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PurposeTo assess the dietary share of ultra-processed foods (UPF) among Belgian children, adolescents and adults and associations with diet quality.MethodsData from the national Food Consumption Surveys 2004 (N = 3083; ≥ 15 years) and 2014–2015 (N = 3146; 3–64 years) were used. Two 24-h recalls (dietary records for children) were used for data collection. Foods consumed were classified by the level of processing using the NOVA classification. The usual proportion of daily energy intake from UPF was determined using SPADE (Statistical Program to assess dietary exposure).ResultsIn 2014/2015, 36.4% of foods consumed were ultra-processed, while 42.4% were unprocessed/minimally processed. The usual proportion of daily energy intake from UPF was 33.3% (95% CI 32.1–35.0%) for children, 29.2% (95% CI 27.7–30.3%) for adolescents and 29.6% (95% CI 28.5–30.7%) for adults. There were no differences in UPF consumption between 2004 and 2014/2015. The products contributing most to UPF consumption were processed meat (14.3%), cakes, pies, pastries (8.9%), sweet biscuits (7.7%) and soft drinks (6.7%). The UPF dietary share was significantly lower during consumption days when participants met the WHO salt intake recommendation (≤ 5 g/day) and when saturated fat was ≤ 10% of their total energy intake. The dietary share of unprocessed/minimally processed foods was significantly higher during consumption days when participants met the WHO salt and fruit/vegetable intake (≥ 400 g/day) recommendations and when saturated fat was ≤ 10% of their total energy intake.ConclusionsThe UPF dietary share is substantial and associated with lower diet quality. Internationally recommended policies to limit UPF accessibility and marketing need to be implemented to reduce UPF consumption.

AbstractObjectiveTo assess the prospective associations between consumption of ultra-processed food and risk of cancer.DesignPopulation based cohort study.Setting and participants104 980 participants aged at least 18 years (median age 42.8 years) from the French NutriNet-Santé cohort (2009-17). Dietary intakes were collected using repeated 24 hour dietary records, designed to register participants’ usual consumption for 3300 different food items. These were categorised according to their degree of processing by the NOVA classification.Main outcome measuresAssociations between ultra-processed food intake and risk of overall, breast, prostate, and colorectal cancer assessed by multivariable Cox proportional hazard models adjusted for known risk factors.ResultsUltra-processed food intake was associated with higher overall cancer risk (n=2228 cases; hazard ratio for a 10% increment in the proportion of ultra-processed food in the diet 1.12 (95% confidence interval 1.06 to 1.18); P for trend<0.001) and breast cancer risk (n=739 cases; hazard ratio 1.11 (1.02 to 1.22); P for trend=0.02). These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet (lipid, sodium, and carbohydrate intakes and/or a Western pattern derived by principal component analysis).ConclusionsIn this large prospective study, a 10% increase in the proportion of ultra-processed foods in the diet was associated with a significant increase of greater than 10% in risks of overall and breast cancer. Further studies are needed to better understand the relative effect of the various dimensions of processing (nutritional composition, food additives, contact materials, and neoformed contaminants) in these associations.Study registrationClinicaltrials.gov NCT03335644.

ObjectivesWe conducted a systematic literature review and meta-analysis of observational studies to investigate the association between diabetes, hypertension, body mass index (BMI) or smoking with the risk of death in patients with COVID-19 and to estimate the proportion of deaths attributable to these conditions.MethodsRelevant observational studies were identified by searches in the PubMed, Cochrane library and Embase databases through 14 November 2020. Random-effects models were used to estimate summary relative risks (SRRs) and 95% CIs. Certainty of evidence was assessed using the Cochrane methods and the Grading of Recommendations, Assessment, Development and Evaluations framework.ResultsA total of 186 studies representing 210 447 deaths among 1 304 587 patients with COVID-19 were included in this analysis. The SRR for death in patients with COVID-19 was 1.54 (95% CI 1.44 to 1.64, I2=92%, n=145, low certainty) for diabetes and 1.42 (95% CI 1.30 to 1.54, I2=90%, n=127, low certainty) for hypertension compared with patients without each of these comorbidities. Regarding obesity, the SSR was 1.45 (95% CI 1.31 to 1.61, I2=91%, n=54, high certainty) for patients with BMI ≥30 kg/m2 compared with those with BMI <30 kg/m2 and 1.12 (95% CI 1.07 to 1.17, I2=68%, n=25) per 5 kg/m2 increase in BMI. There was evidence of a J-shaped non-linear dose–response relationship between BMI and mortality from COVID-19, with the nadir of the curve at a BMI of around 22–24, and a 1.5–2-fold increase in COVID-19 mortality with extreme obesity (BMI of 40–45). The SRR was 1.28 (95% CI 1.17 to 1.40, I2=74%, n=28, low certainty) for ever, 1.29 (95% CI 1.03 to 1.62, I2=84%, n=19) for current and 1.25 (95% CI 1.11 to 1.42, I2=75%, n=14) for former smokers compared with never smokers. The absolute risk of COVID-19 death was increased by 14%, 11%, 12% and 7% for diabetes, hypertension, obesity and smoking, respectively. The proportion of deaths attributable to diabetes, hypertension, obesity and smoking was 8%, 7%, 11% and 2%, respectively.ConclusionOur findings suggest that diabetes, hypertension, obesity and smoking were associated with higher COVID-19 mortality, contributing to nearly 30% of COVID-19 deaths.Trial registration numberCRD42020218115.

