OBJECTIVE: Several studies have shown positive associations between ultra-processed foods and drinks and cancer risk. However, evidence remains limited for liver cancer. We aimed to evaluate the associations between ultra-processed foods and drinks and liver cancer risk.
METHODS: We included 73,119 participants (22,431 Whites, 47,837 Blacks, 2851 other race) from the Southern Community Cohort Study. Ultra-processed products were defined based on the Nova classification using data from a validated food frequency questionnaire and calculated as percentage of daily foods by weight. Incident liver cancer and vital status were ascertained via linkages to state cancer registries and the National Death Index as of December 31, 2019.
RESULTS: With a median of 13.9 year\'s follow-up, we documented 453 incident liver cancer cases. Participants with higher intake of ultra-processed foods had an elevated risk of liver cancer (hazard ratios [HR] Tertile 3 vs. tertile 1 1.69, 95% confidence intervals [CI]: 1.28-2.22; Ptrend<0.001). The subclasses of ultra-processed foods, such as ultra-processed grains and fried potatoes (HR T3 vs. T1 1.29, 95% CI: 1.01-1.65; Ptrend = 0.03), processed protein foods (HR T3 vs. T1 1.49, 95% CI: 1.14-1.94; Ptrend = 0.007) and mixed dishes (HR T3 vs. T1 1.39, 95% CI: 1.09-1.77; Ptrend = 0.01), were positively associated with liver cancer risk. No significant association was found for ultra-processed drinks (HR T3 vs. T1 0.85, 95% CI: 0.67-1.07; Ptrend = 0.16).
CONCLUSIONS: In a prospective cohort with predominantly low-income Southern US adults, we found certain ultra-processed foods were associated with a higher risk of liver cancer. Further studies are needed to confirm our findings.

UNASSIGNED: The consumption of ultra-processed products has been associated with the etiology of various diseases, mainly metabolic diseases. On the other hand, physical activity acts as a protective factor that helps prevent the appearance of this type of disease. In addition to the physical effects, both the consumption of ultra-processed products (UPPs) and sedentary behaviors have been associated with a significant impact on people\'s mental health. These problems occur significantly in university students. Online internet interventions are an alternative that has the advantage of reaching a broader sample size and adapting to various problems.
UNASSIGNED: A randomized controlled clinical superiority trial with two independent groups will be developed with 176 participants. Participants in both groups will be evaluated in 5 steps: (1) pretest, (2) middle of the intervention, (3) post-test, (4) follow-up at 3 months, and (5) follow-up at 6 months. In the experimental group (\"UNISALUD\"), participants will receive an intervention composed of 11 sessions with interactive elements such as videos, audio, and infographics created through the user experience (UX) principles and based on the health action process approach (HAPA). The participants in the control group will be on the waiting list and will receive treatment 27 days after fulfilling the inclusion criteria. Thus, participants will not receive the treatment immediately.
UNASSIGNED: The study is expected to establish the feasibility of a self-help internet-based intervention created based on the user experience methodology and the health action process model, leading to a significant decrease and increase in the consumption of UPPs, ultra-healthy products, and physical activity, respectively.
UNASSIGNED: Internet-based interventions are scarce in Latin America. Due to their potential, this study will provide data about consumption of UPPs, physical activity, and mental health of the Mexican population, which will influence the reduction of health-related complications through prevention strategies or measures.Clinical Trial Registration:ClinicalTrials.gov, NCT05834842.

