1. Use of Different Food Classification Systems to Assess the Association between Ultra-Processed Food Consumption and Cardiometabolic Health in an Elderly Population with Metabolic Syndrome (PREDIMED-Plus Cohort)
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Josep Vidal, Jose M. Ordovas, José Alfredo Martínez, Ángel M. Alonso-Gómez, Estefanía Toledo, Nerea Becerra-Tomás, Dolores Corella, Aurora Bueno-Cavanillas, Jessica Vaquero-Luna, María Concepción Barceló-Iglesias, Beatriz Pérez-Sanz, Antonio García Ríos, María Julia Ajejas Bazán, Ramon Estruch, Vicente Martín Sánchez, Rodrigo San-Cristobal, Miguel Ángel Martínez-González, Xavier Pintó, Dora Romaguera, Jesús Vioque, José J. Gaforio, Pilar Matía-Martín, Lluis Serra-Majem, Itziar Abete, Camille Lassale, Júlia Muñoz-Martínez, Jose Lopez-Miranda, Stephanie K. Nishi, José Lapetra, Lidia Daimiel, Anai Moreno-Rodriguez, Clotilde Vázquez, José V. Sorlí, Celia Martinez-Perez, José Manuel Santos-Lozano, Maira Bes-Rastrollo, Julia Wärnberg, Emilio Ros, María Rosa Bernal-López, Pilar Guallar-Castillón, Nancy Babio, Oscar Lecea-Juarez, María Dolores Zomeño, Olga Castañer, Josep A. Tur, Jordi Salas-Salvadó, Francisco J. Tinahones, Olga Portolés, Jadwiga Konieczna, [Martinez-Perez,C, Ordovás,JM, Daimiel,L] Nutritional Genomics and Epigenomics Group, Precision Nutrition and Obesity Program, IMDEA Food, CEI UAM + CSIC, Madrid, Spain. [San-Cristobal,R, Martinez, JA] Cardiometabolic Nutrition Group, Precision Nutrition and Cardiometabolic Health Program, IMDEA Food, CEI UAM + CSIC, Madrid, Spain. [Guallar-Castillon,P] Cardiovascular and Nutritional Epidemiology Group, IMDEA Food, CEI UAM + CSIC, Madrid, Spain. [Guallar-Castillon,P] Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid—IdiPaz Hospital, Madrid, Spain. [Guallar-Castillon,P, Vioque,J, Bueno-Cavanillas,A, Martín Sánchez,V, Gaforio,JJ] Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain. [Guallar-Castillon,P] Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, USA. [Martínez-González,MA, Salas-Salvadó,J, Corella,D, Castañer,O, Martinez,JA, Alonso-Gómez,AM, Wärnberg,J, Romaguera,D, López-Miranda,J, Estruch,R, Tinahones,FJ, Lapetra,J, Serra-Majem,L, Tur,JA, Pintó,X, Vázquez,C, Ros,E, Bes-Rastrollo,M, Babio,N, Sorlí,JV, Lassale,C, Vaquero-Luna,J, Konieczna,J, García Ríos,A, Santos-Lozano,JM, Toledo,E, Becerra-Tomás,N, Portoles,O, Abete,I, Moreno-Rodriguez,A] Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. [Martínez-González,MA, Toledo,E] Department of Preventive Medicine and Public Health, University of Navarra, IdiSNA, Pamplona, Spain. [Martínez-González,MA] Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA. [Salas-Salvadó,J, Becerra-Tomás,T, Nishi,SK] Unitat de Nutrició Humana, Departament de Bioquímica i Biotecnologia, Universitat Rovira i Virgili, Reus, Spain. [Salas-Salvadó,J, Becerra-Tomás,N] Human Nutrition Unit, Institut d’Investigació Sanitària Pere Virgili (IISPV), Reus, Spain. [Corella,D, Portoles,O] Department of Preventive Medicine, University of Valencia, Valencia, Spain. [Castañer,O, Zomeño,MD, Muñoz-Martínez,J] Cardiovascular Risk and Nutrition Research Group (CARIN), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain. [Martinez,JA, Pérez-Sanz,B, Abete,I] Department of Nutrition, Food Sciences and Physiology, University of Navarra, Pamplona, Spain. [Alonso-Gómez,AM, Moreno-Rodriguez,A] Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain. [Wärnberg, Ajejas Bazán,MJ] Department of Nursing, School of Health Sciences, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga. [Vioque,J] Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-UMH), Alicante, Spain. [Romaguera,D, Konieczna,J] Research Group on Nutritional Epidemiology & Cardiovascular Physiopathology (NUTRECOR), Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases (HUSE), Palma de Mallorca, Spain. [López-Miranda,J, García Ríos,A] Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba, Spain. [Estruch,R] Department of Internal Medicine, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain. [Tinahones,FJ] Department of Endocrinology, Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria Hospital, University of Málaga, Málaga, Spain. [Lapetra,J, Santos-Lozano,JM] Department of Family Medicine, Research Unit, Distrito Sanitario Atención Primaria Sevilla, Sevilla, Spain. [Serra-Majem,L] Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria and Service of Preventive Medicine, Complejo Hospitalario Universitario Insular Materno Infantil (CHUIMI), Canary Health Service, Las Palmas de Gran Canaria, Spain. [Bueno-Cavanillas,A] Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain. [Tur,JA] Research Group on Community Nutrition & Oxidative Stress, University of Balearic Islands-IUNICS & IDISBA, Palma de Mallorca, Spain. [Martín Sánchez,V] Institute of Biomedicine (IBIOMED), University of León, León, Spain. [Pintó,X] Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain. [Gaforio,JJ] Departamento de Ciencias de la Salud, Centro de Estudios Avanzados en Olivar y Aceites de Oliva, Universidad de Jaén, Jaén, Spain. [Matía-Martín,P] Department of Endocrinology and Nutrition, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain. [Vidal,J] Biomedical Research Centre for Diabetes and Metabolic Diseases Network (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. [Vidal,J, Ros,E] Endocrinology and Nutrition Service, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain. [Vázquez,C] Department of Endocrinology and Nutrition, Hospital Fundación Jiménez Díaz, Instituto de Investigaciones Biomédicas IISFJD, University Autónoma, Madrid, Spain. [Ajejas Bazán,MJ] Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain. [Barceló-Iglesias,MC] Centro Salud Cabo Huertas, Alicante, Spain. [Bernal-López,MR] Internal Medicine Department, Instituto de Investigación Biomédica de Málaga (IBIMA), Regional University Hospital of Malaga, Malaga, Spain. [Zomeño,MD] School of Health Sciences, Blanquerna-Ramon Llull University, Barcelona, Spain. [Lecea-Juarez,O] Atención Primaria, Osasunbidea, Servicio Navarro de Salud, Pamplona, Spain. [Ordovás,JM] Nutrition and Genomics Laboratory, JM_USDA Human Nutrition Research Center on Aging, Tufts University, Boston, USA., The PREDIMED-Plus trial was supported by the European Research Council (Advanced Research grant 2014–2019, agreement #340918, granted to M.Á.M.-G.), the official Spanish institutions for funding scientific biomedical research, CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN) and Instituto de Salud Carlos III (ISCIII) through the Fondo de Investigación para la Salud (FIS) which is co-funded by the European Regional Development Fund (coordinated FIS projects led by J.S-S. and J.V., including the following projects: PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/00728, PI13/01090, PI13/01056, PI14/01722, PI14/00636, PI14/00618, PI14/00696, PI14/01206, PI14/01919, PI14/00853, PI14/01374, PI14/00972, PI14/00728, PI14/01471, PI16/00473, PI16/00662, PI16/01873, PI16/01094, PI16/00501, PI16/00533, PI16/00381, PI16/00366, PI16/01522, PI16/01120, PI17/00764, PI17/01183, PI17/00855, PI17/01347, PI17/00525, PI17/01827, PI17/00532, PI17/00215, PI17/01441, PI17/00508, PI17/01732, PI17/00926, PI19/00957, PI19/00386, PI19/00309, PI19/01032, PI19/00576, PI19/00017, PI19/01226, PI19/00781, PI19/01560, PI19/01332), and the Especial Action Project 'Implementación y evaluación de una intervención intensiva sobre la actividad física Cohorte PREDIMED-Plus' (J.S.-S.), the Recercaixa (grant number 2013ACUP00194) (J.S.