A research roadmap about processed foods, food processing, and human health in the context of the US food system: proceedings from an interdisciplinary workshop

Authors: O'Connor, Lauren; Higgins, Kelly; SMILJANEC, KATARINA - Archer Daniels Midland; BERGIA, ROBERT - Archer Daniels Midland; BROWN, ANDREW - University Arkansas For Medical Sciences (UAMS); Baer, David; Davis, Cindy; FERRUZZI, MARIO - University Arkansas For Medical Sciences (UAMS); MILLER, KEVIN - General Mills, Inc; ROWE, SYLVIA - Consultant; RUEDA, JANICE - Archer Daniels Midland; ANDRES, ALINE - University Arkansas For Medical Sciences (UAMS); CASH, SEAN - Tufts University; COUPLAND, JOHN - Pennsylvania State University; CRIMMINS, MEGHAN - (NCE, CECR)networks Of Centres Of Exellence Of Canada, Centres Of Excellence For Commercilization A; FIECKE, CHELSEY - University Arkansas For Medical Sciences (UAMS); FORDE, CIARÁN - Wageningen University And Research Center; Fukagawa, Naomi; HALL, KEVIN - National Institutes Of Health (NIH); HAMAKER, BRUCE - Purdue University; HERRICK, KIRSTEN - National Institutes Of Health (NIH); Hess, Julie; HEUVEN, LISE - Wageningen University And Research Center; JUUL, FILIPPA - New York University; MALCOMSON, FIONA - Newcastle University; MARTINEZ-STEELE, EURIDICE - Universidade De Sao Paulo; MATTES, RICK - Purdue University; MESSINA, MARK - Soy Nutrition Institute Global; MITCHELL, ALYSON - University Of California, Davis; ZHANG, FANG FANG - Tufts University

Submitted to: Advances in Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 9/13/2023
Publication Date: 9/16/2023
Citation: O'Connor, L.E., Higgins, K.A., Smiljanec, K., Bergia, R., Brown, A., Baer, D.J., Davis, C.D., Ferruzzi, M., Miller, K., Rowe, S., Rueda, J., Andres, A., Cash, S.B., Coupland, J., Crimmins, M., Fiecke, C., Forde, C.G., Fukagawa, N.K., Hall, K., Hamaker, B., Herrick, K.A., Hess, J.M., Heuven, L.A., Juul, F., Malcomson, F.C., Martinez-Steele, E., Mattes, R.D., Messina, M., Mitchell, A., Zhang, F. 2023. A research roadmap about processed foods, food processing, and human health in the context of the US food system: Proceedings from an interdisciplinary workshop. Advances in Nutrition. 14(16):1255-1269. https://doi.org/10.1016/j.advnut.2023.09.005.
DOI: https://doi.org/10.1016/j.advnut.2023.09.005

Interpretive Summary: Food processing is vital to the US food system to increase food safety and security, meet nutrient needs, and decrease food waste. A subclass of processed foods, often referred to as ‘ultra-processed foods (UPFs)’, are raising concern due to potentially negative contributions to the US dietary pattern that may increase risk for obesity and cardiometabolic diseases (CMDs). Currently, the body of evidence about UPF intake and risk for obesity and CMDs is largely observational and mechanisms or causality remain unknown. To promote generation of a stronger evidence base and to help inform future dietary guidelines in the US, we hosted an interdisciplinary workshop to convene experts in human nutrition, food science, public health, and epidemiology from government, academia, and industry to develop a Research Roadmap to guide causal and mechanistic research investigating if and how UPFs may impact risk for obesity and CMDs for US populations. The 6 main research priority areas were: 1) What objective methods or measures could further categorize UPFs, considering food processing, formulation, and the interaction of the two? 2) How can we improve exposure assessment of UPF intake? 3) Does UPF intake influence obesity or CMD risk independent of diet quality? 4) What attributes of UPFs may influence ingestive behavior and contribute to excess energy intake? 5) What attributes of UPFs may contribute to clinically meaningful metabolic responses? 6) What environmental factors lead people to consume high amounts of UPFs? This Roadmap will serve as a resource for the research community to improve our understanding of this topic for future dietary guidelines in the US in the best interest of public health.

Technical Abstract: The objective of this workshop was to convene experts in nutrition, food science, and epidemiology from government, academia, and industry to develop a Research Roadmap to identify priorities for investigating effects of processed foods intake on obesity and cardiometabolic diseases (CMD) in the US. We convened attendees at various career stages with diverse viewpoints on the topic. We started with a “Food Processing Primer” to build foundational knowledge of how and why foods are processed, followed by presentations about how processed foods influence energy intake and risk for obesity and CMD. We formed breakout groups to brainstorm mechanistic or confounding explanations for associations between processed foods and risk for obesity and CMD. Facilitators created research questions (RQs) based on key themes from the breakout groups. Different breakout groups convened to discuss what is known and unknown for each RQ and to develop sub-RQs that could address gaps. Workshop attendees generally agreed that RQs should focus on ultra-processed foods (UPFs) as classified by Nova Group 4 because the preponderance of evidence is based on this classification system. Yet, heterogeneity and subjectivity in UPF classification was a challenge for RQ development. The 6 main RQs were: 1) What objective methods or measures could further categorize UPFs, considering food processing, formulation, and the interaction of the two? 2) How can we improve exposure assessment of UPF intake? 3) Does UPF intake influence obesity or CMD risk independent of diet quality? 4) What attributes of UPFs may influence ingestive behavior and contribute to excess energy intake? 5) What attributes of UPFs may contribute to clinically meaningful metabolic responses? 6) What environmental factors lead people to consume high amounts of UPFs? The uncertainty and complexity around UPF intake warrants further causal, mechanistic, and methodological research to better understand the utility of applying this classification to foods in the US.