Hochverarbeitete Lebensmittel und Gesundheit: Differenzieren statt dämonisieren

Hochverarbeitete Lebensmittel (Ultra-Processed Foods, UPF) haben – unabhängig vom Nährstoff- und Kaloriengehalt – einen schlechten Ruf. Dieser Beitrag betrachtet die zugrundeliegende NOVA-Klassifikation kritisch und gibt einen differenzierten Überblick über die postulierten Mechanismen und die aktuelle Studienlage.

Abstract

Epidemiological studies show associations between the consumption of ultra-processed food (UPF) and numerous diseases. So far, however, there is no evidence of a causal relationship from randomised controlled trials. In addition, the individual UPFs differ considerably regarding their nutritional profiles and physiological effects. Differentiated analyses of epidemiological data indicate that the association of UPF consumption with adverse health effects is dominated by two food groups only (meat products, sugar-sweetened beverages). Other UPFs show no respective or even protective associations. The UPF concept therefore has no advantage compared to the established classification systems; this applies in particular with regard to the health assessment of foods with a high content of (saturated) fatty acids, salt, and sugar. The undifferentiated assessment of all UPFs, regardless of their nutritional profile, contradicts the current data and therefore lacks a scientific basis.

Schlüsselwörter

hochverarbeitete Lebensmittel - NOVA-Klassifikation - Lebensmittelverarbeitung - nicht übertragbare Krankheiten - Lebensmittelzusatzstoffe

Key words

ultra-processed food - NOVA classification - food processing - non-communicable diseases - food additives

Publication History

Article published online:
07 October 2024

• Literatur

• 1 Weaver CM, Dwyer J, Fulgoni VL. et al. Processed foods: contributions to nutrition. Am J Clin Nutr 2014; 99: 1525-1542
• 2 Knorr D, Watzke H. Food Processing at a Crossroad. Front Nutr 2019; 6: 85
• 3 Forde CG. Beyond ultra-processed: considering the future role of food processing in human health. Proc Nutr Soc 2023; 82: 406-418
• 4 Ministry of Health of Brazil. Dietary guidelines for the Brazilian population. 2015; Im Internet: https://bvsms.saude.gov.br/bvs/publicacoes/dietary_guidelines_brazilian_population.pdf; Stand: 10.10.2023
• 5 Srour B, Hercberg S, Galan P. et al. Effect of a new graphically modified Nutri-Score on the objective understanding of foods’ nutrient profile and ultraprocessing: a randomised controlled trial. BMJ Nutr Prev Health 2023; 6: 108-118
• 6 Touvier M, Srour B, Hercberg S. et al. Health impact of foods: Time to switch to a 3D-vision. Front Nutr 2022; 9: 966310
• 7 Gibney MJ, Forde CG. Nutrition research challenges for processed food and health. Nat Food 2022; 3: 104-109
• 8 Hall KD, Ayuketah A, Brychta R. 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: 67-77.e3
• 9 Monteiro CA. Nutrition and health. The issue is not food, nor nutrients, so much as processing. Public Health Nutr 2009; 12: 729-731
• 10 Monteiro CA, Cannon G, Moubarac J-C. et al. The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutr 2018; 21: 5-17
• 11 Monteiro CA, Cannon G, Lawrence M. Ultra-processed foods, diet quality, and health using the NOVA classification system. 2019. Im Internet: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://openknowledge.fao.org/server/api/core/bitstreams/5277b379-0acb-4d97-a6a3-602774104629/content; Stand: 30.04.2024
• 12 Lawrence MA, Baker PI. Ultra-processed food and adverse health outcomes. BMJ 2019; 365: l2289
• 13 Julia C, Martinez L, Allès B. et al. Contribution of ultra-processed foods in the diet of adults from the French NutriNet-Santé study. Public Health Nutr 2018; 21: 27-37
• 14 Adams J, White M. Characterisation of UK diets according to degree of food processing and associations with socio-demographics and obesity: cross-sectional analysis of UK National Diet and Nutrition Survey (2008–12). Int J Behav Nutr Phys Act 2015; 12: 160
