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. 2020 Aug 27;17(8):e1003256.
doi: 10.1371/journal.pmed.1003256. eCollection 2020 Aug.

Ultra-processed food intake in association with BMI change and risk of overweight and obesity: A prospective analysis of the French NutriNet-Santé cohort

Marie Beslay  1 , Bernard Srour  1 , Caroline Méjean  2 , Benjamin Allès  1 , Thibault Fiolet  1 , Charlotte Debras  1 , Eloi Chazelas  1 , Mélanie Deschasaux  1 , Méyomo Gaelle Wendeu-Foyet  1 , Serge Hercberg  1   3 , Pilar Galan  1 , Carlos A Monteiro  4 , Valérie Deschamps  5 , Giovanna Calixto Andrade  1   6 , Emmanuelle Kesse-Guyot  1 , Chantal Julia  1   3 , Mathilde Touvier  1
Affiliations

Ultra-processed food intake in association with BMI change and risk of overweight and obesity: A prospective analysis of the French NutriNet-Santé cohort

Marie Beslay et al. PLoS Med. .

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).

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart for study population, NutriNet-Santé cohort, 2009–2019.
Fig 2
Fig 2. BMI change over time in the four quartiles of the proportion of UPF in the diet, NutriNet-Santé, 2009–2019 (n = 110,260).
The average BMI for each year and each quartile of UPF intake is presented along with the 95% CI of the mean. BMI, body mass index; UPF, ultra-processed food
See this image and copyright information in PMC

References

    1. World Health Organization. Factsheet on Obesity and overweight. In: WHO [Internet]. 16 Feb 2018 [cited 3 Dec 2019]. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight.
    1. World Health Organization; Global Strategy on Diet, Physical Activity and Health. Geneva: WHO Technical Report; 2004. [cited 2020 Feb 4]. Available from: http://www.who.int/dietphysicalactivity/strategy/eb11344/strategy_englis....
    1. Équipe de surveillance et d’épidémiologie nutritionnelle (Esen). Étude de santé sur l’environnement, la biosurveillance, l’activité physique et la nutrition (Esteban), 2014–2016. Volet Nutrition. Chapitre Consommations alimentaires. Saint-Maurice: Santé Publique France; 2018 Sep p. 193. [cited 2020 Jan 15]. Available from: www.santepubliquefrance.fr.
    1. Latino-Martel P, Cottet V, Druesne-Pecollo N, Pierre FHF, Touillaud M, Touvier M, et al. Alcoholic beverages, obesity, physical activity and other nutritional factors, and cancer risk: A review of the evidence. Crit Rev Oncol Hematol. 2016;99: 308–323. 10.1016/j.critrevonc.2016.01.002 - DOI - PubMed
    1. WCRF/AICR. Diet, Nutrition, Physical Activity and Cancer: a Global Perspective. Continuous Update Project Expert Report 2018. Recommendations and public health and policy implications. 2018.

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