BACKGROUND: Despite substantial evidence regarding independent associations between physical activity (PA) and ultra-processed foods (UPF) consumption with depression, the joint effects of these two factors remain unknown.
METHODS: This study included 99,126 participants without depression in the UK Biobank at baseline. A 24-h recall method was used to assess UPF consumption, and self-reported total physical activity (TPA), moderate-to-vigorous physical activity (MVPA), and vigorous physical activity (VPA) were assessed by metabolic equivalent task (MET). A series of Cox proportional hazard regression models were used to explore the independent and joint effects of TPA, MVPA, VPA and UPF consumption on depression.
RESULTS: The incidence rate of depression was 1.94 % [95 % confidence interval (CI): 1.80 %-2.10 %] per 1000 person-years after an average follow-up of 12.10 years. We found that MVPA and UPF consumption had additive interactions on depression risk (p < 0.05). Participants in Q1 of TPA and Q4 of UPF consumption (HR: 1.83, 95%CI: 1.45-2.31) showed a higher risk for depression than those in Q4 of TPA and Q1 of UPF consumption. Compared with the participants with WHO guideline-recommended MVPA and the lowest UPF consumption, those below recommended MVPA (HR: 1.51, 95%CI: 1.20-1.89) or above recommended MVPA (HR: 1.40, 95%CI: 1.10-1.78) and with the highest UPF consumption had a higher risk for depression.
CONCLUSIONS: Study limitations include use of self-reported data, observational study and concerns regarding generalizability.
CONCLUSIONS: Higher UPF consumption, accompanied by lower PA levels regardless of TPA, MVPA, and VPA, is associated with a higher risk of depression. Our study offers insights on public health priorities to decrease the risk of depression in the population by addressing both PA and UPF consumption together.

The prevalence of obesity globally has tripled over the last half century, and currently affects around 650 million adults and 340 million children and adolescents (ages 5-19 years). Obesity contributes towards >50 co-morbidities and premature mortality. Obesity is a highly stigmatised condition that is associated with much mental and emotional distress and dysfunction. Thus, obesity is a major contributor to healthcare expenditure globally. Traditionally, the management of obesity stratifies into three major groups that include metabolic (bariatric) surgery, pharmacotherapies, and lifestyle (primarily dietary) strategies. Although listed as a separate category, dietary strategies for obesity remain a central component of any management plan, and often complement other surgical and pharmacotherapeutic options. Indeed, the effectiveness of any management approach for obesity relies upon successful behavioural changes, particularly relating to eating behaviours. In this concise review, we explore the foundational pillars of dietary strategies for obesity: sleep, listening, routine, de-stressing and optimisation of social conditions. We then discuss the importance of balancing dietary macronutrients (including dietary fibre, carbohydrates, protein and ultra-processed foods [UPFs]) as a key dietary strategy for obesity. Although we focus on general principles, we should provide bespoke dietary strategies for our patients, tailored to their individual needs. Rather than judging the utility of a diet based simply on its associated magnitude of weight loss, we should adopt a more holistic perspective in which a dietary strategy is valued for its overall health benefits, including the nurturing of our gut microbiota, to enable them to nurture and protect us.

Objective: Analyse the breakfast cereal market to help to help healthcare professionals to guide parents in choosing healthy products for their children. Study design: Observational study of the breakfast cereals available in the biggest supermarkets, discount stores and organic chains in France, Belgium and Luxembourg. Methods: An analysis of nutritional qualities using three indicators: Nutri-Score (initial and modified version), WHO Europe nutrient profile model, and Nova. Results: 645 products were listed; 559 excluding duplicates. A total of 28.8% are marketed to children and make up the group of \"children\'s\" cereals, 62.1% of cereals are Muesli, Oats and other cereal flakes (MOCF), and 54.9% are \"organic\". The study shows that \"children\'s\" cereals have a poorer nutritional profile: a higher proportion of Nutri-Score D, higher sugar content, lower fibre content, less conformity with the WHO Europe nutrient profile model and a higher proportion ofultra-processed. On the other hand, MOCF and \"organic\" products generally have a better nutritional profile: less sugar, more fibre, more Nutri-Score A, less Nutri-Score D and fewer ultra-processed products. Conclusions: Parents should therefore opt for cereals that do not bear any reference to children on the packaging.