-S.). Moreover, J.S-S. gratefully acknowledges the financial support by ICREA under the ICREA Academia program, the SEMERGEN grant, Department of Health of the Government of Navarra (61/2015), the Fundació La Marató de TV (Ref. 201630.10), the AstraZeneca Young Investigators Award in Category of Obesity and T2D 2017 (D.R.), grants from the Consejería de Salud de la Junta de Andalucía (PI0458/2013, PS0358/2016, PI0137/2018), the PROMETEO/2017/017 grant from the Generalitat Valenciana, the SEMERGEN grant, grant of support to research groups 35/2011 (Balearic Islands Government, and FEDER funds) (J.A.T.). R.S.-C. acknowledges financial support from the Juan de la Cierva Program Training Grants of the Spanish State Research Agency of the Spanish Ministerio de Ciencia e Innovación y Ministerio de Universidades (FJC2018-038168- I). N.B.-T. acknowledges financial support from the Juan de la Cierva Formación Program Training Grants of the Spanish State Research Agency of the Spanish Ministerio de Ciencia e Innovación y Ministerio de Universidades (FJC2018-036016-I). M.R.B.-L. was supported by 'Miguel Servet Type I' program (CP15/00028) from the ISCIII-Madrid (Spain), cofinanced by the Fondo Europeo de Desarrollo Regional-FEDER. S.K.N. acknowledges financial support from the Canadian Institute for Health Research, CIHR Fellowship. J.K. was supported by the ‘FOLIUM’ programme within the FUTURMed project from the Fundación Instituto de Investigación Sanitaria Illes Balears (financed by 2017 annual plan of the sustainable tourism tax and at 50% with charge to the ESF Operational Program 2014–2020 of the Balearic Islands. C.M.-P. was financially supported by a joint grant from the Community of Madrid and the European Social Fund (grant PEJD-2019-POST/SAL-15892). The METHYL-UP project was supported by the Spanish Ministry of Science and Innovation (RTI2018-095569-B-I00, Programa de Proyectos Orientados a los Retos de la Sociedad 'Projects Toward Society Challenges Program').
- Subjects
Síndrome metabólico ,Male ,Food processing ,Mediterranean diet ,NOVA ,Obesidad ,Índice de masa corporal ,Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings] ,0302 clinical medicine ,ultra-processed food ,Medicine ,TX341-641 ,Diseases::Pathological Conditions, Signs and Symptoms::Signs and Symptoms::Body Weight::Overweight [Medical Subject Headings] ,Body mass index ,classification systems ,Incidence ,IARC ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Questionnaires [Medical Subject Headings] ,Metabolic syndrome ,3. Good health ,Nutrición ,Cohort ,Manipulación de alimentos ,Dieta ,Factores de riesgo cardiometabólico ,Concordance ,UNC ,Check Tags::Male [Medical Subject Headings] ,Clasificación ,Classification systems ,Diet Surveys ,Article ,03 medical and health sciences ,food processing ,Humans ,Diseases::Cardiovascular Diseases [Medical Subject Headings] ,Aged ,030109 nutrition & dietetics ,Health Care::Health Care Economics and Organizations::Organizations::International Agencies [Medical Subject Headings] ,Persons::Persons::Age Groups::Adult::Middle Aged [Medical Subject Headings] ,PREDIMED-Plus ,medicine.disease ,Obesity ,Diseases::Nutritional and Metabolic Diseases::Nutrition Disorders::Overnutrition::Obesity [Medical Subject Headings] ,Blood pressure ,Check Tags::Female [Medical Subject Headings] ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies [Medical Subject Headings] ,Linear Models ,Fast Foods ,Older people ,0301 basic medicine ,Síndrome metabòlica ,Food Handling ,Overweight ,Diet, Mediterranean ,Persones grans ,Cohort Studies ,cardiometabolic risk ,Endocrinología ,030212 general & internal medicine ,Persons::Persons::Age Groups::Adult::Aged [Medical Subject Headings] ,2. Zero hunger ,Metabolic Syndrome ,Nutrition and Dietetics ,Technology and Food and