Consumption of Ultra-Processed Foods Increases the Likelihood of Having Obesity in Korean Women

This study aimed to determine the association between consumption of ultra-processed foods and obesity among Korean adults. We used the data of 7364 participants (men 3219, women 4145) aged 19–64 years from the Korea National Health and Nutrition Examination Survey (KNHANES), 2016–2018. Food items were classified using the NOVA food classification system, depending on the extent and purpose of food processing: (1) unprocessed or minimally processed foods, (2) processed culinary ingredients, (3) processed foods, and (4) ultra-processed foods. Consumption of ultra-processed foods accounted for 26.8% of the total energy intake. After adjusting for potential confounders including sociodemographic and lifestyle characteristics, subjects with the highest consumption of ultra-processed foods (fourth quartile of % energy intake from ultra-processed foods) had 0.61 kg/m² higher body mass index (BMI; 95% confidence interval [CI] 0.23–0.99, p-trend 0.0047), 1.34 cm higher waist circumference (WC; 95% CI 0.35–2.34, p-trend 0.0146), 51% higher odds of being obese (BMI > 25 kg/m²; odds ratio [OR] 1.51, 95% CI 1.14–1.99, p-trend 0.0037), and 64% higher odds of abdominal obesity (men: WC ≥ 90 cm, women: WC ≥ 85 cm; OR 1.64, 95% CI 1.24–2.16, p-trend 0.0004) than those with the lowest consumption (first quartile) among women. However, no association was found in men. These findings provide evidence that high consumption of ultra-processed foods is positively associated with obesity in Korean women. Further studies with a large-scale cohort or intervention trial are needed to identify the mechanism of associations between consumption of ultra-processed foods and health-related outcomes including obesity in Korea.     

Consumption of ultra-processed foods and obesity in Brazilian adolescents and adults

ObjectivesThe aim of this study was to evaluate the relationship between the consumption of ultra-processed foods and obesity indicators among Brazilian adults and adolescents.MethodsWe used cross-sectional data on 30,243 individuals aged ≥ 10 years from the 2008–2009 Brazilian Dietary Survey. Food consumption data were collected through 24-h food records. We classified food items according to characteristics of food processing. Ultra-processed foods were defined as formulations made by the food industry mostly from substances extracted from foods or obtained with the further processing of constituents of foods or through chemical synthesis, with little if any whole food. Examples included candies, cookies, sugar-sweetened beverages, and ready-to-eat dishes. Regression models were fitted to evaluate the association of the consumption of ultra-processed foods (% of energy intake) with body-mass-index, excess weight, and obesity status, controlling for socio-demographic characteristics, smoking, and physical activity.ResultsUltra-processed foods represented 30% of the total energy intake. Those in the highest quintile of consumption of ultra-processed foods had significantly higher body-mass-index (0.94 kg/m²; 95% CI: 0.42,1.47) and higher odds of being obese (OR = 1.98; 95% CI: 1.26,3.12) and excess weight (OR = 1.26; 95% CI: 0.95,1.69) compared with those in the lowest quintile of consumption.ConclusionOur findings support the role of ultra-processed foods in the obesity epidemic in Brazil.     

Associations Between Ultra-processed Foods Consumption and Indicators of Adiposity in US Adolescents: Cross-Sectional Analysis of the 2011-2016 National Health and Nutrition Examination Survey