OBJECTIVE: Investigate the associations of ultra-processed foods (UPF) in healthful (hPDI) and unhealthful (uPDI) plant-based diets with all-cause mortality, greenhouse gas emissions (GHGE), and blue water consumption (BWC).
METHODS: Analyses were based on 35,030 participants (20-70 years; 74% females) from the EPIC-NL cohort who were followed up from 1993 to 1997 through 2014. Plant-based diet indices (hPDI and uPDI) and UPF consumption were calculated from a validated FFQ, assessed at baseline. Cox proportional hazard and multiple linear regression models were used to estimate associations between combined quartiles of the PDI indices and UPF consumption.
RESULTS: With lower hPDI and higher UPF diets as the reference, we observed the following. Risk estimates of all-cause mortality were 0.98 (95% CI: 0.83, 1.16) for lower UPF consumption, 0.86 (95% CI: 0.68, 1.08) for higher hPDI, and 0.78 (95% CI: 0.66, 0.89) for combined higher hPDI and lower UPF consumption. Results with the uPDI were inconclusive. Mean differences in GHGE and BWC were 1.4% (95% CI: 0.3, 2.4) and 1.6% (95% CI: -0.5, 3.7) for lower UPF consumption, -7.4% (95% CI: -8.6, -6.4) and 9.6% (95% CI: 7.2, 12.0) for higher hPDI, and - 6.8% (95% CI: -7.4, -6.1) and 13.1% (95% CI: 11.6, 14.8) for combined higher hPDI and lower UPF consumption. No apparent conflict between environmental impacts was observed for the uPDI; GHGE and BWC were lower for higher uPDI scores.
CONCLUSIONS: Mortality risk and environmental impacts were mostly associated with the amount of plant-based foods and to a lesser extent UPF in the diet. Shifting to a more healthful plant-based diet could improve human health and reduce most aspects of environmental impact (GHGE, but not BWC) irrespective of UPF consumption.

OBJECTIVE: Population-based studies suggest an inverse relationship between the dietary share of ultra-processed foods (UPF), as defined by NOVA classification, and the overall dietary nutritional quality. However, few studies have evaluated the impact of ultra-processed foods on the fatty acid profile of the diet. The aim of this study was to assess the association between consumption of UPF and the fatty acids profile of the diet in Portugal.
RESULTS: Cross-sectional data from IAN-AF 2015-2016 were used for this study. Food consumption data were collected through two 24-h food recalls, and food items were classified according to the NOVA system. For both adults and elderly, the contents of total fatty acids (TFA), saturated fatty acids (SFA) and trans fatty (TRFA) were higher in the fraction of UPF, compared to the other three NOVA groups, while [monounsaturated fatty acids (MUFA)+, polyunsaturated fatty acids (PUFA)/SFA] ratio was lower. The UPF population attributable fraction (PAF) demonstrated that if the dietary contribution of UPF was reduced to levels observed in the first quintile, statistically significant reductions in the prevalence of inadequate intakes of fatty acids would be observed for adults [TRFA (PAF 98.37%, 95% CI 87.27-99.79) and SFA (PAF 37.26%, 95% CI 25.46-47.19)] and for elderly [TRFA (PAF 94.61%, 95% CI 77.59-98.71) and PUFA (PAF 98.28, 95% CI 48.22-99.94)].
CONCLUSIONS: In this study the consumption of UPF was associated with a worse fatty acids profile in the Portuguese diet, adding evidence regarding the negative impact of UPF on diet quality.

BACKGROUND: Increased consumption of ultra-processed foods (UPFs) which have additives such as artificial colours, flavours and are usually high in salt, sugar, fats and specific preservatives, are associated with diet-related non-communicable diseases (NCDs). In India, there are no standard criteria for identifying UPFs using a classification system based on extent and purpose of industrial processing. Scientific literature on dietary intake of foods among Indian consumers classifies foods as unhealthy based on presence of excessive amounts of specific nutrients which makes it difficult to distinguish UPFs from other commercially available processed foods.
METHODS: A literature review followed by an online grocery retailer scan for food label reading was conducted to map the types of UPFs in Indian food market and scrutinize their ingredient list for the presence of ultra-processed ingredients. All UPFs identified were randomly listed and then grouped into categories, followed by saliency analysis to understand preferred UPFs by consumers. Indian UPF categories were then finalized to inform a UPF screener.
RESULTS: A lack of application of a uniform definition for UPFs in India was observed; hence descriptors such as junk-foods, fast-foods, ready-to-eat foods, instant-foods, processed-foods, packaged-foods, high-fat-sugar-and-salt foods were used for denoting UPFs. After initial scanning of such foods reported in literature based on standard definition of UPFs, an online grocery retailer scan of food labels for 375 brands (atleast 3 brands for each food item) confirmed 81 food items as UPFs. A range of packaged traditional recipes were also found to have UPF ingredients. Twenty three categories of UPFs were then developed and subjected to saliency analysis. Breads, chips and sugar-sweetened beverages (e.g. sodas and cold-drinks) were the most preferred UPFs while frozen ready-to-eat/cook foods (e.g. chicken nuggets and frozen kebabs) were least preferred.
CONCLUSIONS: India needs to systematically apply a food classification system and define Indian food categories based on the level of industrial processing. Mapping of UPFs is the first step towards development of a quick screener that would generate UPF consumption data to inform clear policy guidelines and regulations around UPFs and address their impact on NCDs.