• 15 Baraldi LG, Martinez Steele E, Canella DS. et al. Consumption of ultra-processed foods and associated sociodemographic factors in the USA between 2007 and 2012: evidence from a nationally representative cross-sectional study. BMJ Open 2018; 8: e020574
• 16 Slimani N, Deharveng G, Southgate DAT. et al. Contribution of highly industrially processed foods to the nutrient intakes and patterns of middle-aged populations in the European Prospective Investigation into Cancer and Nutrition study. Eur J Clin Nutr 2009; 63: S206-S225
• 17 Lane MM, Davis JA, Beattie S. et al. Ultraprocessed food and chronic noncommunicable diseases: A systematic review and meta-analysis of 43 observational studies. Obesity Reviews 2021; 22: e13146
• 18 Wang L, Du M, Wang K. et al. Association of ultra-processed food consumption with colorectal cancer risk among men and women: results from three prospective US cohort studies. BMJ 2022; e068921
• 19 Fiolet T, Srour B, Sellem L. et al. Consumption of ultra-processed foods and cancer risk: results from NutriNet-Santé prospective cohort. BMJ 2018; k322
• 20 Shu L, Huang Y, Si C. et al. Association between ultra-processed food intake and risk of colorectal cancer: a systematic review and meta-analysis. Front Nutr 2023; 10: 1170992
• 21 Srour B, Fezeu LK, Kesse-Guyot E. et al. Ultra-processed food intake and risk of cardiovascular disease: prospective cohort study (NutriNet-Santé). BMJ 2019; 365: l1451
• 22 Mendonça RDD, Lopes ACS, Pimenta AM. et al. Ultra-Processed Food Consumption and the Incidence of Hypertension in a Mediterranean Cohort: The Seguimiento Universidad de Navarra Project. Am J Hypertens 2017; 30: 358-366
• 23 Mambrini SP, Menichetti F, Ravella S. et al. Ultra-Processed Food Consumption and Incidence of Obesity and Cardiometabolic Risk Factors in Adults: A Systematic Review of Prospective Studies. Nutrients 2023; 15: 2583
• 24 Moradi S, Hojjati Kermani MA, Bagheri R. et al. Ultra-Processed Food Consumption and Adult Diabetes Risk: A Systematic Review and Dose-Response Meta-Analysis. Nutrients 2021; 13: 4410
• 25 Harb AA, Shechter A, Koch PA. et al. Ultra-processed foods and the development of obesity in adults. Eur J Clin Nutr 2023; 77: 619-627
• 26 Beslay M, Srour B, Méjean C. et al. Ultra-processed food intake in association with BMI change and risk of overweight and obesity: A prospective analysis of the French NutriNet-Santé cohort. PLoS Med 2020; 17: e1003256
• 27 Askari M, Heshmati J, Shahinfar H. et al. Ultra-processed food and the risk of overweight and obesity: a systematic review and meta-analysis of observational studies. Int J Obes 2020; 44: 2080-2091
• 28 Moradi S, Entezari MH, Mohammadi H. et al. Ultra-processed food consumption and adult obesity risk: a systematic review and dose-response meta-analysis. Critical Reviews in Food Science and Nutrition 2023; 63: 249-260
• 29 Martínez Steele E, Juul F, Neri D. et al. Dietary share of ultra-processed foods and metabolic syndrome in the US adult population. Preventive Medicine 2019; 125: 40-48
• 30 Adjibade M, Julia C, Allès B. et al. Prospective association between ultra-processed food consumption and incident depressive symptoms in the French NutriNet-Santé cohort. BMC Med 2019; 17: 78
• 31 Lee S, Choi M. Ultra-Processed Food Intakes Are Associated with Depression in the General Population: The Korea National Health and Nutrition Examination Survey. Nutrients 2023; 15: 2169
• 32 Lane MM, Gamage E, Travica N. et al. Ultra-Processed Food Consumption and Mental Health: A Systematic Review and Meta-Analysis of Observational Studies. Nutrients 2022; 14: 2568
• 33 Henney AE, Gillespie CS, Alam U. et al. Ultra-Processed Food Intake Is Associated with Non-Alcoholic Fatty Liver Disease in Adults: A Systematic Review and Meta-Analysis. Nutrients 2023; 15: 2266
• 34 Schnabel L, Buscail C, Sabate J-M. et al. Association Between Ultra-Processed Food Consumption and Functional Gastrointestinal Disorders: Results From the French NutriNet-Santé Cohort. American Journal of Gastroenterology 2018; 113: 1217-1228
• 35 He Q, Sun M, Zhao H. et al. Ultra-processed food consumption, mediating biomarkers, and risk of chronic obstructive pulmonary disease: a prospective cohort study in the UK Biobank. Food Funct 2023; 14: 8785-8796
