What are the effects of including unhealthy foods in an otherwise healthy diet ?

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Eating a healthy diet, such as the Mediterranean diet, has a positive impact on health, but little is known about the effects of including unhealthy foods in an otherwise healthy diet.

Now researchers at Rush University Medical Center have reported diminished benefits of a Mediterranean diet among those with high frequency of eating unhealthy foods.

The results of their study were published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association on Jan. 7.

“Eating a diet that emphasizes vegetables, fruit, fish and whole grains may positively affects a person’s health,” said Puja Agarwal, Ph.D., a nutritional epidemiologist and assistant professor in the Department of Internal Medicine at Rush Medical College.

“But when it is combined with fried food, sweets, refined grains, red meat and processed meat, we observed that the benefits of eating the Mediterranean part of the diet seems to be diminished.”

A Mediterranean diet is associated with slower rates of cognitive decline in older adults.

The observational study included 5,001 older adults living in Chicago who were part of the Chicago Health and Aging Project, an evaluation of cognitive health in adults over the age of 65 conducted from 1993 to 2012. Every three years, the study participants completed a cognitive assessment questionnaire that tested basic information processing skills and memory, and they filled out a questionnaire about the frequency with which they consumed 144 food items.

The researchers analyzed how closely each of the study participants adhered to a Mediterranean diet, which includes daily consumption of fruit, vegetables, legumes, olive oil, fish, potatoes and unrefined cereals, plus moderate wine consumption.

They also assessed how much each participant followed a Western diet, which included fried foods, refined grains, sweets, red and processed meats, full-fat dairy products and pizza. They assigned scores of zero to five for each food item to compile a total Mediterranean diet score for each participant along a range from zero to 55.

The researchers then examined the association between Mediterranean diet scores and changes in participants’ global cognitive function, episodic memory and perceptual speed. Participants with slower cognitive decline over the years of follow-up were those who adhered closest to the Mediterranean diet, along with limiting foods that are part of Western diet, whereas participants who ate more of the Western diet had no beneficial effect of healthy food components in slowing cognitive decline.

There was no significant interaction between age, sex, race or education and the association with cognitive decline in either high or low levels of Western diet foods. The study also included models for smoking status, body mass index and other potential variables such as cardiovascular conditions and findings remained the same.

“Western diets may adversely affect cognitive health,” Agarwal said.

“Individuals who had a high Mediterranean diet score compared to those who had the lowest score were equivalent to being 5.8 years younger in age cognitively.”

Agarwal said that the results complement other studies showing that a Mediterranean diet reduces the risk of heart disease, certain cancers and diabetes and also support previous studies on Mediterranean diet and cognition. The study also notes that most of the dietary patterns that have shown improvement in cognitive function among older adults, including the Mediterranean, MIND, and DASH diets, have a unique scoring matrix based on the amount of servings consumed for each diet component.

The more we can incorporate green leafy vegetables, other vegetables, berries, olive oil, and fish into our diets, the better it is for our aging brains and bodies.

Other studies show that red and processed meat, fried food and low whole grains intake are associated with higher inflammation and faster cognitive decline in older ages,” Agarwal said.

“To benefit from diets such as the Mediterranean diet, or MIND diet, we would have to limit our consumption of processed foods and other unhealthy foods such as fried foods and sweets.”

The study and its findings cannot be readily generalized. Future longitudinal studies on diet and cognition among the middle-aged population are needed to extend these findings.


The concept of ultra-processed food (UPF) as a descriptor of unhealthy foods within dietary patterns is increasingly recognised in the nutrition literature [1,2,3,4,5] and authoritative reports [6,7]. Understanding of the contribution of UPFs to dietary quality and as a risk factor for diet-related diseases, disorders and conditions is rapidly emerging [8].

Yet, limited consideration has been given to UPF in strategies aiming to improve population health [9]. A crucial missing step in closing that gap is a review of the evidence base of the associations between UPF consumption and adverse health outcomes.

Dietary risk factors are leading contributors to the global burden of disease (GBD), responsible for an estimated 11 million deaths from non-communicable diseases (NCDs) (22% of all adult deaths) and 15% of disability life years (DALYs) lost in 2017 [10].