BACKGROUND: Food intakes 1-2 years following bariatric surgery depend more on patients than the surgery\'s gastrointestinal tract changes. This study aimed to determine the major dietary patterns of patients after the first two years of sleeve gastrectomy and to investigate their associations with total weight loss (TWL) and the proportion of TWL as fat mass (FM) and fat-free mass (FFM) loss.
METHODS: This cross-sectional study included 146 patients undergoing sleeve gastrectomy 2-4 years after surgery. Dietary patterns were determined using principal component analysis based on the 19 food groups. The percentage of FM loss relative to TWL (%FML) and FFM loss relative to TWL (%FFML) were calculated. A suboptimal clinical response was defined as a TWL of less than 25%. High FM loss and excessive FFM loss were defined based on the highest tertiles. Linear and logistic regression models were used to derive unstandardized (B) coefficients and odds ratios (OR), with dietary pattern scores serving as both a continuous and a binary variable (higher vs. lower adherence groups based on median).
RESULTS: Two predominant dietary patterns were retained. Each 1-unit increase in the first dietary pattern score characterized by high intakes of fast foods, soft drinks, processed meats, sugar confectionary, salty snacks, grains, and organ meats was associated with higher %FFML (B = 1.99; 95% confidence interval (CI) 0.34, 3.66), lower %FML (B = - 1.84; 95% CI - 3.49, - 0.20), and higher odds of excessive FFM loss (OR = 1.84; 95% CI 1.09, 3.11). Participants with higher adherence to the first dietary pattern had lower %TWL, and greater odds of suboptimal clinical response and excessive FFM loss than those with lower adherence. Each 1-unit increase in score for the second dietary pattern characterized by a high intake of fruits, dairy, vegetables, legumes, eggs, nuts, red meats, poultry, and fish was associated with lower odds of suboptimal clinical response (OR = 0.51; 95% CI 0.31, 0.86).
CONCLUSIONS: Patients should be encouraged to modify their diet by reducing the consumption of ultra-processed foods and increasing their intake of high-quality protein sources, fruits, and vegetables to achieve the best postoperative outcome.

BACKGROUND: This prospective cohort study aimed to investigate the association between ultra-processed food (UPF) and the risk of metabolic syndrome (MetS), as well as to assess whether fruit and vegetable intake and weight change modify this association.
METHODS: We included 1915 healthy participants who participated in the Tehran Lipid and Glucose Study (TLGS), all of whom had complete demographic, anthropometric, and dietary measurements. A validated food frequency questionnaire was used to assess UPF consumption based on the NOVA classification system. MetS was defined according to the Joint Interim Statement. Multivariable adjusted Cox regression was used to estimate hazard ratios (HRs) for MetS events across tertiles of UPF. The effect of fruit and vegetable consumption and weight change on this association was assessed using joint classification by Cox regression.
RESULTS: UFP consumption showed no association with MetS risk after adjusting for confounders. However, after adjustment for dietary fiber, fruits, and vegetables, the highest tertile of UPF consumption was positively linked to MetS risk, compared to the lowest tertile. There was a significant interaction between fruit, vegetable, and dietary fiber intake and UPF consumption concerning the risk of MetS (All P values < 0.05). Among individuals consuming less than 248 g/day of fruit, the risk of MetS increased by 54% (confidence interval: 1.13-2.10) in the highest UPF tertile. Consuming vegetables and dietary fiber below the median (258 g/day and 42.2 g/day, respectively) increased the risk of MetS in the third tertile of UPF. However, consuming vegetables and fiber ≥ median intake, reduced the risk of MetS among those with the lowest UPF consumption. Furthermore, the risk of MetS was observed in the third tertile of UPF consumption among individuals with fruit and vegetable consumption < 537 g/day. UPF consumption was not associated with the risk of MetS in different weight change statuses.
CONCLUSIONS: Consuming more fruits and vegetables mitigated the adverse effect of UPF on the risk of developing MetS.