Consumption of ultra-processed food products and its effects on children's lipid profiles: A longitudinal study
Introduction
Cardiovascular disease remains the leading cause of premature death worldwide [1], [2]. The development and progression of cardiovascular disease is related to a number of risk factors that begin in childhood, such as diet and specific blood lipid levels [3], [4]. Dietary habits that are formed early are likely to track later in childhood and form the basis for adult eating patterns [5]. Evidence from the “Cardiovascular Risk in Young Finns” study showed substantial tracking of dietary patterns, reflecting food choices from childhood to adulthood [6]. In subsequent longitudinal analyses, such patterns were found to be associated with several cardiovascular risk factors [7], [8].
Furthermore, it has been reported that elevated lipid concentrations track from childhood to adulthood, as lipid and lipoprotein results in childhood are predictive of future adult lipoprotein profiles [4]. There are a number of specific nutrient intake factors that are associated with cardiovascular disease, including high saturated and trans fat intake [9], low dietary fiber intake [10] and low polyunsaturated fat intake [11]. Among the various dietary factors that have been identified as contributors to the development of cardiovascular risk factors, the consumption of processed and ultra-processed products has received attention [12], [13], [14].
Processed products are foods that have been altered to add substances that substantially change their nature or use, while ultra-processed products are food products formulated mainly or entirely from processed ingredients, typically including little or no whole foods [12]. Evidence has shown that these products (particularly ultra-processed products) are more energy-dense and have more fat, sugar and sodium than fresh or minimally-processed foods and culinary ingredients (such as oils, sugar, and salt) [15], [16]. Moreover, the sale and consumption of ultra-processed products is rapidly increasing throughout the world [13], [17], [18], [19], [20].
Therefore, there is reason to believe that consumption of processed and ultra-processed products may play a role in the development of chronic diseases [21], [22]. Thus far, only a limited number of studies have addressed the relationship between food processing and cardiovascular disease risk. One study reported that processed and ultra-processed product consumption increased the risk for metabolic syndrome in adolescents [23]. A second study demonstrated a positive and independent association between the household availability of ultra-processed products and obesity in a national representative sample of the Brazilian population [24]. However, the association between processed and ultra-processed product consumption and lipid profiles in children has not been studied and is poorly understood.
Our objective was to assess whether children's consumption of processed and ultra-processed products at preschool age predicted an increase in lipid concentrations from preschool to school age. Given that processed and ultra-processed product consumption is associated with low diet quality in adults [15], [16] and cardiovascular risk factors in youths [23], we hypothesized that the consumption of these products at preschool age would be a positive and significant predictor of an increase in blood lipid levels from preschool to school age.
Section snippets
Study population
This study used data from children who participated in a randomized trial of dietary counseling on breastfeeding and dietary practices during the first year of life [25]. Five hundred mother–child pairs were recruited between October 2001 and June 2002 in the maternity ward of a hospital that attends to low-income population, in São Leopoldo, Brazil, and the same children have been followed since. Inclusion criteria were full-term (>37 weeks) babies with a birth weight ≥2500 g. Exclusion
Results
Among the 500 children initially recruited at birth, 356 underwent assessment at age 3–4 and 315 underwent assessment at age 7–8. Loss to follow-up in this cohort was due to refusal to participate, change of address, child or maternal death and genetic disease. No differences were found between children who were lost to follow-up and those who remained at 7–8 years of age in terms of race, sex, birth weight, birth length, maternal age at child's birth, maternal education level, and annual
Discussion
The prevalence of cardiovascular disease continues to increase throughout the world [1]. While there is consistent and substantial evidence that cardiovascular diseases are associated with specific dietary and activity patterns (such as high-fat, low-fiber diets and little or no physical activity), there is little if any research on how diet in childhood contributes to the development of such diseases [28]. To our knowledge, ours is the first study to examine the longitudinal relationship
Conflicts of interest
The authors declare that they have no conflicts of interest.
Acknowledgments
This study was supported by the Brazil CNPq (National Funding for Research) and Capes Foundation, Ministry of Education (FR doctoral fellowship, proc. no. 9853-11-1). The contributors had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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