Beyond ultra-processed foods: The ZOE processed food (ZPF) risk scale and associations with cardiometabolic health

Le résumé fourni par la source

Diets high in ultra-processed foods (UPFs) are associated with adverse health (1,2) . In the UK and US, UPFs account for almost 60% of total energy intake (3) . The NOVA system (4) classifies foods based on extent of processing but does not capture features that may underlie health associations. Proposed mechanisms include certain additives (5) , unnaturally high sensory appeal or ‘hyper-palatability’ (6) , and food matrix disruption that increases the rate of energy intake (EIR) (7) . There is an urgent need for a practical tool that characterises processing features relevant to health; to guide consumers in making healthier food choices. The aim of this study was to develop the novel ZOE Processed Food (ZPF) Risk Scale, based on processing features relevant to health, and to examine its associations with cardiometabolic outcomes. Processing features included in the ZPF scale were additives and non-culinary ingredients (number and grading); hyper-palatability (true/false); and EIR (high ≥72kcal/min; low <72kcal/min) (8) . Processed foods (whole foods excluded) were categorised into four classes, from ZPF1 (best) to ZPF4 (worst). Cross-sectional data from 550 US participants in the ZOE PREDICT 2 study (NCT03983733), were used to explore associations between mean daily energy intake (%EI) from ZPF1–4 and NOVA UPF categories (weighed food diaries) and anthropometry and blood biomarkers, using multivariable linear regression adjusted for age, sex, education, ethnicity, total energy intake, and diet quality (Healthy Eating Index), with false discovery rate correction (q<0.05). Participants (74% female, mean±SD age 43.4±11.6y; BMI 25.8±5.2kg/m 2 ) consumed 23.1%, 17.4%, 23.5%, and 17.5% of energy from ZPF1–4 respectively, compared with 38.4% from UPFs (NOVA). The proportion of unique logged foods (n=13,847) classified as UPF was 11.0%, 38.9%, 63.4%, and 72.5%, from ZPF1–4 respectively. Processed foods within food groups were distributed across ZPF classes (e.g. breakfast cereals (n=186); ZPF1-4, 18.8%, 45.2%, 19.9% and 16.1% respectively) compared to NOVA (UPF=78.5%). Higher %EI from ZPF4 was significantly associated with higher BMI (β=0.07kg/m 2 , q<0.001), weight (β=0.17kg, q=0.005), and glycA (inflammatory marker) (β=0.001μmol/L, q=0.003), whereas higher %EI from ZPF1 predicted lower BMI (β= −0.07kg/m 2 , q=0.001), weight (β= −0.14kg, q=0.022), and glycA (β= −0.002μmol/L, q=0.001). The ZOE Processed Food Risk Scale captures specific processing features driving associations with health, providing a more precise and less stigmatising classification than NOVA. By distinguishing harmful from benign or potentially beneficial processed foods, the ZPF scale provides an evidence-based tool to inform consumer education, public health policy, and nutrition research.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.