BackgroundUltra-processed foods represent a considerable part of the diet of US children and adolescents, yet their association with total, abdominal, and visceral overweight/obesity remains understudied.ObjectiveTo examine associations between dietary contribution of ultra-processed foods and total, abdominal, and visceral overweight/obesity in a nationally representative sample of US adolescents.DesignCross-sectional analyses were performed on data collected from adolescents participating in the 2011-2016 National Health and Nutrition Examination Survey.Participants/settingParticipants included 3587 adolescents aged 12 to 19 years, who had data from at least 1 day of valid 24-hour dietary recall data.Main outcome measuresTotal overweight/obesity, abdominal overweight/obesity, and visceral overweight/obesity data were collected.Statistical analyses performedAll food items (grams per day) recorded in the 24-hour recalls were classified according to Nova. Multiple logistic regressions were used to evaluate associations between the dietary contribution of ultra-processed foods (expressed in percentage of total grams per day) and outcomes. Multivariable models were adjusted for sociodemographic covariates, physical activity, total energy intake, whether the individual was following a special diet for weight loss, and indicators of the nutritional quality of the diet.ResultsIn multivariable analyses, the highest consumption of ultra-processed food was associated with 45%, 52%, and 63% higher odds of total, abdominal, and visceral overweight/obesity, respectively (odds ratio [OR] 1.45, 95% CI 1.03-2.06, P for linear trend = .040; OR 1.52, 95% CI 1.06-2.18, P for linear trend = .026; OR 1.63, 95% CI 1.19-2.24, P for linear trend = .005, respectively), compared with the lowest consumption. A 10% increment in the proportion of ultra-processed foods in the diet was associated with an increased risk of both abdominal overweight/obesity (OR 1.07; 95% CI 1.01-1.13) and visceral overweight/obesity (OR 1.07; 95% CI 1.02-1.13).ConclusionsStudy findings support the growing evidence of cross-sectional and prospective associations between ultra-processed foods and increased adiposity and also with metabolically unhealthy phenotypes of obesity in adolescence. Timely action to reduce the consumption of ultra-processed foods among adolescents is needed.     

Association between Ultra-processed Food Consumption and Dietary Intake and Diet Quality in Korean Adults

BackgroundFood environments have changed rapidly, and the global interest in ultra-processed foods has increased. Ultra-processed foods are typically energy dense, high in sugars and fat, and low in fiber, protein, minerals, and vitamins.ObjectiveThis study aimed to estimate the energy contribution of ultra-processed foods in the diet of Korean adults and to examine the association between ultra-processed food consumption and dietary intake and diet quality.DesignThis study is a secondary analysis of cross-sectional data from the Korea National Health and Nutrition Examination Survey (2016–2018).Participants/settingsA total of 16,657 adults aged ≥19 years who completed a 1-day 24-hour recall.Main outcome measuresAbsolute and relative intake of energy and nutrients were measured and dietary quality was assessed using the Korean Healthy Eating Index (KHEI).Statistical analysisMultiple regression models adjusted for sociodemographic variables were used to examine the association between quintiles of ultra-processed foods dietary energy contribution and dietary intake and quality.ResultsMean reported daily energy intake was 2,031 kcal, with 25.1% of calories coming from ultra-processed foods. Mean energy contribution from ultra-processed foods ranged from 3.6% kcal (Q1) to 52.4% kcal (Q5). Energy contribution of ultra-processed foods was positively associated with reported intake of daily energy, total sugars, and total and saturated fat and inversely associated with reported intake of carbohydrates, fiber, minerals, and vitamins. Both sodium and potassium were negatively associated with percentage of energy from ultra-processed foods. However, the sodium-to-potassium ratio was high regardless of quintile of energy contribution from ultra-processed foods, and the ratio was positively associated with percentage of total energy from ultra-processed foods. Although the KHEI score was inversely associated with percentage of daily energy from ultra-processed foods, all levels of ultra-processed food consumption were associated with poor diet quality.ConclusionsThe ultra-processed foods consumption of Korean adults accounted for one fourth of daily energy intake, and a higher dietary energy contribution from ultra-processed foods was associated with poorer dietary intakes and a lower dietary quality. Further studies are needed to understand factors influencing selection and consumption of ultra-processed foods and to identify effective strategies to promote healthy food choices.     

