Tegan Taylor: And it is increasingly clear that ultra-processed foods, such as candies, packaged soups, nuggets, sugary cereals, are not good for you. But is it because ultra-processed foods are often high in fat, sugar and salt? Or is there something in the treatment? Yet another new study points to the latter, showing that higher consumption of ultra-processed foods is associated with a greater risk of dying from any cause. So what could lead to this? And should the level of processing be included as a warning label on foods, along with the nutritional information we already get? I spoke to researcher Marialaura Bonaccio.
Marialaure Bonaccio: We wanted to compare how these two ways of looking at foods fit together or if they say something different in relation to health outcomes. In the case of our study, these were mortality, all-cause mortality, and cause-specific mortality. And we found some interesting things.
Tegan Taylor: Well, let’s talk about it. Let’s start with the top line. What effect did eating ultra-processed foods have on death from any cause?
Marialaure Bonaccio: We have just confirmed what has been seen by others; a diet rich in UPF, therefore ultra-processed foods, is associated with an increased risk of dying from any cause, but also from cardiovascular and specifically ischemic heart disease and cerebrovascular disease.
But it was also true when you look at food through a traditional approach, that means you use the diet score which essentially assesses the nutritional content of the food, it’s emphasis on fiber consumption , vitamins, all the good things you know you have to eat every day. And in a way, it negatively marks foods high in saturated fats, salts, etc. Diets that are not nutritionally adequate, as reflected in this score, are also associated with risk of all-cause and cardiovascular mortality.
But what happened is that by analyzing these two dimensions of food together, we realized that the risk, the risk associated with the traditional view of food is almost totally explained , or at least for a greater part, by the fact that these nutritionally unhealthy foods are also ultra-processed.
Tegan Taylor:Okay, so there are foods that are naturally high in saturated fat, but what you’re saying is that the foods that seem to confer the most risk on this measuring stick also tend to be the ones that have been ultra-transformed.
Marialaure Bonaccio: Exactly. So what matters most, the fact that the nutritional balance is not ideal or optimal, or the fact that these foods are ultra-processed. In our study, more of the risk associated with this non-nutritious diet is explained, i.e. it disappears or decreases a lot when taking into account that these foods are also ultra-processed. While the converse, the reverse, is not true.
I mean, the risk associated with UPF is still there after adjusting for the fact that these foods are also nutritionally unbalanced. The fact is that when you look at a diet, especially in these times when all the foods we put on the table are mostly from supermarkets are highly processed, it’s important to take into account when analyzing the nutritional content of foods also for consider for the fact that they can be ultra-processed.
So researchers are starting to wonder, if there is another explanation, there are many in fact, one is that these foods are packaged in mostly plastic-based packaging. Thus, plastic contains chemicals that have the ability to migrate from plastic to food. So if you are exposed to huge amounts of these foods every day, you are also indirectly exposed to contamination from these chemicals. And that’s a hypothesis, but there are also other hypotheses that perhaps point to the fact that these foods, for example, are the result of a long process of deconstruction of the food matrix. It’s not whole food, what you eat, but it’s just the result of several processes that essentially break down the food matrix. And this makes, for example, the absorption of certain nutrients more available in the body. If you destroy fiber and then recompose it, it’s not the same as having fiber in the original version.
There was a third pointing out that these foods are also fortified with so many food additives that you don’t usually get in home kitchens, for example artificial sweeteners instead of sugar, or you have the task of preserving foods so they can have a long shelf life, maybe all of these pathways interact in some way. So you have like, you know, a cocktail effect. And now it’s hard to sort out because you have several hypotheses, but none exclude the others. So maybe that’s all that can contribute to what we’re seeing in very large population cohorts around the world. Also in a population that has a relatively low consumption of this food, like Italy, you can see these huge differences in mortality, and it’s very, you know, alarming, worrying.
Tegan Taylor: What are the policy implications of this research? Because many people depend on ultra-processed foods for their food supply, especially low-income people,
Marialaure Bonaccio: Yes, because they are cheaper, yes. Well, this document that we are talking about was designed within the framework of a lively debate at European level now, with a view to the adoption of a labeling system on the front of the packaging, common to all countries of the EU. Now in Europe it’s an option, but it’s not mandatory. But the EU wants to opt for a mandatory front-of-package nutrition labeling system. The one that has gained the most support in recent years is the Nutri-Score. I don’t know if you are…
Tegan Taylor: We have different versions of it.
Marialaure Bonaccio: Yes, but you know, the concept is very similar, because also the one you have in Australia is based on the fact that only nutritional quality is taken into account. This food is said to be good for your health because it is nutritionally balanced. But the fact is that we are not against this system, but we are simply saying that this information from a nutritional quality assessment must be supplemented. So our proposal at the end of the study is to place, along with the nutrition warning, also the processing warning, you know, diet sugary drinks that have very low calories, they get an A, a green light , but they are ultra-processed.
Tegan Taylor: Are you saying that what you need is to take together, the nutritional information, but in addition to that, the level of transformation?
Marialaure Bonaccio: Yes, you know, a double dimension of considering food.
Tegan Taylor: Marialaura, thank you for giving us the time.
Marialaure Bonaccio: Thanks.
Tegan Taylor: Dr. Marialaura Bonaccio works in the Department of Epidemiology and Prevention of the Neuromed Institute in Italy.
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