澳大利亚迪肯大学Melissa M Lane团队研究了超加工食品暴露与不良健康结局之间的相关性。该项研究成果发表在2024年2月28日出版的《英国医学杂志》上。

该研究旨在评估Nova食品分类系统定义的超加工食品暴露与不良健康结局之间关系的现有荟萃分析证据。研究组在MEDLINE、PsycINFO、Embase和Cochrane系统评价数据库，以及2009年至2023年6月参考文献列表中手动检索，并对现有荟萃分析进行系统综述。

符合资格标准的研究包括队列、病例对照和/或横断面研究设计的系统综述和荟萃分析。为了评估证据的可信度，研究组采用了预先规定的证据分类标准，分为令人信服（“I类”）、高度暗示（“II类”），暗示（“III级”）、微弱（“IV类”）或无证据（“V类”）。证据质量使用GRADE（建议、评定、发展和评估分级）框架进行评估，分为“高”、“中等”、“低”或“非常低”质量。

该研究确定了45种独特的汇总分析，包括13种剂量反应关联和32种非剂量反应关联（n=9888373）。 总体而言，发现接触超加工食品与32项（71%）健康参数之间存在直接关联，这些健康参数包括死亡率、癌症、精神、呼吸、心血管、胃肠道和代谢健康结局。

根据预先规定的证据分类标准，令人信服的证据（I类）支持更多的超加工食品暴露与更高的心血管疾病相关死亡（风险比1.50，95%置信区间1.37-1.63；等级=非常低）和2型糖尿病风险（剂量反应风险比1.12，1.11至1.13；中等）之间的直接关联，以及更高的普遍焦虑预后风险（优势比1.48，1.37-1.59；低）和合并常见精神障碍结果风险（优势比1.53，1.43-1.63；低）之间的直接关联。

高度提示性（II类）证据表明，更多地接触超加工食品与更高的事件全因死亡率（风险比1.21，1.15至1.27；低）、心脏病相关死亡率（风险比1.66，1.51至1.84；低）、2型糖尿病（风险比1.40，1.23至1.59；非常低）和抑郁结局（风险比1.22，1.16至1.28；低1.77；低）的风险相关。在其余34份汇总分析中，21份被评为暗示或弱强度（III-IV级），13份被评为无证据（V级）。总体而言，使用GRADE框架，22项汇总分析被评为低质量，19项被评为极低质量，4项被评为由中等质量。

研究结果表明，更多地接触超加工食品与更高的不良健康结局风险相关，尤其是心脏代谢、常见精神障碍和死亡率方面。这些发现为制定和评估使用基于人群的公共卫生措施来针对和减少超加工食品的饮食暴露以改善人类健康的有效性提供了依据。它们还为紧急的机制研究提供信息和支持。

附：英文原文

Title: Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses

Author: Melissa M Lane, Elizabeth Gamage, Shutong Du, Deborah N Ashtree, Amelia J McGuinness, Sarah Gauci, Phillip Baker, Mark Lawrence, Casey M Rebholz, Bernard Srour, Mathilde Touvier, Felice N Jacka, Adrienne O’Neil, Toby Segasby, Wolfgang Marx

Issue&Volume: 2024/02/28

Abstract:

Objective To evaluate the existing meta-analytic evidence of associations between exposure to ultra-processed foods, as defined by the Nova food classification system, and adverse health outcomes.

Design Systematic umbrella review of existing meta-analyses.

Data sources MEDLINE, PsycINFO, Embase, and the Cochrane Database of Systematic Reviews, as well as manual searches of reference lists from 2009 to June 2023.

Eligibility criteria for selecting studies Systematic reviews and meta-analyses of cohort, case-control, and/or cross sectional study designs. To evaluate the credibility of evidence, pre-specified evidence classification criteria were applied, graded as convincing (“class I”), highly suggestive (“class II”), suggestive (“class III”), weak (“class IV”), or no evidence (“class V”). The quality of evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework, categorised as “high,” “moderate,” “low,” or “very low” quality.

Results The search identified 45 unique pooled analyses, including 13 dose-response associations and 32 non-dose-response associations (n=9888373). Overall, direct associations were found between exposure to ultra-processed foods and 32 (71%) health parameters spanning mortality, cancer, and mental, respiratory, cardiovascular, gastrointestinal, and metabolic health outcomes. Based on the pre-specified evidence classification criteria, convincing evidence (class I) supported direct associations between greater ultra-processed food exposure and higher risks of incident cardiovascular disease related mortality (risk ratio 1.50, 95% confidence interval 1.37 to 1.63; GRADE=very low) and type 2 diabetes (dose-response risk ratio 1.12, 1.11 to 1.13; moderate), as well as higher risks of prevalent anxiety outcomes (odds ratio 1.48, 1.37 to 1.59; low) and combined common mental disorder outcomes (odds ratio 1.53, 1.43 to 1.63; low). Highly suggestive (class II) evidence indicated that greater exposure to ultra-processed foods was directly associated with higher risks of incident all cause mortality (risk ratio 1.21, 1.15 to 1.27; low), heart disease related mortality (hazard ratio 1.66, 1.51 to 1.84; low), type 2 diabetes (odds ratio 1.40, 1.23 to 1.59; very low), and depressive outcomes (hazard ratio 1.22, 1.16 to 1.28; low), together with higher risks of prevalent adverse sleep related outcomes (odds ratio 1.41, 1.24 to 1.61; low), wheezing (risk ratio 1.40, 1.27 to 1.55; low), and obesity (odds ratio 1.55, 1.36 to 1.77; low). Of the remaining 34 pooled analyses, 21 were graded as suggestive or weak strength (class III-IV) and 13 were graded as no evidence (class V). Overall, using the GRADE framework, 22 pooled analyses were rated as low quality, with 19 rated as very low quality and four rated as moderate quality.

Conclusions Greater exposure to ultra-processed food was associated with a higher risk of adverse health outcomes, especially cardiometabolic, common mental disorder, and mortality outcomes. These findings provide a rationale to develop and evaluate the effectiveness of using population based and public health measures to target and reduce dietary exposure to ultra-processed foods for improved human health. They also inform and provide support for urgent mechanistic research.

DOI: 10.1136/bmj-2023-077310

Source: https://www.bmj.com/content/384/bmj-2023-077310