Ultra-Processed Food Consumption Associated with Overweight/Obesity among Chinese Adults—Results from China Health and Nutrition Survey 1997–2011

The association between the consumption of ultra-processed food (UPF) with overweight/obesity in Chinese adults has not been investigated. This study included a cohort of 12,451 adults aged >20 years who participated at least twice in the China Nutrition and Health Survey (CNHS) during 1997–2011. Food intake at each survey was assessed using a 3-day 24-h dietary recall. Body weight (kg), height (m), and waist circumference (WC) were measured during the survey. UPF was defined by the NOVA classification. Mixed effect logistic regression analyses were used. The mean UPF consumption of the study population (baseline mean age 43.7 years) increased from 12.0 g in 1997 to 41.5 g in 2011 with the corresponding proportion of UPF in daily diet from 1.0% to 3.6%. The adjusted odds ratios (95% CI) for BMI ≥ 25 kg/m² for those with mean UPF consumption of 1–19 g/d, 20–49 g/d, and ≥50 g/d were 1.45 (1.26–1.65), 1.34 (1.15–1.57), and 1.45 (1.21–1.74), respectively (p-trend = 0.015), compared with the non-consumers. Similarly, the corresponding adjusted ORs (95% CI) for central obesity were 1.54 (1.38–1.72), 1.35 (1.19–1.54), and 1.50 (1.29–1.74). Higher long-term UPF consumption was associated with increased risk of overweight/obesity among Chinese adults.     

Disentangling Race and Social Context in Understanding Disparities in Chronic Conditions among Men

Disparities in men’s health research may inaccurately attribute differences in chronic conditions to race rather than the different health risk exposures in which men live. This study sought to determine whether living in the same social environment attenuates race disparities in chronic conditions among men. This study compared survey data collected in 2003 from black and white men with similar incomes living in a racially integrated neighborhood of Baltimore to data from the 2003 National Health Interview Survey. Multivariable logistic regression models estimated to determine whether race disparities in chronic conditions were attenuated among men living in the same social environment. In the national sample, black men exhibited greater odds of having hypertension (odds ratio [OR] = 1.58, 95 % confidence interval [CI] 1.34, 1.86) and diabetes (OR = 1.62, 95 % CI 1.27–2.08) than white men. In the sample of men living in the same social context, black and white respondents had similar odds of having hypertension (OR = 1.05, 95 % CI 0.70, 1.59) and diabetes (OR = 1.12, 95 % CI 0.57–2.22). There are no race disparities in chronic conditions among low-income, urban men living in the same social environment. Policies and interventions aiming to reduce disparities in chronic conditions should focus on modifying social aspects of the environment.     

Socioeconomic Characteristics and Trends in the Consumption of Ultra-Processed Foods in Korea from 2010 to 2018

There is growing evidence for a global transition to a more highly processed diet. While the dietary share of ultra-processed foods depends on a country’s economic status, food choice and consumption are also influenced by the socioeconomic situation of individuals. This study investigated whether ultra-processed food consumption differed across socioeconomic subgroups and over time (2010–2018) in Korea. Cross-sectional data from the Korea National Health and Nutrition Examination Survey 2010–2018 were analyzed. Food and beverages reported in a one-day 24 h recall were classified according to the NOVA food classification criteria. The dietary energy contribution of ultra-processed foods was high among men and urban residents, and increased with education and income level; additionally, it reached its peak in adolescents and thereafter decreased with increasing age. After adjusting the socioeconomic variables, such associations remained significant, except for income level. The overall contribution of ultra-processed foods increased from 23.1% (2010–2012) to 26.1% (2016–2018), and the same trend over time was observed in all age groups and socioeconomic strata. In the Korean population, ultra-processed food consumption differed by individual socioeconomic characteristics, but gradually increased over time, and this trend was consistently found in all socioeconomic subgroups. Future strategies to promote healthy food choices are needed for the Korean population.     