• 36 [36] Kong W, Xie Y, Zhong J. et al. Ultra-processed foods and allergic symptoms among children and adults in the United States: A population-based analysis of NHANES 2005–2006. Front Public Health 2022; 10: 1038141
• 37 Zhao Y, Chen W, Li J. et al. Ultra-Processed Food Consumption and Mortality: Three Cohort Studies in the United States and United Kingdom. Am J Prev Med 2023; S0749379723003513
• 38 Pagliai G, Dinu M, Madarena MP. et al. Consumption of ultra-processed foods and health status: a systematic review and meta-analysis. Br J Nutr 2021; 125: 308-318
• 39 Schnabel L, Kesse-Guyot E, Allès B. et al. Association Between Ultraprocessed Food Consumption and Risk of Mortality Among Middle-aged Adults in France. JAMA Intern Med 2019; 179: 490
• 40 Kim H, Hu EA, Rebholz CM. Ultra-processed food intake and mortality in the USA: results from the Third National Health and Nutrition Examination Survey (NHANES III, 1988–1994). Public Health Nutr 2019; 22: 1777-1785
• 41 García-Blanco L, De La OV, Santiago S. et al. High consumption of ultra-processed foods is associated with increased risk of micronutrient inadequacy in children: The SENDO project. Eur J Pediatr 2023; 182: 3537-3547
• 42 Vandevijvere S, De Ridder K, Fiolet T. et al. Consumption of ultra-processed food products and diet quality among children, adolescents and adults in Belgium. Eur J Nutr 2019; 58: 3267-3278
• 43 Martínez Steele E, Popkin BM, Swinburn B. et al. The share of ultra-processed foods and the overall nutritional quality of diets in the US: evidence from a nationally representative cross-sectional study. Popul Health Metrics 2017; 15: 6
• 44 González-Castell D, González-Cossío T, Barquera S. et al. Alimentos industrializados en la dieta de los preescolares mexicanos. Salud pública Méx 2007; 49
• 45 Asfaw A. Does consumption of processed foods explain disparities in the body weight of individuals? The case of Guatemala. Health Econ 2011; 20: 184-195
• 46 Eicher-Miller HA, Fulgoni VL, Keast DR. Contributions of Processed Foods to Dietary Intake in the US from 20032008: A Report of the Food and Nutrition Science Solutions Joint Task Force of the Academy of Nutrition and Dietetics, American Society for Nutrition, Institute of Food Technologists, and International Food Information Council4. J Nutr 2012; 142: 2065S-2072S
• 47 Davidou S, Christodoulou A, Fardet A. et al. The holistico-reductionist Siga classification according to the degree of food processing: an evaluation of ultra-processed foods in French supermarkets. Food Funct 2020; 11: 2026-2039
• 48 Bleiweiss-Sande R, Chui K, Evans EW. et al. Robustness of Food Processing Classification Systems. Nutrients 2019; 11: 1344
• 49 De Araújo TP, De Moraes MM, Afonso C. et al. Food Processing: Comparison of Different Food Classification Systems. Nutrients 2022; 14: 729
• 50 Martinez-Perez C, San-Cristobal R, Guallar-Castillon P. et al. 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). Nutrients 2021; 13: 2471
• 51 Astrup A, Monteiro CA. Does the concept of “ultra-processed foods” help inform dietary guidelines, beyond conventional classification systems? Debate consensus. Am J Clin Nutr 2022; 116: 1489-1491
• 52 Drewnowski A, Gupta S, Darmon N. An Overlap Between “Ultraprocessed” Foods and the Preexisting Nutrient Rich Foods Index?. Nutr Today 2020; 55: 75-81
• 53 Visioli F, Marangoni F, Fogliano V. et al. The ultra-processed foods hypothesis: a product processed well beyond the basic ingredients in the package. Nutr Res Rev 2022; 1-11
• 54 Braesco V, Souchon I, Sauvant P. et al. Ultra-processed foods: how functional is the NOVA system?. Eur J Clin Nutr 2022; 76: 1245-1253
• 55 Gibney MJ. Ultra-Processed Foods: Definitions and Policy Issues. Curr Dev Nutr 2019; 3: nzy077
• 56 Monteiro CA, Cannon G, Levy RB. et al. Ultra-processed foods: what they are and how to identify them. Public Health Nutr 2019; 22: 936-941
