Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom.
Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom.
J Nutr. 2023 Jan;153(1):176-189. doi: 10.1016/j.tjnut.2022.11.013. Epub 2022 Dec 21.
Global consumption of unhealthy foods, including ultra-processed foods (UPFs) and sugar-sweetened beverages (SSBs), has increased substantially among pediatric populations. Suboptimal diet during early life can track into adulthood, alongside risk factors for cardiometabolic disease.
To inform the development of updated WHO guiding principles for complementary feeding of infants and young children, this systematic review sought to examine the association between unhealthy food consumption during childhood and cardiometabolic risk biomarkers.
PubMed (Medline), EMBASE, and Cochrane CENTRAL were systematically searched, with no language restriction, up to 10 March 2022. Inclusion criteria were randomized controlled trials (RCTs), non-RCTs, and longitudinal cohort studies; children aged ≤10.9 y at exposure; studies reporting greater consumption of unhealthy foods and beverages (defined using nutrient- and food-based approaches) than no or low consumption; studies assessing critical nonanthropometric cardiometabolic disease risk outcomes (blood lipid profile, glycemic control, or blood pressure).
Of 30,021 identified citations, 11 articles from 8 longitudinal cohort studies were included. Six studies focused on exposure to unhealthy foods or UPF, and 4 focused on SSB only. Methodological heterogeneity was too high across studies to meta-analyze effect estimates. A narrative synthesis of quantitative data revealed that exposure to unhealthy foods and beverages, specifically NOVA-defined UPF, in children of preschool age may be associated with a worse blood lipid and blood pressure profile in later childhood (Grading of Recommendations Assessment, Development, and Evaluation [GRADE]: low and very low certainty, respectively). No associations were evident between SSB consumption and blood lipids, glycemic control, or blood pressure (GRADE: all low certainty).
No definitive conclusion can be made because of quality of the data. More high-quality studies that purposefully assess the effects of unhealthy food and beverage exposure during childhood on cardiometabolic risk outcomes are needed. This protocol was registered at https://www.crd.york.ac.uk/PROSPERO/ as CRD42020218109.
儿童人群中超加工食品（UPF）和含糖饮料（SSB）等不健康食品的全球消费量大幅增加。儿童早期的饮食如果不理想，可能会伴随心血管代谢疾病的风险因素持续到成年。
为了为婴儿和幼儿补充喂养提供更新的世卫组织指导原则，本系统评价旨在研究儿童时期不健康食品消费与心血管代谢风险生物标志物之间的关联。
系统检索了 PubMed（Medline）、EMBASE 和 Cochrane CENTRAL，无语言限制，检索时间截至 2022 年 3 月 10 日。纳入标准为随机对照试验（RCT）、非 RCT 和纵向队列研究；暴露时儿童年龄≤10.9 岁；报告不健康食品和饮料（使用基于营养素和食物的方法定义）摄入量较高而不是低或不摄入的研究；评估关键非人体测量心血管代谢疾病风险结果（血脂谱、血糖控制或血压）的研究。
在 30021 篇鉴定文献中，纳入了 8 项纵向队列研究的 11 篇文章。其中 6 项研究侧重于不健康食物或 UPF 的暴露，4 项研究仅关注 SSB。由于研究之间的方法学异质性太高，无法对效应估计进行荟萃分析。对定量数据的叙述性综合表明，学龄前儿童接触不健康食品和饮料，特别是新食品分类系统定义的 UPF，可能与儿童后期血脂和血压状况恶化有关（推荐评估、制定和评估[GRADE]：分别为低和极低确定性）。SSB 消费与血脂、血糖控制或血压之间没有明显关联（GRADE：均为低确定性）。
由于数据质量，无法得出明确的结论。需要更多高质量的研究，有针对性地评估儿童时期不健康食品和饮料暴露对心血管代谢风险结果的影响。本方案在 https://www.crd.york.ac.uk/PROSPERO/ 注册，注册号为 CRD42020218109。