Prevention of chronic diseases has therefore been considered a public health challenge in the past decades [2]. Besides physical activity, the nutritional quality of the diet is a major modifiable risk factor for weight management, with strong levels of evidence for protective factors (i.e., dietary fibre, Mediterranean diets) and risk factors (i.e., high energy density, free sugars, sugar sweetened drinks, and Western-type diets) [5,7]. Another characteristic of UPFs is that they are obtained after sequences of several processes, such as high-temperature extrusion, moulding, and pre-frying, and include several food additives and industrial ingredients used to imitate or enhance sensory qualities of foods or to disguise unpalatable aspects of the final product; they are also often in contact with synthetic packaging materials for long periods [25]. Consistently, several cross-sectional and ecological studies have substantiated a positive association between UPF consumption and obesity [23,35–39], but prospective studies are lacking, as only 2 of them—one in Spain [40] and one in Brazil [41]—were conducted; both relied on dietary data from food frequency questionnaires (FFQs) and studied the contribution of UPF to energy intake and therefore did not account for low-calorie and artificially sweetened products. Several indicators of the nutritional quality of the diet were also computed based on average dietary intakes from baseline 24-hour dietary records and were used as covariates: daily nutrient intake (sugar, fibre, sodium, and saturated fatty acid [SFA]) calculated using the food composition database; consumptions of several food groups (fruit, vegetables, and sugary drinks); and healthy and Western dietary patterns, derived from Principal Component Analysis (see Method D in S1 Appendix).

PurposeLipid intakes such as saturated (SFA), monounsaturated (MUFA) and polyunsaturated (PUFA) fatty acids have been widely studied regarding cardiovascular health, but their relevance to cancer is unclear. Inconsistent epidemiological results may be explained by varied mechanisms involving PUFAs and redox balance, inflammatory status and cell signalling, along with interactions with other dietary components such as antioxidants, dietary fibre and more generally fruits and vegetable intakes. Therefore, this study aimed to investigate the associations between lipid intakes and cancer risk, and their potential modulation by vitamin C, vitamin E, dietary fibre and fruit and vegetable intakes.MethodsThis prospective study included 44,039 participants aged ≥ 45 years from the NutriNet-Santé cohort (2009–2017). Dietary data were collected using repeated 24 h-dietary records. Multivariable Cox models were performed to characterize associations.ResultsSFA intake was associated with increased overall [n = 1722 cases, HRQ5vsQ1 = 1.44 (1.10–1.87), p-trend = 0.008] and breast [n = 545 cases, HRQ5vsQ1 = 1.98 (1.24–3.17), p-trend = 0.01] cancer risks. n-6 PUFA [HRQ5vsQ1 = 0.56 (0.32–0.97), p-trend = 0.01] and MUFA (HRQ5vsQ1 = 0.41 [0.18-0.0.95), p-trend = 0.009] intakes were associated with a decreased risk of digestive cancers (n = 190 cases). Associations between n-6 PUFA, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) intakes and digestive cancer risk were modulated by dietary fibre, vitamin C and fruit and vegetable intakes.ConclusionThese findings suggested that SFA intake could increase overall and breast cancer risks while some unsaturated fatty acids could decrease digestive cancer risk. However, in line with mechanistic hypotheses, our results suggest that intakes of fruits and vegetables and their constituents (antioxidants, fibre) may interact with PUFAs to modulate these associations.

IntroductionPrevious epidemiological studies have found associations between the consumption of ultra-processed foods and the risk of obesity-related outcomes, such as post-menopausal breast cancer, cardiovascular diseases, hypertension and mortality. However, only one Spanish prospective study has explored the associations between the consumption of ultra-processed foods and the risk of overweight and obesity. The aim of this study is to investigate the associations between ultra-processed food consumption and the risk of overweight and obesity, as well as the associations between ultra-processed food consumption and weight trajectories, in middle-aged adults included in the French large scale NutriNet-Santé cohort.MethodsOverall, 110260 participants aged at least 18 years from the French NutriNet-Santé cohort (2009–2019) were included. Dietary intakes were collected using repeated 24 hour dietary records, merged with a food composition database of 3300 different products. These were categorized according to their degree of processing by the NOVA classification. Associations between ultra-processed food intake and risks of overweight and obesity were assessed using multivariable Cox proportional hazard models. Associations between ultra-processed food intake and weight trajectories were assessed using multivariable linear mixed models for repeated measures with random slope and intercept. Models were adjusted for known risk factors (sociodemographic, lifestyle, and nutritional factors).ResultsUltra-processed food intake was associated with a higher risk of overweight (n = 7063 incident cases; hazard ratio for an absolute increment of 10 in the percentage of ultra-processed foods in the diet = 1.11 (95% confidence interval 1.08 to 1.14); P < 0.0001, median follow-up: 4.1y, 260304 person-years) and obesity (n = 3066 incident cases; HR = 1.09 (95% confidence interval 1.05 to 1.13); P < 0.0001, median follow-up: 8.0y 365344 person-years). Higher consumers of ultra-processed foods (4th quartile) were more likely to present an increase in body mass index over time (change of BMI/time-unit in Q4 vs Q1 = 0.04, P < 0.0001). These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet (fruits and vegetables and sugary drinks consumption, intakes of saturated fatty acids, sodium, sugar, dietary fiber or Healthy/Western patterns derived by principal component analysis) and after a large range of sensitivity analyses.ConclusionIn this large observational prospective study, higher consumption of ultra-processed foods in the diet was associated with a higher risk of overweight and obesity. Public health authorities in several countries recently started to recommend privileging unprocessed/minimally processed foods and limiting ultra-processed food consumption.

