School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States.
Am J Clin Nutr. 2024 May;119(5):1133-1142. doi: 10.1016/j.ajcnut.2024.02.017. Epub 2024 Feb 28.
Whole grain (WG) consumption is linked with a reduced risk of chronic disease. However, the recommendations of the Nova classification system tend to contradict this evidence as high WG-containing foods, such as bread and cereals, are considered ultraprocessed, and intake is discouraged.
This study aimed to explore associations of cardiometabolic risk measures with ultraprocessed food (UPF) intake as classified by Nova compared with when foods with ≥25% and ≥50% WG are removed from the Nova UPF category.
A cross-sectional analysis of the 2015-18 National Health and Nutrition Examination Survey. Nova was used to identify UPFs, and the WG Initiative's definition of a WG food and front-of-pack labeling requirements was used to identify high WG foods. Regression models were used to explore impacts on the association of UPF intake (quintiles) and cardiometabolic risk measures when high WG foods were excluded from the Nova UPF category.
Participants in the highest quintile of UPF intake had significantly higher weight [83.6 kg (0.8)], BMI (in kg/m) [30.6 (0.3)], waist circumference [103.1 cm (0.6)], and weight-to-height ratio [0.63 (0.003)] compared to those in the lowest quintile (P < 0.0001 for all). The same was found when foods with ≥25% and ≥50% WG were removed. Positive associations for C-reactive protein were found when ≥25% and ≥50% WG-containing foods were removed only [2.32 mg/L (0.1), P = 0.0209; 2.37 mg/L (0.1), P = 0.0179, respectively]. Participants in the highest quintile had significantly lower total cholesterol after adjustment when foods with ≥50% WG were removed [4.98 mmol/L (0.04), P = 0.0292]. Adjusted R values remained relatively unchanged across each approach for all outcomes.
Foods high in WG may not significantly contribute to the deleterious associations previously observed between UPF intake and cardiometabolic risk factors. Consideration of their contribution to healthful dietary patterns and diet quality in the United States population should be made prior to the endorsement of Nova.
全谷物（WG）的摄入与慢性病风险降低有关。然而，Nova 分类系统的建议往往与这一证据相矛盾，因为高 WG 含量的食物，如面包和谷物，被认为是超加工食品，因此不鼓励摄入。
本研究旨在探索与心血管代谢风险指标的关联，比较 Nova 分类的超加工食品（UPF）摄入量与去除 Nova UPF 类别中≥25%和≥50%WG 食物后的摄入量。
使用 2015-18 年全国健康和营养调查的横断面分析。使用 Nova 来识别 UPF，并用 WG 倡议对 WG 食品的定义和前置包装标签要求来识别高 WG 食品。回归模型用于探索当从 Nova UPF 类别中去除高 WG 食品时，UPF 摄入量（五分位数）与心血管代谢风险指标的关联的影响。
UPF 摄入量最高五分位数的参与者体重明显更高[83.6 千克（0.8）]，BMI（千克/米）[30.6（0.3）]，腰围[103.1 厘米（0.6）]和体重与身高的比值[0.63（0.003）]，与最低五分位数相比（所有 P<0.0001）。当去除≥25%和≥50%WG 的食物时也是如此。仅当去除≥25%和≥50%WG 含量的食物时，C 反应蛋白呈阳性关联[2.32 毫克/升（0.1），P=0.0209；2.37 毫克/升（0.1），P=0.0179]。在调整≥50%WG 食物的摄入量后，最高五分位数的参与者总胆固醇明显降低[4.98 毫摩尔/升（0.04），P=0.0292]。对于所有结果，每种方法的调整后的 R 值基本保持不变。
高 WG 的食物可能不会显著增加 UPF 摄入量与心血管代谢风险因素之间先前观察到的有害关联。在支持 Nova 之前，应该考虑它们对美国人口健康饮食模式和饮食质量的贡献。
