Beyond the Calories—Is the Problem in the Processing?

Abstract

Purpose of review

The purpose of this review is to describe the trends in dietary patterns and food quality over time along with the possible role of ultra-processed foods in obesity, chronic diseases, and all-cause mortality in the US population.

Recent findings

There is a rising obesity epidemic, corresponding chronic diseases, and increases in ultra-processed food consumption. In mice and in vitro trials, emulsifiers, found in processed foods, have been found to alter microbiome compositions, elevate fasting blood glucose, cause hyperphagia, increase weight gain and adiposity, and induce hepatic steatosis. Recent human trials have found ultra-processed foods as a contributor to decreased satiety, increased meal eating rates, worsening biochemical markers, and more weight gain. In contrast, Blue Zone, indigenous South American, and Mediterranean populations with low meat intake, high fiber, and minimally processed foods have far less chronic diseases, obesity rates, and live longer disease-free.

Summary

As the USA continues to industrialize, food has become more processed and cheaper and more convenient along with the coexistent rise in obesity prevalence. This review highlights the overall trends in food: mild improvements in dietary quality in higher socioeconomic populations, but no significant increases in whole fruit, vegetables, legumes, or nuts. Consumption of ultra-processed food is associated with weight gain and may contribute to metabolic syndrome and chronic disease. To combat this epidemic, we must create and disseminate detailed recommendations to improve diet quality and overall nutrition.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.

    Bays HE, Seger J, Primack C, Long J, Shah NN, Clark TW, McCarthy W. 2017–2018. Obesity algorithm presented by the Obesity Medicine Association. www.obesityalgorithm.org ()

  2. 2.

    Centers for Disease Control and Prevention: Overweight &Obesity. Available from: https://www.cdc.gov/obesity/data/adult.html. Assessed 27 March 2019.

  3. 3.

    Keith SW, Redden DT, Katzmarzyk PT, et al. Putative contributors to the secular increase in obesity: exploring the roads less traveled. Int J Obes. 2006;30:1585–94.

    CAS  Article  Google Scholar 

  4. 4.

    Singh RK, Ishikawa S. Food additive P-80 impacts mouse gut microbiota promoting intestinal inflammation, obesity, and liver dysfunction. SOJ Microbioal Infec Dis. 2016;4(1):1–10.

    CAS  Article  Google Scholar 

  5. 5.

    Swinburn BA, Sacks G, Hall KD, et al. The global obesity pandemic: shaped by global drivers and local environments. Lance. 2011;378:804–14.

    Article  Google Scholar 

  6. 6.

    Jeaon JY, Ha KW, Kim DJ. New risk factors for obesity and diabetes: Environmental chemicals. J Diabetes Investig. 2015;6(2):109–11.

    Article  Google Scholar 

  7. 7.

    Lenard NR, Berthoud HR. Central and Peripheral regulation of food intake and physical activity: pathways and genes. Obesity. 2008;16(Suppl3):S11–22.

    CAS  Article  Google Scholar 

  8. 8.

    Makris MC, Alexandrou A, Papatsoutsos EG, et al. Ghrelin and obesity: Identifying gaps and dispelling myths. A reappraisal. In vivo. 2017;31:1047–50.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Flegal K, Kruszon-Moran D, Carroll M, et al. Trends in obesity among adults in the Unites States, 2005–2014. JAMA. 2016;315(21):2284–91.

    CAS  Article  Google Scholar 

  10. 10.

    Mozaffarian D, Hao T, Rimm T, Willet W, Hu F. Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med. 2011;364(25):2392–404.

    CAS  Article  Google Scholar 

  11. 11.

    Monterio CA, et al. Household availability of ultra-processed foods and obesity in nineteen European countries. Public Health Nutr. 21(1):18–26.

  12. 12.

    Rehm C, Penalvo J, Afshin A, Mozaffarian D. Dietary intake among US adults, 199-2012. JAMA. 2016;315(23):2542–53.

    CAS  Article  Google Scholar 

  13. 13.

    Wang D, Leung C, Li Y, Ding E, Chiuve S, Hu F, et al. Trends in dietary quality among adults in the United States, 1999 through 2010. JAMA. 2014;174(10):1587–95.

    Google Scholar 

  14. 14.

    US Department of Health and Human Services. Dietary guidelines for Americans 2015–2020. New York: Skyhorse Publishing Inc.; 2017.

    Google Scholar 

  15. 15.

