Commentary on study: return to evaluation of foods from their nutritional role

February 26, 2024

Several Italian scientists based at different universities read with great interest the paper of the Epic cohort* on the incidence of multimorbidity in relation to the consumption of ultra-processed foods (UPF). Multimorbidity is having more than one non-communicable disease such as cancer and cardiometabolic diseases. They interpret though, that the data presented do not fully support the conclusions of the article and wrote a commentary on The Lancet about it.

Evaluation on nutritional role

Professor Vincenzo Fogliano from the Food, Quality & Design group at Wageningen University & Research explains why he (co)wrote a reaction: “The research indicates that the association between UPF consumption and the risk of multimorbidity would disappear if the data were adjusted not only for the consumption of sugary or artificially sweetened beverages, but also for processed foods of animal origin at the same time. The article - in our opinion – therefore underlines the absolute need to return to the evaluation of foods on the basis of their nutritional values. Think of their nutrient composition (ingredients), the quantities that are consumed and the metabolic effects of these products.”

Protecting force of vegetable products

The study showed that plant-based meat alternatives and vegetable products, processed or not, are protective against cancer and other noncommunicable diseases (NCDs), such as diabetes type 2. The consumption of artificially and sugar-sweetened beverages, animal-based products and sauces, spreads and condiments, on the other hand, is correlated to a higher risk of developing one or more of these diseases (multimorbidity).

Fogliano is not surprised on the outcomes regarding meat products and sugared and artificially sweetened beverages. “We already know for quite some time that there is a link between consuming these products and developing one or more NCD. What surprised me though, is the protection that vegetable products, processed or not, offer to our health. Keeping up a healthy food pattern can be hard and some processed products like whole grain bread, healthy bars or frozen vegetables can help consumers to follow a healthy dietary pattern. Lowering consumption of certain ultra-processed foods (meat products and sodas) by replacing them with similar but healthier plant-based foods, may be beneficial for the prevention of these non-communicable diseases.”

Noncommunicable diseases (NCDs) like heart disease, cancer, and type 2 diabetes are the primary contributors to global mortality and pose a growing threat to public health worldwide. Over the past two decades, there has been a significant rise in the prevalence of individuals developing multiple chronic diseases, particularly notable in high-income nations. Comparable patterns are now evident in low- and middle-income countries as well.

In response to the commentary, the researchers acknowledge that these differences across UPF subgroups appear to impact health outcomes differentially, and not all UPF subgroups affect risk. However, UPFs are usually consumed in combination resulting in a dietary pattern characterized by a higher dietary share across all UPF subgroups. Differences among UPF subgroups are then possibly less important than the average quality of the whole UPF group. Replacing UPFs with less processed foods should therefore be encouraged whenever feasible.”

Fogliano responds to that with: “I believe we should encourage to eat more fruit, vegetables and legumes. If they are processed or not does not really matter for the health outcome I think. I look forward to seeing data showing that those eating more meat analogues also consume more sweetened beverages. My gut feeling is that the opposite is true."