Following an application from PepsiCo International, submitted pursuant to Article 19 of Regulation (EC) No 1924/2006 via the Competent Authority of Ireland, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver an opinion on the modification of an authorised health claim related to beta‐glucans from oats or barley and reduction of postprandial glycaemic responses. The proposed modification concerns a reduction of the lowest effective dose from 4 g to 2 g of beta‐glucans (BG) per 30 g of available carbohydrates (avCHO). Beta‐glucans from oat and barley, which are the subject of the health claim, have been sufficiently characterised. A reduction of postprandial glycaemic responses is a beneficial physiological effect in the context of the food/constituent and the target population for this claim. The applicant submitted 21 pertinent published human intervention studies (59 trial comparisons) investigating the effect of beta‐glucans from oat or barley on the postprandial incremental area under the curve (iAUC) for glucose using matched comparators and conducted a dose–response meta‐regression analysis. Four published systematic reviews and dose–response meta‐regression analyses were also provided. In weighing the evidence, the Panel considered that the human intervention studies did not consistently show a significant effect of beta‐glucans from oats or barley on postprandial glucose iAUC at doses between 2 and < 4 g BG/30 g avCHO, and that dose–response data suggest a lowest effective dose above the 2 g/30 g avCHO proposed by the applicant. The Panel concludes that a consistent effect of beta‐glucans from oats or barley on the reduction of postprandial glycaemic responses has not been demonstrated under the conditions of use proposed by the applicant of at least 2 g BG/30 g avCHO consumed with a meal.

Following an application from Mediconomics APS, submitted for authorisation of a health claim pursuant to Article 13(5) of Regulation (EC) No 1924/2006 via the Competent Authority of Denmark, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver an opinion on the scientific substantiation of a health claim related to calcium sulphate and reduction in body weight. The Panel considers that the food constituent, calcium sulphate, is sufficiently characterised. A reduction in body weight is a beneficial physiological effect for overweight adults. The applicant submitted two human intervention studies investigating the effect of calcium sulphate on body weight. The Panel notes that no conclusions can be drawn from any of the human intervention studies submitted for the scientific substantiation of the claim and that no convincing evidence has been provided for a mechanism by which calcium sulphate could exert the claimed effect in vivo in humans. The Panel concludes that a cause and effect relationship has not been established between the consumption of calcium sulphate and a beneficial physiological effect on body weight under the proposed conditions of use.

Following an application from QvExtra! Internacional pursuant to Article 14 of Regulation (EC) No 1924/2006 via the Competent Authority of Spain, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver an opinion on the scientific substantiation of a health claim related to phenolic compounds naturally present in olive oil and lowering of blood LDL‐cholesterol (LDL‐c) and systolic blood pressure (SBP), therefore reducing the risk of coronary heart disease (CHD). The scope of the application was proposed to fall under a health claim referring to disease risk reduction. The Panel considers that the food/constituent, phenolic compounds naturally present in olive oil, is sufficiently characterised, and that lowering of blood LDL‐c and SBP are beneficial effects by reducing the risk of CHD. The applicant identified seven pertinent human intervention studies investigating the effect of olive oil polyphenols on LDL‐c and/or SBP. In weighing the evidence with regard to blood LDL‐c, the Panel considered that, although one human intervention study in hypercholesteraemic individuals showed a reduction in LDL‐c following daily consumption of olive oil polyphenols for 3 weeks, these results are not supported by other studies. The Panel also considered that no evidence was available for the sustainability of the effect over longer periods of time (e.g. ≥ 8 weeks), or for a plausible mechanism of action. In weighing the evidence with regard to SBP, the Panel took into account that, although some evidence for a plausible mechanism by which phenolic compounds in olive oil could exert the claimed effect has been provided, the studies submitted did not show an effect of olive oil polyphenols on SBP. The Panel concludes that a cause‐and‐effect relationship has not been established between the consumption of phenolic compounds naturally present in olive oil and the reduction of blood LDL‐c or SBP.