    Storey M, Anderson P. Income and race/ethnicity influence dietary fiber intake and vegetable consumption. Nutr Res. 2014;34(10):844–50.

    CAS  Article  Google Scholar 

  16. 16.

    Veronese N, Solmi M, Caruso MG, et al. Dietary fiber and health outcomes: an umbrella review of systematic reviews and meta-analyses. Am J Clin Nutr. 2018;107(3):436–44.

    Article  Google Scholar 

  17. 17.

    North CJ, Venter CS, Jerling JC. The effects of dietary fibre on C-reactive protein, an inflammation marker predicting cardiovascular disease. Eur J Clin Nutr. 2009;63(8):921–33.

    CAS  Article  Google Scholar 

  18. 18.

    Krishnamurthy VMR, Wei G, Baird BC, et al. High dietary fiber intake is associated with decreased inflammation and all-cause mortality in patients with chronic kidney disease. Kidney Int. 2012;81(3):300.

    CAS  Article  Google Scholar 

  19. 19.

    Kuo S-M. The interplay between fiber and the intestinal microbiome in the inflammatory response. Adv Nutr. 2013;4(1):16–28.

    CAS  Article  Google Scholar 

  20. 20.

    Veiga M, Costa EM, Silva S, Pintado M. Impact of plant extracts upon human health: a review. Crit Rev Food Sci Nutr. 2018. https://doi.org/10.1080/10408398.2018.1540969.

  21. 21.

    Flint HJ. The impact of nutrition on the human microbiome. Nutr Rev. 2012;70:S10–3.

    Article  Google Scholar 

  22. 22.

    Holscher HD. Dietary fiber and prebiotics and the gastrointestinal microbiota. Gut Microbes. 2017;8(2):172–84.

    CAS  Article  Google Scholar 

  23. 23.

    Cummings JH, et al. Fecal weight, colon cancer risk, and dietary intake of nonstarch polysaccharides (dietary fiber). Gastroenterology. 1992:1783–9.

  24. 24.

    Rose DJ, DeMeo MT, Keshavarzian A, et al. Influence of dietary fiber on inflammatory bowel disease and colon cancer: importance of fermentation pattern. Nutr Rev. 2007;65(2):51–62.

    Article  Google Scholar 

  25. 25.

    Roca-Saavedra P, Mendez-Vilabrille V, Miranda JM, et al. Food additives, contaminants and other minor components: effects on human gut microbiota-a review. J Physiol Biochem. 2018;74(1):69–83.

    CAS  Article  Google Scholar 

  26. 26.

    Krajmalnik-Brown R, Ilhan ZE, Kang DW, DiBaise JK. Effects of gut microbes on nutrient absorption and energy regulation. Nutr Clin Pract. 2012;27(2):201–14.

    Article  Google Scholar 

  27. 27.

    Tap J, Furet JP, Bensaada M, et al. Gut microbiota richness promotes its stability upon increased dietary fibre intake in healthy adults. Environ Microbiol. 2015. https://doi.org/10.1111/1462-2920.13006.

    CAS  Article  Google Scholar 

  28. 28.

    Deehan EC, Walter J. The fiber gap and the disappearing gut microbiome: implications for human nutrition. Trends Endocrinol Metab. 2016. https://doi.org/10.1016/j.tem.2016.03.001.

    CAS  Article  Google Scholar 

  29. 29.

    Glade MJ, Meguid MM. A glance at dietary emulsifiers, the human intestinal mucus and microbiome, and dietary fiber. Nutrition. 2016;32:609–14.

    Article  Google Scholar 

  30. 30.

    Whitehead RH, Young GP, Bhathal PS. Effects of short chain fatty acids on a new human colon carcinoma cell line (LIM1215). Gut. 1986;27(12):1457–63. https://doi.org/10.1136/GUT.27.12.1457.

    CAS  Article  Google Scholar 

  31. 31.

    Ogawa H, Rafiee P, Fisher PJ, Johnson NA, et al. Butyrate modulates gene and protein expression in human intestinal endothelial cells. Biochem Biophys Res Commun. 2003;309(3):512–9.

    CAS  Article  Google Scholar 

  32. 32.

    Hoyles L, Snelling T, Umlai UK, et al. Microbiome-host systems interactions: protective effects of propionate upon the blood-brain barrier. Microbiome. 2018. https://doi.org/10.1186/s40168-018-0439-y.