Relationship of Soft Drink Consumption to Global Overweight,Obesity, and Diabetes: A Cross-National Analysis of 75 Countries

Objectives. We estimated the relationship between soft drink consumption and obesity and diabetes worldwide.Methods. We used multivariate linear regression to estimate the association between soft drink consumption and overweight, obesity, and diabetes prevalence in 75 countries, controlling for other foods (cereals, meats, fruits and vegetables, oils, and total calories), income, urbanization, and aging. Data were obtained from the Euromonitor Global Market Information Database, the World Health Organization, and the International Diabetes Federation. Bottled water consumption, which increased with per-capita income in parallel to soft drink consumption, served as a natural control group.Results. Soft drink consumption increased globally from 9.5 gallons per person per year in 1997 to 11.4 gallons in 2010. A 1% rise in soft drink consumption was associated with an additional 4.8 overweight adults per 100 (adjusted B; 95% confidence interval [CI] = 3.1, 6.5), 2.3 obese adults per 100 (95% CI = 1.1, 3.5), and 0.3 adults with diabetes per 100 (95% CI = 0.1, 0.8). These findings remained robust in low- and middle-income countries.Conclusions. Soft drink consumption is significantly linked to overweight, obesity, and diabetes worldwide, including in low- and middle-income countries.Obesity and associated diabetes rates are rising worldwide.1–3 More than 1.5 billion people worldwide are now overweight, and at least 1 in 20 adults now have diabetes.2,3 Globally, obesity has doubled since 1980, such that most of the world’s population now lives in countries where there are more deaths attributable to being overweight than to being underweight.3 The prevalence of diabetes among adults aged 20 to 79 years rose from 5.5% in 2000 to 7.0% in 2010; 60% of people with diabetes live in low- or middle-income countries.2These adverse trends are often attributed to changing patterns of nutrition and decreased physical activity, in association with broader socioeconomic changes, such as economic development, urbanization, and aging.4 There is controversy whether increasing consumption of so-called “Western” foods, such as soft drinks and processed foods, is a contributing factor to obesity outside of the United States and Western Europe.5–7 In the United States, consumption of sugar-sweetened beverages, particularly soft drinks, has been associated with rising obesity and diabetes.8–11 Sugar-sweetened beverages contain large amounts of refined sugars, conferring a high glycemic load while having poor satiating properties, which is believed to contribute to excessive weight gain, the metabolic syndrome, and insulin resistance.12–14There have been few empirical studies of the role of soft drinks on the epidemiology of obesity and diabetes in low- and middle-income countries.15,16 Major increases in soft drink consumption have occurred not only in the United States and Western Europe but also in other countries; three fifths of global consumption now occurs outside of Western countries. However, evidence to test the hypothesis that such consumption is related to obesity and obesity-related health outcomes has been limited for 2 reasons. First, there has been a lack of consistent, comparable data on obesity and related health outcomes in low- and middle-income countries; only recently have international efforts been made to systematically estimate body mass index and diabetes prevalence worldwide.2,3 Second, there has been a lack of data to reflect the actual consumption of soft drinks in these countries. Although the Food and Agricultural Organization publishes data describing the availability of different commodities, industry data on actual consumer-level purchasing only recently has become available in a systematically collected, comparable format.17In this study, we drew upon recently published overweight, obesity, and diabetes prevalence data, and compared these data with new industry data sources to test the hypothesis that soft drink consumption was related to population-level rates of overweight, obesity, and diabetes worldwide.     

Weight bias and support of public health policies

ObjectivesPublic health policies have been proposed to help address prevalent Canadian obesity rates. Along with the increase in obesity prevalence, explicit weight bias is also rampant in Western society. This paper aimed to assess the association between explicit weight bias attitudes and Canadian public support of these policy recommendations.MethodsCanadian adults (N = 903; 51% female; BMI = 27.3 ± 7.0 kg/m²) completed an online survey measuring explicit weight bias, using the three subscales of the Anti-Fat Attitudes Questionnaire: Willpower (belief in weight controllability), Fear of fat (fear of gaining weight), and Dislike (antipathy towards people with obesity). Whether these subscales were associated with policy support was assessed with logistic regression. Analyses were adjusted for age, race, gender, and income.ResultsPublic support of policy recommendations ranged from 53% to 90%. Explicit weight bias was primarily expressed through a fear of weight gain and the belief that weight gain was within the individual’s control based on willpower. Although the Dislike subscale was associated with lower support for several policies that enable or guide individual choice in behaviour change, the Willpower and Fear of fat subscales were associated with greater support for similar policies.ConclusionThis study contributes to evidence-informed public health action by describing public support of public health policies and demonstrating an association between explicit weight bias and public support. A higher total explicit weight bias score increased the odds of supporting primarily less intrusive policies. However, dislike of individuals with obesity was associated with decreased odds of supporting many policies.     

