Intake of ultra-processed foods and sleep-related outcomes: A systematic review and meta-analysis

Delpino, Felipe Mendes; Figueiredo, Lílian Munhoz; Flores, Thaynã Ramos; Silveira, Érika Aparecida; Santos, Francine Silva dos; Werneck, André O.; Louzada, Maria Laura da Costa; Arcêncio, Ricardo Alexandre; Nunes, Bruno Pereira

doi:10.1016/j.nut.2022.111908

Cited by 21 publications

(19 citation statements)

References 55 publications

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“…The systematic search identified 430 de-duplicated articles (fig 1). After applying the eligibility criteria, we included 14 meta-analysis studies with 45 distinct pooled analyses 1718404142434445464748495051…”

Section: Resultsmentioning

confidence: 99%

“…Pooled analyses included estimates from original research articles that comprised either prospective cohorts (n=18), mixed study designs (n=15), or cross sectional designs (n=12). Most pooled analyses included adults as the main population, except for five, which included children and adolescents in examining mental health outcomes and respiratory conditions 184950. In 87% of pooled analyses, estimates of exposure to ultra-processed food were obtained from a combination of tools, including food frequency questionnaires, 24 hour dietary recalls, and dietary history, as reported in the meta-analysis studies.…”

Section: Resultsmentioning

confidence: 99%

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Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses

Lane,

Gamage,

et al. 2024

BMJ

100

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ObjectiveTo evaluate the existing meta-analytic evidence of associations between exposure to ultra-processed foods, as defined by the Nova food classification system, and adverse health outcomes.DesignSystematic umbrella review of existing meta-analyses.Data sourcesMEDLINE, PsycINFO, Embase, and the Cochrane Database of Systematic Reviews, as well as manual searches of reference lists from 2009 to June 2023.Eligibility criteria for selecting studiesSystematic reviews and meta-analyses of cohort, case-control, and/or cross sectional study designs. To evaluate the credibility of evidence, pre-specified evidence classification criteria were applied, graded as convincing (“class I”), highly suggestive (“class II”), suggestive (“class III”), weak (“class IV”), or no evidence (“class V”). The quality of evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework, categorised as “high,” “moderate,” “low,” or “very low” quality.ResultsThe search identified 45 unique pooled analyses, including 13 dose-response associations and 32 non-dose-response associations (n=9 888 373). Overall, direct associations were found between exposure to ultra-processed foods and 32 (71%) health parameters spanning mortality, cancer, and mental, respiratory, cardiovascular, gastrointestinal, and metabolic health outcomes. Based on the pre-specified evidence classification criteria, convincing evidence (class I) supported direct associations between greater ultra-processed food exposure and higher risks of incident cardiovascular disease related mortality (risk ratio 1.50, 95% confidence interval 1.37 to 1.63; GRADE=very low) and type 2 diabetes (dose-response risk ratio 1.12, 1.11 to 1.13; moderate), as well as higher risks of prevalent anxiety outcomes (odds ratio 1.48, 1.37 to 1.59; low) and combined common mental disorder outcomes (odds ratio 1.53, 1.43 to 1.63; low). Highly suggestive (class II) evidence indicated that greater exposure to ultra-processed foods was directly associated with higher risks of incident all cause mortality (risk ratio 1.21, 1.15 to 1.27; low), heart disease related mortality (hazard ratio 1.66, 1.51 to 1.84; low), type 2 diabetes (odds ratio 1.40, 1.23 to 1.59; very low), and depressive outcomes (hazard ratio 1.22, 1.16 to 1.28; low), together with higher risks of prevalent adverse sleep related outcomes (odds ratio 1.41, 1.24 to 1.61; low), wheezing (risk ratio 1.40, 1.27 to 1.55; low), and obesity (odds ratio 1.55, 1.36 to 1.77; low). Of the remaining 34 pooled analyses, 21 were graded as suggestive or weak strength (class III-IV) and 13 were graded as no evidence (class V). Overall, using the GRADE framework, 22 pooled analyses were rated as low quality, with 19 rated as very low quality and four rated as moderate quality.ConclusionsGreater exposure to ultra-processed food was associated with a higher risk of adverse health outcomes, especially cardiometabolic, common mental disorder, and mortality outcomes. These findings provide a rationale to develop and evaluate the effectiveness of using population based and public health measures to target and reduce dietary exposure to ultra-processed foods for improved human health. They also inform and provide support for urgent mechanistic research.Systematic review registrationPROSPERO CRD42023412732.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses

Lane,

Gamage,

et al. 2024

BMJ

100

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“…The systematic search identified 430 deduplicated articles (Figure 1). After applying the eligibility criteria, 14 meta-analysis studies with 45 distinct pooled analyses were included 18,[41][42][43][44][45][46][47][48][49][50][51][52][53] .…”

Section: Resultsmentioning

confidence: 99%

Ultra-Processed Food Exposure and Adverse Health Outcomes: An Umbrella Review of Epidemiological Meta-Analyses