• 57 Martini D, Godos J, Bonaccio M. et al. Ultra-Processed Foods and Nutritional Dietary Profile: A Meta-Analysis of Nationally Representative Samples. Nutrients 2021; 13: 3390
• 58 Brown AW, Aslibekyan S, Bier D. et al. Toward more rigorous and informative nutritional epidemiology: The rational space between dismissal and defense of the status quo. Crit Rev Food Sci Nutr 2023; 63: 3150-3167
• 59 Chen X, Zhang Z, Yang H. et al. Consumption of ultra-processed foods and health outcomes: a systematic review of epidemiological studies. Nutr J 2020; 19: 86
• 60 Martinez-Perez C, Daimiel L, Climent-Mainar C. et al. Integrative development of a short screening questionnaire of highly processed food consumption (sQ-HPF). Int J Behav Nutr Phys Act 2022; 19: 6
• 61 Ioannidis JPA. Biases in obesity research: Identify, correct, endorse, or abandon effort?. Obesity 2016; 24: 767-768
• 62 Griffin J, Albaloul A, Kopytek A. et al. Effect of ultraprocessed food intake on cardiometabolic risk is mediated by diet quality: a cross-sectional study. BMJNPH 2021; 4: 174-180
• 63 Gehring J, Touvier M, Baudry J. et al. Consumption of Ultra-Processed Foods by Pesco-Vegetarians, Vegetarians, and Vegans: Associations with Duration and Age at Diet Initiation. J Nutr 2021; 151: 120-131
• 64 Cordova R, Kliemann N, Huybrechts I. et al. Consumption of ultra-processed foods associated with weight gain and obesity in adults: A multi-national cohort study. Clin Nutr 2021; 40: 5079-5088
• 65 Sjöberg A, Moraeus L, Yngve A. et al. Overweight and obesity in a representative sample of schoolchildren - exploring the urban-rural gradient in Sweden: National survey – childhood obesity in Sweden. Obes Rev 2011; 12: 305-314
• 66 Faeh D, Braun J, Bopp M. Prevalence of obesity in Switzerland 1992-2007: the impact of education, income and occupational class: Obesity inequality in Switzerland. Obes Rev 2011; 12: 151-166
• 67 Pereira MA. Food processing in nutritional epidemiology: proceed with caution. Am J Clin Nutr 2022; 115: 1455-1456
• 68 Osté MC, Duan M-J, Gomes-Neto AW. et al. Ultra-processed foods and risk of all-cause mortality in renal transplant recipients. Am J Clin Nutr 2022; 115: 1646-1657
• 69 Taneri PE, Wehrli F, Roa-Díaz ZM. et al. Association Between Ultra-Processed Food Intake and All-Cause Mortality: A Systematic Review and Meta-Analysis. Am J Epidemiol 2022; 191: 1323-1335
• 70 Chang K, Gunter MJ, Rauber F. et al. Ultra-processed food consumption, cancer risk and cancer mortality: a large-scale prospective analysis within the UK Biobank. eClinicalMedicine 2023; 56: 101840
• 71 Cordova R, Viallon V, Fontvieille E. et al. Consumption of ultra-processed foods and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study. Lancet Reg Health Eur 2023; 35: 100771
• 72 Scientific Advisory Committee on Nutrition (SACN). SACN statement on processed foods and health (2023). Im Internet: https://assets.publishing.service.gov.uk/media/64ac1fe7b504f7000ccdb89a/SACN-position-statement-Processed-Foods-and-Health.pdf; Stand: 05.05.2024
• 73 Welthungerhilfe. Verborgener Hunger. Welthungerhilfe.de – Für eine Welt ohne Hunger und Armut. Im Internet: https://www.welthungerhilfe.de/informieren/themen/gesunde-ernaehrung-sichern/verborgener-hunger; Stand: 11.10.2023
• 74 Keats EC, Neufeld LM, Garrett GS. et al. Improved micronutrient status and health outcomes in low- and middle-income countries following large-scale fortification: evidence from a systematic review and meta-analysis. Am J Clin Nutr 2019; 109: 1696-1708
• 75 Srour B, Kordahi MC, Bonazzi E. et al. Ultra-processed foods and human health: from epidemiological evidence to mechanistic insights. Lancet Gastroenterol Hepatol 2022; 7: 1128-1140
• 76 Tobias DK, Hall KD. Eliminate or reformulate ultra-processed foods? Biological mechanisms matter. Cell Metabolism 2021; 33: 2314-2315
• 77 Valicente VM, Peng C-H, Pacheco KN. et al. Ultraprocessed Foods and Obesity Risk: A Critical Review of Reported Mechanisms. Adv Nutr 2023; 14: 718-738
• 78 Fazzino TL, Dorling JL, Apolzan JW. et al. Meal composition during an ad libitum buffet meal and longitudinal predictions of weight and percent body fat change: The role of hyper-palatable, energy dense, and ultra-processed foods. Appetite 2021; 167: 105592