Leading contributors to diet-related deaths are cardiovascular disease (CVD), cancer and type 2 diabetes [10]. Contributors to DALYs from non-fatal chronic conditions include asthma, musculoskeletal conditions and mental health disorders [11].

Implicated dietary risk factors include certain nutrients, foods and dietary pattern exposures. Nutrient exposures include high amounts of sodium [10,12], saturated fat, trans-fat and added sugar [12]. Food exposures include low amounts of whole grains, fruit, vegetables, nuts and seeds [10] and fish [10,12], and high amounts of red meat, processed meat, potato chips and sugar-sweetened beverages (SSB) [12,13].

Dietary patterns include low scores on the Healthy Eating Index or Alternative Healthy Eating Index [14], or Mediterranean Dietary Pattern [15]; low adherence to the Dietary Approaches to Stop Hypertension diet [16]; or a high score on the Western dietary pattern [17,18,19,20].

In a novel approach to food categorization, NOVA (a name not an acronym) classifies foods and beverages ‘according to the extent and purpose of industrial processing’ [21,22], an aspect generally overlooked by public health nutrition science, policy and guidance.

In 2009, a Brazilian research group, following studies on national trends over 25 years on household food acquisition and health implications [23,24], concluded diets containing high proportions of UPFs are intrinsically nutritionally unbalanced, harmful to health, or both [9]. This led to the development of the NOVA food classification system [25], which has since evolved [21,22,26,27,28,29,30].

The NOVA classification assigns foods to one of four groups, based on ‘the extent and purpose of industrial processing’ [21]:

  • (1) ‘unprocessed or minimally processed foods’ (MPF), comprising edible parts of plants, animals or fungi without any processes applied to them or natural foods altered by minimal processing designed to preserve natural foods to make them suitable for storage, or to make them safe, edible or more palatable (e.g., fresh fruit, vegetables, grains, legumes, meat, milk);
  • (2) processed culinary ingredients (PCI), which are substances extracted from group 1 (e.g., fats, oils, sugars and starches) or from nature (e.g., salt) used to cook and season MPF, not intended for consumption on their own;
  • (3) processed foods (PF), where industrial products are made by adding PCI to MPF (e.g., canned vegetables in brine, fruit in syrup, cheese); and
  • (4) UPFs, which are defined as ‘formulations of ingredients, mostly of exclusive industrial use, that result from a series of industrial processes (hence “ultra-processed”), many requiring sophisticated equipment and technology’ (e.g., sweet and savoury snacks, reconstituted meats, pizza dishes and confectionery, among others) [21].

Ingredients characteristic of UPFs include food substances of no or rare culinary use, including sugar, protein and oil derivatives (e.g., high-fructose corn syrup, maltodextrin, protein isolates, hydrogenated oil) and cosmetic additives (e.g., colours, flavours, flavour enhancers, emulsifiers, thickeners, and artificial sweeteners) designed to make the final product more palatable [21].

Since NOVA was established, nutrition researchers worldwide have increasingly implicated UPFs with poor dietary quality, and with adverse metabolic and health outcomes across a range of populations and country contexts [7]. Furthermore, UPFs have become dominant components in diets of populations worldwide [31], contributing up to more than 50% of energy intake in high-income countries [32,33], and up to 30% in middle-income countries [34,35], with consumption volumes rapidly increasing [36,37,38]. Because middle-income countries are home to the vast bulk of the world’s population, understanding the implications of rising UPF consumption for global human health is of utmost importance.

Several reviews have reported on UPFs and health outcomes [2,3,4,5,7,39]. However, despite the large and rapidly growing body of evidence linking UPFs with adverse health outcomes, the number of reviews and summarizing reports to date have been scarce, possibly delaying the inclusion of the ‘extent and purpose of industrial processing’ [21] as an independent factor for assessing the health potential of diets.

As most dietary advice relies on systematic reviews and meta-analyses when reviewing evidence, a comprehensive review could be helpful in strengthening the evidence base and moving this field forward. To our knowledge, no review to date has employed a systematic search to identify all studies, without the restriction of health outcomes or study design.

The aim of this narrative review was to systematically identify and appraise the findings of studies on healthy participants (adults, adolescents and children) that have investigated associations between levels of UPF consumption and health outcomes.

reference link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7399967/


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