ANN/THE STAR – Many people’s diets have evolved over the years. In the past, meals were typically home-cooked and focused on vegetables and fruits.
Today, mass-produced foods with a wide range of ingredients and additives have become more common. While some meals are still home-cooked, many are now processed to varying degrees for mass consumption.
FOODS CLASSIFICATION
Foods are defined using the Nova food classification system, developed by researchers at the University of Sao Paolo, Brazil. The categories in the classification are:
– Unprocessed or minimally processed food which include food with no added ingredients and have been little altered from their natural state eg fruits, vegetables, fish, eggs.
– Processed ingredients which include foods added to other foods instead of being eaten by themselves eg salt, sugar and oils.
– Processed foods which include combining foods from previous two groups, which are altered in a way that home cooks could do themselves. They include jam, pickles, tinned fruit and vegetables, homemade breads and cheeses.
– Ultra-processed foods (UPFs) typically have more than one ingredient that is never or rarely found in a kitchen. They include many additives and ingredients that are not typically used in home cooking eg preservatives, emulsifiers, sweeteners as well as artificial colours and flavours. These foods usually have a long shelf life.
Common UPFs include ice cream, sausages, crisps, mass-produced bread, cereals, biscuits, carbonated drinks, fruit-flavoured yoghurts and instant soups.
GLOBAL SHIFT TO UPFS
There has been a global shift towards an increasingly ultra-processed diet although there are national and regional variations.
The share of dietary energy from UPF varies from 42 per cent, 50 per cent and 58 per cent in Australia, United Kingdom (UK) and United States (US) respectively, to 10 per cent and 25 per cent in Italy and South Korea respectively.
Various factors have contributed to the shift from unprocessed and minimally processed foods to UPF and their increasing contribution to global diets.
They include work and behavioural changes, food environments and commercial influences.
These factors, and the specific features of UPFs have raised concerns about diet quality and its impact on population health.
The latter include alterations to food matrices; potential contamination from packaging and processing; the presence of food additives and other industrial ingredients; and poor nutrient features like higher energy, salt, sugar and saturated fat content, and lower levels of dietary fibre, micronutrients, and vitamins.
LOCAL STUDIES
There are limited Malaysian UPF studies and in the ones published, healthy information was not reported. A study published in BMC Public Health 2022 of 2,983 adults of low household income in six low-cost flats in Kuala Lumpur reported that 89.5 per cent of adults did not consume adequate daily amounts of fruits and vegetables; 68.1 per cent consumed sugar-sweetened beverages at least once weekly, including commercially packed ready-to-drink beverages, sugar-added self-prepared drinks, and premixed drinks; and 52.9 per cent consumed other commercially baked foods and bread weekly.
A study of product label information from commercially produced complementary foods (CPCF) purchased in 2021 in Cambodia, Indonesia, Laos, Malaysia, Philippines, Thailand, and Vietnam, and a review of the level of processing-based and the presence of additives, found data that is of concern.
Published in August 2024 in Clinical Nutrition, the study found a whopping 43 per cent of all CPCF in Malaysia were ultra-processed; with total sugar and sodium content significantly higher among ultra-processed CPCF; 31.7 per cent of all CPCF contained cosmetic additives; and 23.5 per cent of products contained additives not permitted in the Codex Alimentarius Commission Procedural Manual (standards and guidelines for CPCF).
ILL-HEALTH EFFECTS OF UPFS
There are hundreds of studies which have reported adverse health outcomes associated with UPFs. There are direct associations reported between exposure to UPFs and various health parameters including mortality, cancer, and mental, respiratory, cardiovascular, gastrointestinal and metabolic disorders.
In a review of 45 pooled analyses involving 9,888,373 participants, UPFs have been found to be associated with 30 health conditions.
The following were some of the findings:
– There were direct associations between greater exposure to UPFs and higher risks of cancer overall, particularly colorectal cancer, breast cancer, central nervous system tumours, chronic lymphocytic leukaemia, pancreatic cancer and prostate cancer.
– There were direct associations between greater exposure to UPFs and higher risks of adverse sleep related, anxiety and depression outcomes.
– There were direct associations between greater UPF exposure and higher risks of cardiovascular disease morbidity and mortality.
– There was weak to no evidence of associations between exposure to UPFs and hypertriglyceridaemia and low high density lipoprotein concentrations.
– There was limited evidence of an association between greater exposure to UPFs and risks of prevalent asthma and wheezing.
– There was weak or no evidence of associations between greater exposure to ultra-UPFs and higher risks of Crohn’s disease and ulcerative colitis.
– There were direct associations of abdominal obesity with greater UPF exposure.
– There were direct associations between greater UPF exposure and higher risk of overweight and obesity.
– A 10 per cent increase in UPF consumption was associated with a 12 per cent higher incidence of type 2 diabetes.
– There was weak or no evidence of associations between exposure to UPFs and hyperglycaemia, metabolic syndrome and non-alcoholic fatty liver disease.
– Greater exposure to UPFs, whether measured as higher versus lower consumption, additional servings per day, or a 10 per cent increment, was consistently associated with a higher risk of adverse health outcomes (71 per cent of outcomes).
Another recent 2024 study in Neurology reported an increase in the intake of UPFs by just 10 per cent was associated with a significantly greater risk of cognitive impairment and stroke; intake of unprocessed or minimally processed foods was associated with a lower risk of cognitive impairment; and the effect of UPFs on stroke risk was greater for Blacks compared to whites.
TAKE HOME MESSAGES
UPFs are unhealthy simply because they are easier to eat. They contain chemicals to keep the food fresh for a longer time.
UPFs have been designed to be delicious and easy to eat with other additives like salts, spices and oils as well as removal of fibres from grains to facilitate chewing.
Currently, there are limitations in the research findings on UPFs: association is not the same as causation.
It is also not known whether it is something within the UPFs that is the issue or whether eating a diet high in UPFs suggests a lifestyle linked to poorer health.
However, given the high salt, sugar and saturated fat content of most UPFs, which are all unhealthy, reducing them is a sensible approach. While the Health Ministry has emphasised on reduction of sugar and salt intake, its silence on UPFs has been deafening.
It is important to remember that not all UPFs are equivalent. When consuming UPFs, those with more nutritional benefit should be chosen eg wholegrain bread and cereals instead of crisps, sweets or pizzas.
In addition, reading food labels enables easy identification and reduction of foods with high sugar, salt, or saturated fat content. It is crucial to ensure the diet is balanced.
This means ensuring that the diet contains unprocessed or minimally processed foods ie eat fruits and vegetables and drinking water instead of sugary drinks. The best food is home cooked. – Dr. Milton Lum