Beverages::Technology, Industry, and Agriculture::Industry::Food Industry::Food Handling [Medical Subject Headings] ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Nutrition Therapy::Diet Therapy::Diet, Mediterranean [Medical Subject Headings] ,Middle Aged ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Health Surveys::Nutrition Surveys::Diet Surveys [Medical Subject Headings] ,Female ,Technology and Food and Beverages::Food and Beverages::Food::Fast Foods [Medical Subject Headings] ,medicine.symptom ,Diseases::Nutritional and Metabolic Diseases::Metabolic Diseases::Glucose Metabolism Disorders::Hyperinsulinism::Insulin Resistance::Metabolic Syndrome X [Medical Subject Headings] ,Dietética y nutrición ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Diagnostic Techniques and Procedures::Physical Examination::Body Constitution::Body Weights and Measures::Body Mass Index [Medical Subject Headings] ,Phenomena and Processes::Physiological Phenomena::Nutritional Physiological Phenomena::Diet [Medical Subject Headings] ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Vital Statistics::Morbidity::Incidence [Medical Subject Headings] ,Environmental health ,Alimentos ultraprocesados ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Models, Statistical::Linear Models [Medical Subject Headings] ,Nutrició ,Nutrition ,Geographical Locations::Geographic Locations::Europe::Spain [Medical Subject Headings] ,business.industry ,Nutrition. Foods and food supply ,Cardiometabolic Risk Factors ,Dieta mediterránea ,Cardiometabolic risk ,Ultra-processed food ,Diet ,Spain ,IFIC ,Sobrepeso ,business ,diet ,Food Science - Abstract
The PREDIMED-Plus trial was supported by the European Research Council (Advanced Research grant 2014–2019; agreement #340918; granted to M.Á.M.-G.); the official Spanish institutions for funding scientific biomedical research, CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN) and Instituto de Salud Carlos III (ISCIII) through the Fondo de Investigación para la Salud (FIS) which is co-funded by the European Regional Development Fund (coordinated FIS projects led by J.S-S. and J.V., including the following projects: PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/00728, PI13/01090, PI13/01056, PI14/01722, PI14/00636, PI14/00618, PI14/00696, PI14/01206, PI14/01919, PI14/00853, PI14/01374, PI14/00972, PI14/00728, PI14/01471, PI16/00473, PI16/00662, PI16/01873, PI16/01094, PI16/00501, PI16/00533, PI16/00381, PI16/00366, PI16/01522, PI16/01120, PI17/00764, PI17/01183, PI17/00855, PI17/01347, PI17/00525, PI17/01827, PI17/00532, PI17/00215, PI17/01441, PI17/00508, PI17/01732, PI17/00926, PI19/00957, PI19/00386, PI19/00309, PI19/01032, PI19/00576, PI19/00017, PI19/01226, PI19/00781, PI19/01560, PI19/01332), and the Especial Action Project “Implementación y evaluación de una intervención intensiva sobre la actividad física Cohorte PREDIMED-Plus” (J.S.-S.); the Recercaixa (grant number 2013ACUP00194) (J.S.-S.). Moreover, J.S-S. gratefully acknowledges the financial support by ICREA under the ICREA Academia program; the SEMERGEN grant; Department of Health of the Government of Navarra (61/2015), the Fundació La Marató de TV (Ref. 201630.10); the AstraZeneca Young Investigators Award in Category of Obesity and T2D 2017 (D.R.); grants from the Consejería de Salud de la Junta de Andalucía (PI0458/2013; PS0358/2016; PI0137/2018), the PROMETEO/2017/017 grant from the Generalitat Valenciana, the SEMERGEN grant; grant of support to research groups 35/2011 (Balearic Islands Government; FEDER funds) (J.A.T.). R.S.-C. acknowledges financial support from the Juan de la Cierva Program Training Grants of the Spanish State Research Agency of the Spanish Ministerio de Ciencia e Innovación y Ministerio de Universidades (FJC2018-038168- I). N.B.