• 79 Fazzino TL, Rohde K, Sullivan DK. Hyper-Palatable Foods: Development of a Quantitative Definition and Application to the US Food System Database. Obesity 2019; 27: 1761-1768
• 80 Sproesser G, Ruby MB, Arbit N. et al. Understanding traditional and modern eating: the TEP10 framework. BMC Public Health 2019; 19: 1606
• 81 Mennella JA, Pepino MY, Reed DR. Genetic and Environmental Determinants of Bitter Perception and Sweet Preferences. Pediatrics 2005; 115: e216-e222
• 82 Wise PM, Nattress L, Flammer LJ. et al. Reduced dietary intake of simple sugars alters perceived sweet taste intensity but not perceived pleasantness. Am J Clin Nutr 2016; 103: 50-60
• 83 Johnson F, Wardle J. Variety, Palatability, and Obesity. Advances in Nutrition 2014; 5: 851-859
• 84 Vandevijvere S, Pedroni C, De Ridder K. et al. The Cost of Diets According to Their Caloric Share of Ultraprocessed and Minimally Processed Foods in Belgium. Nutrients 2020; 12: 2787
• 85 Vellinga RE, Van Bakel M, Biesbroek S. et al. Evaluation of foods, drinks and diets in the Netherlands according to the degree of processing for nutritional quality, environmental impact and food costs. BMC Public Health 2022; 22: 877
• 86 Bouzas C, Pastor R, García S. et al. Association of monetary diet cost of foods and diet quality in Spanish older adults. Front Public Health 2023; 11: 1166787
• 87 Rao M, Afshin A, Singh G. et al. Do healthier foods and diet patterns cost more than less healthy options? A systematic review and meta-analysis. BMJ Open 2013; 3: e004277
• 88 Hess JM, Comeau ME, Casperson S. et al. Dietary Guidelines Meet NOVA: Developing a Menu for A Healthy Dietary Pattern Using Ultra-Processed Foods. J Nutr 2023; 153: 2472-2481
• 89 Miller SR, Knudson WA. Nutrition and Cost Comparisons of Select Canned, Frozen, and Fresh Fruits and Vegetables. Am J Lifestyle Med 2014; 8: 430-437
• 90 Lansigan RK, Emond JA, Gilbert-Diamond D. Understanding eating in the absence of hunger among young children: A systematic review of existing studies. Appetite 2015; 85: 36-47
• 91 Feig EH, Piers AD, Kral TVE. et al. Eating in the absence of hunger is related to loss-of-control eating, hedonic hunger, and short-term weight gain in normal-weight women. Appetite 2018; 123: 317-324
• 92 Cena H, Calder PC. Defining a Healthy Diet: Evidence for the Role of Contemporary Dietary Patterns in Health and Disease. Nutrients 2020; 12: 334
• 93 Amato AA, Wheeler HB, Blumberg B. Obesity and endocrine-disrupting chemicals. Endocr Connect 2021; 10: R87-R105
• 94 Sun Z, Tang Z, Yang X. et al. Perturbation of 3-tert-butyl-4-hydroxyanisole in adipogenesis of male mice with normal and high fat diets. Science of The Total Environment 2020; 703: 135608
• 95 Kolatorova L, Sramkova M, Vitku J. et al. Parabens and Their Relation to Obesity. Physiol Res 2018; S465-S472
• 96 Quirós-Alcalá L, Buckley JP, Boyle M. Parabens and measures of adiposity among adults and children from the U.S. general population: NHANES 2007–2014. Int J Hyg Environ Health 2018; 221: 652-660
• 97 Xue J, Wu Q, Sakthivel S. et al. Urinary levels of endocrine-disrupting chemicals, including bisphenols, bisphenol A diglycidyl ethers, benzophenones, parabens, and triclosan in obese and non-obese Indian children. Environ Res 2015; 137: 120-128
• 98 Hoffmann V, Moser C, Saak A. Food safety in low and middle-income countries: The evidence through an economic lens. World Development 2019; 123: 104611
• 99 Holt GM, Owen LJ, Till S. et al. Systematic literature review shows that appetite rating does not predict energy intake. Crit Rev Food Sci Nutr 2017; 57: 3577-3582
• 100 McKiernan F, Hollis JH, McCabe GP. et al. Thirst-Drinking, Hunger-Eating; Tight Coupling?. J Am Diet Assoc 2009; 109: 486-490
• 101 Tremblay A, Bellisle F. Nutrients, satiety, and control of energy intake. Appl Physiol Nutr Metab 2015; 40: 971-979
• 102 Morales I, Berridge KC. ‘Liking’ and ‘wanting’ in eating and food reward: Brain mechanisms and clinical implications. Physiol Behav 2020; 227: 113152