A Systematic Review on Processed/Ultra-Processed Foods and Arterial Hypertension in Adults and Older People

The increase in the availability of processed and ultra-processed foods has altered the eating patterns of populations, and these foods constitute an exposure factor for the development of arterial hypertension. This systematic review analyzed evidence of the association between consumption of processed/ultra-processed foods and arterial hypertension in adults and older people. Electronic searches for relevant articles were performed in the PUBMED, EMBASE and LILACS databases. The review was conducted following the PRISMA guidelines and the Newcastle–Ottawa Scale. The search of the databases led to the retrieval of 2323 articles, eight of which were included in the review. A positive association was found between the consumption of ultra-processed foods and blood pressure/arterial hypertension, whereas insufficient evidence was found for the association between the consumption of processed foods and arterial hypertension. The results reveal the high consumption of ultra-processed foods in developed and middle-income countries, warning of the health risks of such foods, which have a high energy density and are rich in salt, sugar and fat. The findings underscore the urgent need for the adoption of measures that exert a positive impact on the quality of life of populations, especially those at greater risk, such as adults and older people.     

Do statutory holidays impact the number of opioid-related hospitalizations among Canadian adults? Findings from a national case-crossover study

ObjectiveIn Canada, emergency department visits, hospitalizations, and deaths due to opioid use have risen substantially in recent years. While these events have exhibited seasonal and day of week patterns, there have been no attempts to investigate the extent to which statutory holidays influence these patterns, particularly opioid-related hospitalizations.MethodsWe applied a time-stratified case-crossover study design to investigate whether statutory holidays were predictive of opioid-related hospitalizations using the Canadian Discharge Abstract Database (excluding Quebec) for fiscal years 2011/2012 to 2016/2017. This design controls for day of week effects. We restricted analyses to opioid hospitalizations (ICD-10 codes: F11.x, T40.0–T40.4, and T40.6) among individuals 15 years and older. Conditional logistic regression models were fit to estimate the odds of opioid-related hospitalization on holidays relative to non-holidays. We examined these patterns across different holiday types, namely social gathering holidays (e.g., Canada Day) and family holidays (e.g., Christmas). Stratified analyses were done to identify whether these associations varied by age group and sex.ResultsWe identified a total of 59,965 opioid-related hospitalizations. Overall, we found a 12% reduced odds in opioid hospitalizations on holidays (odds ratio [OR] = 0.88, 95% CI 0.83, 0.93) relative to non-holidays. Similar reductions were observed for both family (OR = 0.86, 95% CI 0.79, 0.93) and social gathering holidays (OR = 0.90, 95% CI 0.84, 0.96). No substantive differences were noted by age group or sex.ConclusionsOur findings support the hypothesis that opioid-related hospitalizations occur less frequently on statutory holidays. This knowledge may help inform healthcare resources and health promotion activities to reduce the impacts of opioid use.     

Ultra-processed Foods and Cardiovascular Diseases: Potential Mechanisms of Action

Ultra-processed foods are industrially manufactured ready-to-eat or ready-to-heat formulations containing food additives and little or no whole foods, in contrast to processed foods, which are whole foods preserved by traditional techniques such as canning or pickling. Recent epidemiological studies suggest that higher consumption of ultra-processed food is associated with increased risk of cardiovascular disease (CVD). However, epidemiological evidence needs to be corroborated with criteria of biological plausibility. This review summarizes the current evidence on the putative biological mechanisms underlying the associations between ultra-processed foods and CVD. Research ranging from laboratory-based to prospective epidemiological studies and experimental evidence suggest that ultra-processed foods may affect cardiometabolic health through a myriad of mechanisms, beyond the traditionally recognized individual nutrients. Processing induces significant changes to the food matrix, for which ultra-processed foods may affect health outcomes differently than unrefined whole foods with similar nutritional composition. Notably, the highly degraded physical structure of ultra-processed foods may affect cardiometabolic health by influencing absorption kinetics, satiety, glycemic response, and the gut microbiota composition and function. Food additives and neo-formed contaminants produced during processing may also play a role in CVD risk. Key biological pathways include altered serum lipid concentrations, modified gut microbiota and host–microbiota interactions, obesity, inflammation, oxidative stress, dysglycemia, insulin resistance, and hypertension. Further research is warranted to clarify the proportional harm associated with the nutritional composition, food additives, physical structure, and other attributes of ultra-processed foods. Understanding how ultra-processing changes whole foods and through which pathways these foods affect health is a prerequisite for eliminating harmful processing techniques and ingredients.     

