In a recent study published in JAMA Network Open, researchers investigated associations between ultra-processed food (UPF) consumption and cardiometabolic risk factors in young children.
Study: Ultraprocessed Food Consumption and Cardiometabolic Risk Factors in Children. Image Credit: Irina Wilhauk/Shutterstock.com
Background
Abnormal cardiometabolic risk factors often appear in childhood, and their early detection and regulation can prevent or delay future cardiovascular disease (CVD) onset.
Recent studies have highlighted the potential role of UPFs in chronic disease risks. UPFs are foods with extensive industrial processing and often contain multiple ingredients, preservatives, and additives.
UPFs are low in essential nutrients but rich in sugars, saturated fats, sodium, and others, all linked to cardiometabolic health. Given their high affordability and availability, UPFs have become common in modern diets, especially among adolescents and children and in families with low education and socioeconomic status.
While studies have revealed that UPF intake is positively associated with obesity, CVD, diabetes, and mortality, evidence in children is limited.
About the study
In the present study, researchers examined the associations of UPF intake with cardiometabolic risk factors in a pediatric population in Spain.
They used data on school children aged 3–6 enrolled from March 22, 2019, to June 30, 2022, in the childhood obesity risk assessment longitudinal study. Caregivers or parents completed questionnaires on sociodemographics, three-day food intake, and leisure-time physical activity at home.
The COME-kids food and beverage frequency questionnaire was used to estimate the dietary intake of UPFs. Health centers determined adiposity and assessed cardiometabolic risk factors. Blood pressure was measured thrice at five-minute intervals.
Fasting blood samples were obtained, and plasma glucose, insulin, total cholesterol, and high- (HDL) and low-density lipoprotein (LDL) cholesterol levels were measured.
The residual regression method adjusted UPF intake for total energy intake. Subjects were stratified into energy-adjusted UPF intake tertiles. Linear regression models estimated the sex- and age-specific z-scores of adiposity and cardiometabolic parameters.
Further, multivariable linear regression models examined associations between UPF intake tertiles and z-scores of cardiometabolic parameters.
A simulation model was also fitted to evaluate associations between healthier food consumption and outcomes by substituting 100 g of UPFs with an equivalent amount of minimally processed or unprocessed foods. Sensitivity analyses examined associations by socio-professional levels, maternal education, and diet quality.
Findings
Overall, 1,426 children (728 girls and 698 boys) were included. Children with the highest UPF intake (third or top tertile) showed a higher systolic blood pressure, waist-to-height ratio, BMI, prevalence of obesity/overweight, and lower levels of LDL and HDL cholesterol.
Mothers with the highest UPF intake were younger and more likely to be overweight/obese. They also had a higher BMI and lower education and employment rates.
Further, children with the highest UPF intake were more likely to consume increased quantities of carbohydrates, yogurt, sugary beverages, candy, and total energy.
They were also likely to consume lower amounts of fiber, milk, protein, fat, protein, mono- and poly-unsaturated fatty acids, white meat, cheese, eggs, fish, unprocessed red meat, nuts, fruits, vegetables, seafood, and cereals.
Children in the highest tertile showed increased z-scores of BMI, fat mass index, fasting plasma glucose, and waist circumference and a lower HDL cholesterol z-score.
These associations for HDL cholesterol and fasting plasma glucose were sustained when adjusted for the Mediterranean diet. Substituting UPFs with minimally processed or unprocessed foods was associated with lower z-scores of BMI, fat mass index, and fasting plasma glucose.
Energy-adjusted UPF intake was positively associated with z-scores of fat mass index, waist circumference, fasting plasma glucose, diastolic blood pressure, and waist-to-height ratio in children with unemployed mothers. Further, energy-adjusted UPF intake was positively associated with the fasting plasma glucose z-score.
There was a negative association between energy-adjusted UPF intake and HDL cholesterol in children with employed mothers.
Besides, children whose mothers had high educational levels had a lower z-score of HDL cholesterol. Children whose mothers had low educational levels had higher z-scores of fat mass index, BMI, fasting plasma glucose, and waist circumference.
Conclusions
In sum, UPF intake was positively associated with fasting plasma glucose levels, BMI, fat mass index, and waist circumference and, inversely, with HDL cholesterol levels in young children.
The study’s limitations include the observational nature, non-generalizability to other populations, and residual confounding, among others.
Overall, the results underscore the significance of minimally processed or unprocessed foods and curbing UPF intake; further studies are needed for validation.
Moderate choline intake lowers heart disease risk