• 103 Jansen E, Thapaliya G, Beauchemin J. et al. The Development of Appetite: Tracking and Age-Related Differences in Appetitive Traits in Childhood. Nutrients 2023; 15: 1377
• 104 Braden A, Barnhart WR, Kalantzis M. et al. Eating when depressed, anxious, bored, or happy: An examination in treatment-seeking adults with overweight/obesity. Appetite 2023; 184: 106510
• 105 Ludwig DS, Ebbeling CB. The Carbohydrate-Insulin Model of Obesity: Beyond “Calories In, Calories Out”. JAMA Intern Med 2018; 178: 1098
• 106 Vega-López S, Venn B, Slavin J. Relevance of the Glycemic Index and Glycemic Load for Body Weight, Diabetes, and Cardiovascular Disease. Nutrients 2018; 10: 1361
• 107 Andersen S, Heller J, Hansen T. et al. Comparison of Low Glycaemic Index and High Glycaemic Index Potatoes in Relation to Satiety: A Single-Blinded, Randomised Crossover Study in Humans. Nutrients 2018; 10: 1726
• 108 Ni C, Jia Q, Ding G. et al. Low-Glycemic Index Diets as an Intervention in Metabolic Diseases: A Systematic Review and Meta-Analysis. Nutrients 2022; 14: 307
• 109 Wu Y, Juraschek SP, Hu J-R. et al. Higher Carbohydrate Amount and Lower Glycemic Index Increase Hunger, Diet Satisfaction, and Heartburn in Overweight and Obese Adults in the OmniCarb Randomized Clinical Trial. J Nutr 2021; 151: 2477-2485
• 110 Gaesser GA, Miller Jones J, Angadi SS. Perspective: Does Glycemic Index Matter for Weight Loss and Obesity Prevention? Examination of the Evidence on “Fast” Compared with “Slow” Carbs. Adv Nutr 2021; 12: 2076-2084
• 111 Sieri S, Agnoli C, Grioni S. et al. Glycemic index, glycemic load, and risk of coronary heart disease: a pan-European cohort study. Am J Clin Nutr 2020; 112: 631-643
• 112 Hafiz MS, Campbell MD, Orsi NM. et al. Impact of food processing on postprandial glycaemic and appetite responses in healthy adults: a randomized, controlled trial. Food Funct 2022; 13: 1280-1290
• 113 Basile A, Ruiz-Tejada A, Mohr A. et al. Ultra-Processed Foods Have a Lower Glycemic Index and Load Compared to Minimally Processed Foods. Curr Dev Nutr 2022; 6: 504
• 114 Raubenheimer D, Simpson SJ. Protein appetite as an integrator in the obesity system: the protein leverage hypothesis. Phil Trans R Soc B 2023; 378: 20220212
• 115 Le Couteur DG, Solon-Biet SM, Cogger VC. et al. Branched chain amino acids, aging and age-related health. Ageing Res Rev 2020; 64: 101198
• 116 Messina M, Sievenpiper JL, Williamson P. et al. Perspective: Soy-based Meat and Dairy Alternatives, Despite Classification as Ultra-processed Foods, Deliver High-quality Nutrition on Par with Unprocessed or Minimally Processed Animal-based Counterparts. Adv Nutr 2022; 13: 726-738
• 117 Agha M, Agha R. The rising prevalence of obesity: part A: impact on public health. Int J Surg Oncol 2017; 2: e17-e17
• 118 Austin GL, Ogden LG, Hill JO. Trends in carbohydrate, fat, and protein intakes and association with energy intake in normal-weight, overweight, and obese individuals: 1971–2006. Am J Clin Nutr 2011; 93: 836-843
• 119 Chawla S, Tessarolo Silva F, Amaral Medeiros S. et al. The Effect of Low-Fat and Low-Carbohydrate Diets on Weight Loss and Lipid Levels: A Systematic Review and Meta-Analysis. Nutrients 2020; 12: 3774
• 120 Polley KR, Kamal F, Paton CM. et al. Appetite responses to high-fat diets rich in mono-unsaturated versus poly-unsaturated fats. Appetite 2019; 134: 172-181
• 121 Dayib M, Larson J, Slavin J. Dietary fibers reduce obesity-related disorders: mechanisms of action. Curr Opin Clin Nutr Metab Care 2020; 23: 445-450
• 122 Reynolds A, Mann J, Cummings J. et al. Carbohydrate quality and human health: a series of systematic reviews and meta-analyses. Lancet 2019; 393: 434-445
• 123 Willis HJ, Eldridge AL, Beiseigel J. et al. Greater satiety response with resistant starch and corn bran in human subjects. Nutr Res 2009; 29: 100-105
• 124 Quinn M, Jordan H, Lacy-Nichols J. Upstream and downstream explanations of the harms of ultra-processed foods in national dietary guidelines. Public Health Nutr 2021; 24: 5426-5435