Socioeconomic position and consumption of sugary drinks,sugar-sweetened beverages and 100% juice among Canadians: a cross-sectional analysis of the 2015 Canadian Community Health Survey–Nutrition

ObjectiveThe aim of this study was to describe sugary drink (beverages with free sugars), sugar-sweetened beverage (beverages with added sugars, SSB) and 100% juice (beverages with natural sugars) consumption across socioeconomic position (SEP) among Canadians.MethodsWe conducted a cross-sectional analysis of 19,742 respondents of single-day 24-h dietary recalls in the nationally representative 2015 Canadian Community Health Survey–Nutrition. Poisson regressions were used to estimate the prevalence of consuming each beverage type on a given day. Among consumers on a given day, linear regressions were used to estimate mean energy intake. Models included household education, food security and income quintiles as separate unadjusted exposures. Sex-specific models were estimated separately for children/adolescents (2–18 years) and adults (19 +).ResultsAmong female children/adolescents, the prevalence of consuming sugary drinks and, separately, SSB ranged from 11 to 21 and 8 to 27 percentage-points higher among lower education compared to ‘Bachelor degree or above’ households. In female adults, the prevalence of consuming sugary drinks and, separately, SSB was 10 (95% CI: 1, 19) and 14 (95% CI: 2, 27) percentage-points higher in food insecure compared to secure households. In males, the prevalence of consuming 100% juice was 9 (95% CI: − 18, 0) percentage-points lower among food insecure compared to secure households. Social inequities in energy intake were observed in female adult consumers, among whom mean energy from sugary drinks was 27 kcal (95% CI: 3, 51) higher among food insecure compared to secure and 35 kcal (95% CI: 2, 67) higher from 100% juice among ‘less than high school’ education compared to ‘Bachelor degree or above’ households.ConclusionSocial inequities in sugary drink consumption exist in Canada. The associations differed by SEP indicator. Equitable interventions to reduce consumption are warranted.     

Racial/Ethnic Disparities in Hypertension Prevalence: Reconsidering the Role of Chronic Stress

Objectives. We investigated the association between anticipatory stress, also known as racism-related vigilance, and hypertension prevalence in Black, Hispanic, and White adults.Methods. We used data from the Chicago Community Adult Health Study, a population-representative sample of adults (n = 3105) surveyed in 2001 to 2003, to regress hypertension prevalence on the interaction between race/ethnicity and vigilance in logit models.Results. Blacks reported the highest vigilance levels. For Blacks, each unit increase in vigilance (range = 0–12) was associated with a 4% increase in the odds of hypertension (odds ratio [OR] = 1.04; 95% confidence interval [CI] = 1.00, 1.09). Hispanics showed a similar but nonsignificant association (OR = 1.05; 95% CI = 0.99, 1.12), and Whites showed no association (OR = 0.95; 95% CI = 0.87, 1.03).Conclusions. Vigilance may represent an important and unique source of chronic stress that contributes to the well-documented higher prevalence of hypertension among Blacks than Whites; it is a possible contributor to hypertension among Hispanics but not Whites.Racial and ethnic disparities in hypertension are some of the most widely studied and consequential sources of social disparities in health in the United States.1–3 For example, recent prevalence estimates show that roughly 40% of Black adults but only 30% of White adults have hypertension.4 In addition, the incidence of hypertension occurs at younger ages for Blacks than Whites.1 These disparities are reflected in the larger burden of hypertension-related health and economic costs carried by non-White than White Americans. For example, mortality rates attributable to hypertension are roughly 15 deaths per 100 000 people for White men and women; the mortality rate for Black women is 40 per 100 000 and more than 50 per 100 000 for Black men.5 Among all health conditions, hypertension accounts for the greatest portion of disparities in years of lost life.6 Economically speaking, if Black Americans had the hypertension prevalence of White Americans, about $400 million would be saved in out-of-pocket health care expenses, about $2 billion would be saved in private insurance costs, and $375 million would be saved from Medicare and Medicaid—per year.7Despite the tremendous amount of research devoted to clarifying the factors that generate these disparities, most studies find that they persist after adjustment for a wide range of socioeconomic, behavioral, and biomedical risk factors.8 In fact, although disparities exist for several of these risk factors (e.g., socioeconomic status), numerous studies have shown no disparities in many others (e.g., smoking, obesity for men, lipid profile).2 Despite substantial investment in interventions to eliminate hypertension disparities, evidence suggests that these disparities have actually grown over the past few decades,9 suggesting that numerous unknown factors drive disparities in hypertension.3     