  33. 33.

    •• Willet W, et al. Food in the Anthropocene: the Eat-Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019;393(10170):447–92 This is a landmark trial describes the intricate worldwide factors that contribute to climate change, obesity, chronic diseases, animal extinction, and many other factors.

    Article  Google Scholar 

  34. 34.

    Shah R, Kolanos R, et al. Dietary exposures for the safety assessment of seven emulsifiers commonly added to foods in the United States and implications for safety. Food Addit Contam. 2017;34(6):905–17.

    CAS  Article  Google Scholar 

  35. 35.

    •• Hall K, Ayuketah A, Brychta R, Cai H, Cassimatis T, Chen K, et al. Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake. Cell Metabolism. 2019;30:1–11 This was the first inpatient trial to study the effects of unprocessed and processed diets in humans on weight, energy intake, biochemical markers, etc.

    Article  Google Scholar 

  36. 36.

    • Chassaing B, Koren O, Goodrich J, et al. Dietary emulsifiers impact the mouse gut microbiota promoting colitis and metabolic syndrome. Nature. 2015;519:92–9 This trial showed small bowel, inflammatory, microbiome, and biochemical changes due to emulsifier use in a mouse model.

    CAS  Article  Google Scholar 

  37. 37.

    Chassaing B, Van de Wiele T, De Bodt J, et al. Dietary emulsifiers directly alter human microbiota composition and gene expression ex vivo potentiating intestinal inflammation. Gut. 2017;66:1414–27.

    CAS  Article  Google Scholar 

  38. 38.

    Swidsinski A, Ung V, Sydora BC, Loening-Baucke V, et al. Bacterial overgrowth and inflammation of small intestine after carboxymethylcellulose ingestion in genetically susceptible mice. Inflamm Bowel Dis. 2009;15(3):359–64.

    Article  Google Scholar 

  39. 39.

    Viennois E, Merlin D, Gewirtz AT, Chassaing B. Dietary emulsifier-induced low grade inflammation promotes colon carcinogenesis. Cancer Res. 2017;77:37–40.

    Article  Google Scholar 

  40. 40.

    Shang Q, Sun W, Shan X, et al. Carrageenan-induced colitis is associated with decreased population of anti-inflammatory bacterium, Akkermansia muciniphila, in the gut microbiota of C57BL/6J mice. Toxicol Lett. 2017;279:87–95.

    CAS  Article  Google Scholar 

  41. 41.

    Martinez Steele E, Raubenheimer D, et al. Ultra-processed foods, protein leverage and energy intake in the USA. Public Health Nutr. 2018;21:114–24.

    Article  Google Scholar 

  42. 42.

    Poti J, Braga B, Qin B. Ultra-processed food intake and obesity: what really matters for health-processing or nutrient content? Curr Obes Rep. 2017;6(4):420–31.

    Article  Google Scholar 

  43. 43.

    Buettner D, Skemp S. Blue zones: lessons from the world’s longest lived. Am J Lifestyle Med. 2016;10(5):318–21.

    Article  Google Scholar 

  44. 44.

    Olich M, Singh P, Sabate J, et al. Vegetarian dietary patterns and mortality in Adventist Health Study 2. JAMA Intern Med. 2013 July 8;173(13):1230–8.

    Article  Google Scholar 

  45. 45.

    Guasch-Ferré M, Salas-Salvadó J, Estruch R, Corella D, Fitó M. Martinez-González MA; PREDIMED Investigators. The PREDIMED trial, Mediterranean diet and health outcomes: how strong is the evidence? Nutr Metab Cardiovasc Dis. 2017;27(7):624–32.

    Article  Google Scholar 

  46. 46.

    Kaplan H, Thompson R, Truble B, Wann L, Allam A, et al. Coronary atherosclerosis in indigenous South American Tsimane: a cross-sectional cohort study. Lancet. 2017;389(10080):1730–9.

    Article  Google Scholar 

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Correspondence to Janese Laster MD.

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Janese Laster declares that she has no conflict of interest. Leigh Frame declares that she has no conflict of interest.

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Laster, J., Frame, L.A. Beyond the Calories—Is the Problem in the Processing?. Curr Treat Options Gastro 17, 577–586 (2019). https://doi.org/10.1007/s11938-019-00246-1

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Keywords

  • Obesity
  • Dietary trends
  • Ultra-processed foods
  • Emulsifiers
  • Calories
  • Fiber