Lane,

Gamage,

et al. 2023

Preprint

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Objective: To evaluate the existing meta-analytic evidence of associations between exposure to ultra-processed foods, as defined by the Nova food classification system, and adverse health outcomes. Design: Systematic umbrella review of existing meta-analyses. Data Sources: MEDLINE, PsycINFO, Embase, and the Cochrane Database of Systematic Reviews, as well as manually searching reference lists from 2009 to June 2023. Inclusion Criteria: Systematic reviews and meta-analyses of cohort, case-control, and/or cross-sectional study designs that evaluated the associations between exposure to ultra-processed foods and adverse health outcomes in humans across the lifespan. Results: The search identified 45 unique pooled analyses, including 13 dose-response and 32 non-dose-response associations (n=9,888,373). Overall, direct associations were found between exposure to ultra-processed foods and 32 (71%) health outcome domains spanning cardiometabolic, gastrointestinal, and respiratory conditions, cancer, mental health, and mortality. Based on a pre-specified evidence classification criteria, convincing evidence (Class I) supported direct associations between greater ultra-processed food exposure and higher risks of incident cardiovascular disease-related mortality (RR: 1.50; 95%CIs: 1.37 to 1.63), type two diabetes (dose-response RR: 1.12; 95%CIs: 1.11 to 1.13), and depressive outcomes (HR: 1.21; 95%CIs: 1.16 to 1.28), as well as higher risks of prevalent anxiety outcomes (OR: 1.48; 95%CIs: 1.37 to 1.59) and combined common mental disorder outcomes (OR: 1.53; 95%CIs: 1.43 to 1.63). Highly suggestive (Class II) evidence indicated that greater exposure to ultra-processed foods was directly associated with higher risks of incident all-cause mortality (RR: 1.21; 95%CIs: 1.15 to 1.27), heart disease-related mortality (dose-response HR: 1.66; 95%CIs: 1.51 to 1.84), and type two diabetes (OR: 1.40; 95%CIs: 1.23 to 1.59), together with higher risks of prevalent obesity (OR: 1.55; 95%CIs: 1.36 to 1.77), adverse sleep-related outcomes (OR: 1.41; 95%CIs: 1.24 to 1.60), and wheezing (RR: 1.40; 95%CIs: 1.27 to 1.55). Out of the remaining 34 pooled analyses, 21 were graded as suggestive or weak strength (Class III-IV) and 13 were graded as no evidence (Class V). Using the GRADE framework, 22 pooled analyses were rated as "Low" quality, with 19 rated as "Very Low” and four rated as "Moderate" quality. Conclusions: Higher exposure to ultra-processed food was associated with a greater risk of adverse health outcomes, especially cardiometabolic, common mental disorder, and mortality outcomes. These findings provide a rationale to evaluate the effectiveness of using population-based measures to target and reduce dietary exposure to ultra-processed foods for improved human health. Systematic Review Registration: PROSPERO CRD42023412732.

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“…Similarly, the proportion of adolescents meeting the sleep recommendations was lower in those who ate sweets and candy frequently. One possible explanation is that these foods are ultra-processed foods (e.g., highly profitable, ready-to-consume, hyperpalatable) according to the NOVA classification [ 37 ], which have been linked to lower sleep quality and duration among adolescents [ 38 ]. As an example, a study conducted on Brazilian adolescents found that consuming a high amount of highly processed foods, such as sweets, was related to a greater likelihood of experiencing poorer sleep quality [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Mediterranean Dietary Patterns Related to Sleep Duration and Sleep-Related Problems among Adolescents: The EHDLA Study

et al. 2023

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Purpose: The aim of the present study was to examine the association of adherence to the Mediterranean Diet (MD) and its specific components with both sleep duration and sleep-related disorders in a sample of adolescents from the Valle de Ricote (Region of Murcia, Spain). Methods: This cross-sectional study included a sample of 847 Spanish adolescents (55.3% girls) aged 12–17 years. Adherence to the MD was assessed by the Mediterranean Diet Quality Index for Children and Teenagers. Sleep duration was reported by adolescents for weekdays and weekend days separately. The BEARS (Bedtime problems, Excessive daytime sleepiness, Awakenings during the night, Regularity and duration of sleep, and Sleep-disordered breathing) screening was used to evaluate issues related to sleep, which include difficulties at bedtime, excessive drowsiness during the day, waking up frequently during the night, irregularity, length of sleep, and breathing issues while sleeping. Results: Adolescents who presented a high adherence to the MD were more likely to meet the sleep recommendations (OR = 1.52, 95% CI 1.12–2.06, p = 0.008) and less likely to report at least one sleep-related problem (OR = 0.56, 95% CI 0.43–0.72, p < 0.001). These findings remained significant after adjusting for sex, age, socioeconomic status, waist circumference, energy intake, physical activity, and sedentary behavior, indicating a significant association of adherence to the MD with sleep outcomes (meeting sleep recommendations: OR = 1.40, 95% CI 1.00–1.96, p = 0.050; sleep-related problems: OR = 0.68, 95% CI 0.50–0.92, p = 0.012). Conclusions: Adolescents with high adherence to the MD were more likely to report optimal sleep duration and fewer sleep-related problems. This association was more clearly observed for specific MD components, such as fruits, pulses, fish, having breakfast, dairies, sweets, and baked goods/pastries.

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Intake of ultra-processed foods and sleep-related outcomes: A systematic review and meta-analysis

Cited by 21 publications

References 55 publications

Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses

Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses

Ultra-Processed Food Exposure and Adverse Health Outcomes: An Umbrella Review of Epidemiological Meta-Analyses

Mediterranean Dietary Patterns Related to Sleep Duration and Sleep-Related Problems among Adolescents: The EHDLA Study

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