explicitly say what foods could be eaten instead
and how they could be provided at the same cost and access.
Evidence-based dietary guidelines for health recommend a
diverse variety of minimally processed foods but there is a
huge mismatch between what food is produced, imported, its
cost and availability and what the guidelines say. It is not
possible to feed all New Zealand people well given the
current state of the food system. Of particular concern is
the present and future health of children which is shaped by
the quality of food they are exposed to from conception.
Food insecurity is not being able to access nutritious food
and the drivers and solutions for this involve all players
in the food system.”

No conflict of
interest.

Dr Sally Mackay, Co-chair Health
Coalition Aotearoa Food Expert Group, Senior Lecturer,
School of Population Health, University of Auckland,
comments:

“The NOVA system classifies foods
according to the level of processing from
unprocessed/minimally processed, processed through to
ultra-processed foods (UPF) (hyperpalatable foods often high
in energy, sodium and sugar). This umbrella review published
in The BMJ assesses the emerging body of evidence that UPFs
are associated with a range of health parameters – 32 were
identified in this review that are beyond the usual
diet-related diseases (cardiovascular disease, diabetes,
cancer) and include respiratory and mental
health.

“UPFs are a large and varied food group that
includes everyday items like sliced, wholegrain bread and
breakfast cereals as well as the foods we typically consider
‘junk food’ like fast-food, extruded snacks, carbonated
drinks and confectionery. In fact in 2018 69% of packaged
foods were ultra-processed. The researchers recommend more
research to understand the aspects of UPFs that are linked
to poor health. This will help us translate this research
into practical recommendations of which UPF are most
harmful.

“However. we don’t need to wait for
research to implement policies that restrict marketing of
unhealthy food and beverages, mandatory display of Health
Star Ratings, and a levy on sugar-sweetened
beverages.”

No conflict of
interest.

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