• 125 Cediel G, Reyes M, Corvalán C. et al. Ultra-processed foods drive to unhealthy diets: evidence from Chile. Public Health Nutr 2021; 24: 1698-1707
• 126 Ello-Martin JA, Ledikwe JH, Rolls BJ. The influence of food portion size and energy density on energy intake: implications for weight management. Am J Clin Nutr 2005; 82: 236S-241S
• 127 Rolls BJ, Roe LS, Meengs JS. Reductions in portion size and energy density of foods are additive and lead to sustained decreases in energy intake. Am J Clin Nutr 2006; 83: 11-17
• 128 Bazshahi E, Sheikhhossein F, Amini MR. et al. The association of dietary energy density and the risk of obesity, type 2 diabetes and metabolic syndrome: A systematic review and meta-analysis of observational studies. Int J Clin Pract 2021; 75
• 129 Arango-Angarita A, Rodríguez-Ramírez S, Serra-Majem L. et al. Dietary Energy Density and Its Association with Overweight or Obesity in Adolescents: A Systematic Review of Observational Studies. Nutrients 2018; 10: 1612
• 130 Forde CG, Mars M, De Graaf K. Ultra-Processing or Oral Processing? A Role for Energy Density and Eating Rate in Moderating Energy Intake from Processed Foods. Curr Dev Nutr 2020; 4: nzaa019
• 131 Robinson E, Khuttan M, McFarland-Lesser I. et al. Calorie reformulation: a systematic review and meta-analysis examining the effect of manipulating food energy density on daily energy intake. Int J Behav Nutr Phys Act 2022; 19: 48
• 132 Zhu Y, Hsu WH, Hollis JH. The Impact of Food Viscosity on Eating Rate, Subjective Appetite, Glycemic Response and Gastric Emptying Rate. PLoS ONE 2013; 8: e67482
• 133 Mackie AR, Rafiee H, Malcolm P. et al. Specific food structures supress appetite through reduced gastric emptying rate. Am J Physiol Gastrointest Liver Physiol 2013; 304: G1038-G1043
• 134 Choy JYM, Goh AT, Chatonidi G. et al. Impact of food texture modifications on oral processing behaviour, bolus properties and postprandial glucose responses. Curr Res Food Sci 2021; 4: 891-899
• 135 Gibney MJ. Food texture trumps food processing in the regulation of energy intake. Am J Clin Nutr 2022; 116: 9-10
• 136 Higgins KA, Mattes RD. A randomized controlled trial contrasting the effects of 4 low-calorie sweeteners and sucrose on body weight in adults with overweight or obesity. Am J Clin Nutr 2019; 109: 1288-1301
• 137 Kawano Y, Edwards M, Huang Y. et al. Microbiota imbalance induced by dietary sugar disrupts immune-mediated protection from metabolic syndrome. Cell 2022; 185: 3501-3519.e20
• 138 Suez J, Cohen Y, Valdés-Mas R. et al. Personalized microbiome-driven effects of non-nutritive sweeteners on human glucose tolerance. Cell 2022; 185: 3307-3328.e19
• 139 Richardson IL, Frese SA. Non-nutritive sweeteners and their impacts on the gut microbiome and host physiology. Front Nutr 2022; 9: 988144
• 140 World Health Organization (WHO). Use of non-sugar sweeteners: WHO guideline (15.05.2023). Im Internet: https://www.who.int/publications/i/item/9789240073616; Stand: 05.05.2024
• 141 World Health Organization (WHO). Health effects of the use of non-sugar sweeteners: a systematic review and meta-analysis. (12.04.2022); Im Internet: https://www.who.int/publications/i/item/9789240046429; Stand: 05.05.2024
• 142 Movahedian M, Golzan SA, Asbaghi O. et al. Assessing the impact of non-nutritive sweeteners on anthropometric indices and leptin levels in adults: A GRADE-assessed systematic review, meta-analysis, and meta-regression of randomized clinical trials. Crit Rev Food Sci Nutr 2023; 1-18
• 143 Zhang R, Noronha JC, Khan TA. et al. The Effect of Non-Nutritive Sweetened Beverages on Postprandial Glycemic and Endocrine Responses: A Systematic Review and Network Meta-Analysis. Nutrients 2023; 15: 1050
• 144 Pavanello S, Moretto A, La Vecchia C. et al. Non-sugar sweeteners and cancer: Toxicological and epidemiological evidence. Regul Toxicol Pharmacol 2023; 139: 105369
• 145 Debras C, Chazelas E, Srour B. et al. Artificial sweeteners and cancer risk: Results from the NutriNet-Santé population-based cohort study. PLoS Med 2022; 19: e1003950