Pre-Gestational Consumption of Ultra-Processed Foods and Risk of Gestational Diabetes in a Mediterranean Cohort. The SUN Project

We aimed to investigate the relationship between the pre-gestational consumption of ultra-processed foods (UPF) and the risk of gestational diabetes (GDM). We carried out a prospective study among 3730 Spanish women of the SUN cohort who reported at least one pregnancy after baseline recruitment. Cases of GDM were identified among women with a confirmed diagnosis of GDM. UPF consumption was assessed through a validated, semi-quantitative food frequency questionnaire and the frequency of UPF consumption was categorized in tertiles. We identified 186 cases of GDM. In the pooled sample, we did not observe a significant association of UPF with the risk of GDM. When we stratified by age, the multivariate OR for the third tertile of UPF consumption compared with the lowest one was 2.05 (95% CI 1.03, 4.07) in women aged ≥30 years at baseline (P_trend = 0.041). The association remained significant in a sensitivity analysis after changing many of our assumptions and adjusting for additional confounders. No association between a higher UPF consumption and GDM risk was observed in women aged 18–29 years. The pre-gestational UPF consumption may be a risk factor for GDM, especially in women aged 30 years or more. Confirmatory studies are needed to validate these findings.     

Dietary Fiber and Its Source Are Associated with Cardiovascular Risk Factors in Korean Adults

We examined the associations of dietary fiber and its source with cardiovascular risk factors in Korean adults. This cross-sectional study involved 16,792 adults from the 2013–2018 Korea National Health and Nutrition Examination Survey data. Dietary data were obtained using a 24 h recall method and used to evaluate intakes of total dietary fiber and its source and fruit consumption. Cardiovascular risk factors included obesity, abdominal obesity, metabolic syndrome, hypercholesterolemia, hypertension, and type 2 diabetes. Multiple logistic regression was used to examine the associations of dietary fiber and its source with cardiovascular risk factors by sex. Total fiber and fruit fiber intake in men were inversely associated with metabolic syndrome (Q5 vs. Q1: odds ratios (OR) = 0.69, 95% confidence intervals (CI) = 0.53–0.92 for total fiber; Q4 vs. Q1: OR = 0.76, 95% CI = 0.61–0.93 for fruit fiber). Among women, a higher intake of fruit fiber was related to a reduced prevalence of obesity (Q4 vs. Q1: OR = 0.85, p trend = 0.029) and abdominal obesity (Q4 vs. Q1: OR = 0.82, p trend = 0.026). Total fruit and whole fruit consumption was inversely associated with obesity, abdominal obesity, and metabolic syndrome in men and hypertension in women. The amount and sources of fiber are associated with metabolic diseases in Korean adults and should be considered in the context of overall dietary quality.     

