Ultraprocessed Food Consumption and Cardiometabolic Risk Factors in Children
Authors: Nadine Khoury, María Ángeles Martínez, Tany E. Garcidueñas-Fimbres, Belén Pastor-Villaescusa, Rosaura Leis, Sara de Las Heras-Delgado, María L. Miguel-Berges, Santiago Navas-Carretero, Olga Portoles, Karla Alejandra Pérez-Vega, Jose Manuel Jurado-Castro, Rocío Vázquez-Cobela, Gisela Mimbrero, Raquel Andía Horno, J. Alfredo Martínez, Katherine Flores-Rojas, Rosaura Picáns-Leis, Verónica Luque, Luis A. Moreno, Cristina Castro-Collado, Mercedes Gil-Campos, Jordi Salas-Salvadó, Nancy Babio
Journal: JAMA Network Open (2024)

Importance High intake of ultraprocessed foods (UPFs) has been associated with higher cardiometabolic risk in adults; however, the evidence in children is limited. Objective To investigate the association between UPF consumption and cardiometabolic risk factors in the Childhood Obesity Risk Assessment Longitudinal Study (CORALS). Design, Setting, and Participants This baseline cross-sectional analysis was conducted using the data of CORALS participants recruited between March 22, 2019, and June 30, 2022. Preschool children (aged 3-6 years) were recruited from schools and centers in 7 cities in Spain. Inclusion criteria included informed consent signed by parents or caregivers and having a completed a set of questionnaires about the child’s prenatal history at home. Exclusion criteria included low command of Spanish or unstable residence. Exposure Energy-adjusted UPF consumption (in grams per day) from food frequency questionnaires and based on the NOVA food classification system. Main Outcomes and Measures Age- and sex-specific z scores of adiposity parameters (body mass index [BMI], fat mass index, waist-to-height ratio, and waist circumference) and cardiometabolic parameters (diastolic and systolic blood pressure, fasting plasma glucose, homeostasis model assessment for insulin resistance, high-density and low-density lipoprotein cholesterol, and triglycerides) were estimated using linear regression models. Results Of 1509 enrolled CORALS participants, 1426 (mean [SD] age, 5.8 [1.1] years; 698 boys [49.0%]) were included in this study. Mothers of children with high UPF consumption were younger, had a higher BMI, were more likely to have overweight or obesity, and had lower education levels and employment rates. Compared with participants in the lowest tertile of energy-adjusted UPF consumption, those in the highest tertile showed higher z scores of BMI (β coefficient, 0.20; 95% CI, 0.05-0.35), waist circumference (β coefficient, 0.20; 95% CI, 0.05-0.35), fat mass index (β coefficient, 0.17; 95% CI, 0.00-0.32), and fasting plasma glucose (β coefficient, 0.22; 95% CI, 0.06-0.37) and lower z scores for HDL cholesterol (β coefficient, −0.19; 95% CI, −0.36 to −0.02). One-SD increments in energy-adjusted UPF consumption were associated with higher z scores for BMI (β coefficient, 0.11; 95% CI, 0.05-0.17), waist circumference (β coefficient, 0.09; 95% CI, 0.02-0.15), fat mass index (β coefficient, 0.11; 95% CI, 0.04-1.18), and fasting plasma glucose (β coefficient, 0.10; 95% CI, 0.03-0.17) and lower HDL cholesterol (β coefficient, −0.07; 95% CI, −0.15 to −0.00). Substituting 100 g of UPFs with 100 g of unprocessed or minimally processed foods was associated with lower z scores of BMI (β coefficient, −0.03; 95% CI, −0.06 to −0.01), fat mass index (β coefficient, −0.03; 95% CI, −0.06 to 0.00), and fasting plasma glucose (β coefficient, −0.04; 95% CI, −0.07 to −0.01). Conclusions and Relevance These findings suggest that high UPF consumption in young children is associated with adiposity and other cardiometabolic risk factors, highlighting the need for public health initiatives to promote the replacement of UPFs with unprocessed or minimally processed foods.