• 146 Ahmad SY, Friel J, Mackay D. The Effects of Non-Nutritive Artificial Sweeteners, Aspartame and Sucralose, on the Gut Microbiome in Healthy Adults: Secondary Outcomes of a Randomized Double-Blinded Crossover Clinical Trial. Nutrients 2020; 12: 3408
• 147 EFSA Panel on Food additives and Nutrient Sources added to Food (ANS). Statement on a conceptual framework for the risk assessment of certain food additives re-evaluated under Commission Regulation (EU) No 257/2010. EFS2 2014; 12: 3697
• 148 Janani R, Tan VWK, Goh AT. et al. Independent and combined impact of texture manipulation on oral processing behaviours among faster and slower eaters. Food Funct 2022; 13: 9340-9354
• 149 Slyper A. Oral Processing, Satiation and Obesity: Overview and Hypotheses. DMSO 2021; 14: 3399-3415
• 150 Teo PS, Lim AJ, Goh AT. et al. Texture-based differences in eating rate influence energy intake for minimally processed and ultra-processed meals. Am J Clin Nutr 2022; 116: 244-254
• 151 Jin Y, Wilde PJ, Hou Y. et al. An evolving view on food viscosity regulating gastric emptying. Crit Rev Food Sci Nutr 2023; 63: 5783-5799
• 152 Pletsch EA, Hayes AM, Chegeni M. et al. Matched whole grain wheat and refined wheat milled products do not differ in glycemic response or gastric emptying in a randomized, crossover trial. Am J Clin Nutr 2022; 115: 1013-1026
• 153 Roager HM, Vogt JK, Kristensen M. et al. Whole grain-rich diet reduces body weight and systemic low-grade inflammation without inducing major changes of the gut microbiome: a randomised cross-over trial. Gut 2019; 68: 83-93
• 154 Meslier V, Laiola M, Roager HM. et al. Mediterranean diet intervention in overweight and obese subjects lowers plasma cholesterol and causes changes in the gut microbiome and metabolome independently of energy intake. Gut 2020; 69: 1258-1268
• 155 Sanders LM, Zhu Y, Wilcox ML. et al. Effects of Whole Grain Intake, Compared with Refined Grain, on Appetite and Energy Intake: A Systematic Review and Meta-Analysis. Adv Nutr 2021; 12: 1177-1195
• 156 Sante Publique France (SPF). Les recommandations sur l’alimentation, l’activité physique et la sédentarité. Manger Bouger. Im Internet: https://www.mangerbouger.fr/l-essentiel/les-recommandations-sur-l-alimentation-l-activite-physique-et-la-sedentarite; Stand: 11.10.2023
• 157 State of Israel Ministry of Health. Processed Food. Processed Food. Im Internet: https://www.health.gov.il/English/Topics/FoodAndNutrition/Nutrition/Adequate_nutrition/processed_food/Pages/default.aspx; Stand: 11.10.2023
• 158 Lockyer S, Spiro A, Berry S. et al. How do we differentiate not demonise – Is there a role for healthier processed foods in an age of food insecurity? Proceedings of a roundtable event. Nutr Bull 2023; 48: 278-295
• 159 Jones JM. Food processing: criteria for dietary guidance and public health?. Proc Nutr Soc 2019; 78: 4-18
• 160 Blomhoff R, Andersen R, Arnesen EK. et al. Nordic Nutrition Recommendations. 2023 Im Internet: https://pub.norden.org/nord2023-003; Stand: 05.05.2024
• 161 Mills S, White M, Brown H. et al. Health and social determinants and outcomes of home cooking: A systematic review of observational studies. Appetite 2017; 111: 116-134
• 162 Adams J, Hofman K, Moubarac J-C. et al. Public health response to ultra-processed food and drinks. BMJ 2020; m2391
• 163 Public Health England (GOV.UK). Plans to cut excess calorie consumption unveiled. Im Internet: https://www.gov.uk/government/news/plans-to-cut-excess-calorie-consumption-unveiled; Stand: 11.10.2023
• 164 Monteiro C, Cannon G. The food system: product reformulation will not improve public health. World Nutr 3 2012; 3: 406-434
• 165 United Nations (UN). 68% of the world population projected to live in urban areas by 2050, says UN | UN DESA | United Nations Department of Economic and Social Affairs. Im Internet: https://www.un.org/development/desa/en/news/population/2018-revision-of-world-urbanization-prospects.html; Stand: 11.10.2023
• 166 Sadler CR, Grassby T, Hart K. et al. Processed food classification: Conceptualisation and challenges. Trends Food Sci Technol 2021; 112: 149-162