-T. acknowledges financial support from the Juan de la Cierva Formación Program Training Grants of the Spanish State Research Agency of the Spanish Ministerio de Ciencia e Innovación y Ministerio de Universidades (FJC2018-036016-I). M.R.B.-L. was supported by “Miguel Servet Type I” program (CP15/00028) from the ISCIII-Madrid (Spain), cofinanced by the Fondo Europeo de Desarrollo Regional-FEDER. S.K.N. acknowledges financial support from the Canadian Institute for Health Research, CIHR Fellowship. J.K. was supported by the ‘FOLIUM’ programme within the FUTURMed project from the Fundación Instituto de Investigación Sanitaria Illes Balears (financed by 2017 annual plan of the sustainable tourism tax and at 50% with charge to the ESF Operational Program 2014–2020 of the Balearic Islands. C.M.-P. was financially supported by a joint grant from the Community of Madrid and the European Social Fund (grant PEJD-2019- POST/SAL-15892). The METHYL-UP project was supported by the Spanish Ministry of Science and Innovation (RTI2018-095569-B-I00, Programa de Proyectos Orientados a los Retos de la Sociedad “Projects Toward Society Challenges Program”)., The association between ultra-processed food (UPF) and risk of cardiometabolic disorders is an ongoing concern. Different food processing-based classification systems have originated discrepancies in the conclusions among studies. To test whether the association between UPF consumption and cardiometabolic markers changes with the classification system, we used baseline data from 5636 participants (48.5% female and 51.5% male, mean age 65.1 4.9) of the PREDIMEDPlus (“PREvention with MEDiterranean DIet”) trial. Subjects presented with overweight or obesity and met at least three metabolic syndrome (MetS) criteria. Food consumption was classified using a 143-item food frequency questionnaire according to four food processing-based classifications: NOVA, International Agency for Research on Cancer (IARC), International Food Information Council (IFIC) and University of North Carolina (UNC). Mean changes in nutritional and cardiometabolic markers were assessed according to quintiles of UPF consumption for each system. The association between UPF consumption and cardiometabolic markers was assessed using linear regression analysis. The concordance of the different classifications was assessed with intra-class correlation coefficients (ICC3, overall = 0.51). The highest UPF consumption was obtained with the IARC classification (45.9%) and the lowest with NOVA (7.9%). Subjects with high UPF consumption showed a poor dietary profile. We detected a direct association between UPF consumption and BMI (p = 0.001) when using the NOVA system, and with systolic (p = 0.018) and diastolic (p = 0.042) blood pressure when using the UNC system. Food classification methodologies markedly influenced the association between UPF consumption and cardiometabolic risk markers., European Research Council (ERC) European Commission #340918, Centro de Investigacion Biomedica en Red-Fisiopatologia de la Obesidad y Nutricion PI16/00473, PI16/00662, PI16/01873, PI16/01094, PI16/00501, PI16/00533, PI16/00381, PI16/00366, PI16/01522, PI16/01120, PI17/00764, PI17/01183, PI17/00855, PI17/01347, PI17/00525, PI17/01827, PI17/00532, PI17/00215, PI17/01441 PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/00728, PI13/01090, PI13/01056, PI14/01722, PI14/00636, PI14/00618, PI14/00696, PI14/01206, PI14/01919, PI14/00853, PI14/01374, PI14/00972, PI14/00728, PI14/01471 PI17/00508, PI17/01732, PI17/00926, PI19/00957, PI19/00386, PI19/00309, PI19/01032, PI19/00576, PI19/00017, PI19/01226, PI19/00781, PI19/01560, PI19/01332
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- 2021
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