Whole-fat dairy food intake is inversely associated with obesity prevalence: findings from the Observation of Cardiovascular Risk Factors in Luxembourg study

Because research focusing on dairy food consumption and the risk for obesity is inconsistent and only a few studies have even examined specific dairy products, in regard to type of food and fat content, in relation to obesity risk, this cross-sectional study investigated whether dairy food consumption is associated with the prevalence of global and abdominal obesity. Data were analyzed from 1352 participants in the Observation of Cardiovascular Risk Factors in Luxembourg survey. We hypothesized that higher total dairy food consumption would be independently associated with reduced prevalence of obesity. A validated food frequency questionnaire was used to measure intakes of dairy foods. Odds for global obesity (body mass index ≥30 kg/m²) and abdominal obesity (waist circumference >102 cm for men and >88 cm for women) were determined based on total dairy food intake as well as intakes of individual low- and whole-fat dairy products (milk, yogurt, and cheese). Total dairy food intake was inversely associated with the likelihood of global obesity (odds ratio [OR], 0.51; 95% confidence interval [CI], 0.30-0.89; P < .05) and abdominal obesity (OR, 0.51; 95% CI, 0.32-0.83; P < .01). Participants in the highest tertile of whole-fat dairy intakes (milk, cheese, yogurt) had significantly lower odds for being obese (global obesity: OR, 0.45; 95% CI, 0.29-0.72; P < .01; abdominal obesity: OR, 0.35; 95% CI, 0.23-0.54; P < .001), compared with those in the lowest intake tertile, after full adjustment for demographic, lifestyle, dietary, and cardiovascular risk factor variables. Increasing consumption of dairy foods may have the potential to lower the prevalence of global and abdominal obesity.     

Associations between attainment of incentivised primary care indicators and emergency hospital admissions among type 2 diabetes patients: a population-based historical cohort study

ObjectivesEngland has invested considerably in diabetes care over recent years through programmes such as the Quality and Outcomes Framework and National Diabetes Audit. However, associations between specific programme indicators and key clinical endpoints, such as emergency hospital admissions, remain unclear. We aimed to examine whether attainment of Quality and Outcomes Framework and National Diabetes Audit primary care diabetes indicators is associated with diabetes-related, cardiovascular, and all-cause emergency hospital admissions.DesignHistorical cohort study.SettingA total of 330 English primary care practices, 2010–2017, using UK Clinical Practice Research Datalink.ParticipantsA total of 84,441 adults with type 2 diabetes.Main Outcome MeasuresThe primary outcome was emergency hospital admission for any cause. Secondary outcomes were (1) diabetes-related and (2) cardiovascular-related emergency admission.ResultsThere were 130,709 all-cause emergency admissions, 115,425 diabetes-related admissions and 105,191 cardiovascular admissions, corresponding to unplanned admission rates of 402, 355 and 323 per 1000 patient-years, respectively. All-cause hospital admission rates were lower among those who met HbA1c and cholesterol indicators (incidence rate ratio = 0.91; 95% CI 0.89–0.92; p < 0.001 and 0.87; 95% CI 0.86–0.89; p < 0.001), respectively), with similar findings for diabetes and cardiovascular admissions. Patients who achieved the Quality and Outcomes Framework blood pressure target had lower cardiovascular admission rates (incidence rate ratio = 0.98; 95% CI 0.96–0.99; p = 0.001). Strong associations were found between completing 7–9 (vs. either 4–6 or 0–3) National Diabetes Audit processes and lower rates of all admission outcomes (p-values < 0.001), and meeting all nine National Diabetes Audit processes had significant associations with reductions in all types of emergency admissions by 22% to 26%. Meeting the HbA1c or cholesterol Quality and Outcomes Framework indicators, or completing 7–9 National Diabetes Audit processes, was also associated with longer time-to-unplanned all-cause, diabetes and cardiovascular admissions.ConclusionsAttaining Quality and Outcomes Framework-defined diabetes intermediate outcome thresholds, and comprehensive completion of care processes, may translate into considerable reductions in emergency hospital admissions. Out-of-hospital diabetes care optimisation is needed to improve implementation of core interventions and reduce unplanned admissions.