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期刊来源：BMJ

原文链接：https://doi.org/10.1136/bmj-2023-077310

摘要内容如下：

客观

根据NOVA食品分类系统的定义，评估暴露于超加工食品与不良健康后果之间关联的现有荟萃分析证据。

设计

对现有荟萃分析进行系统的总括审查。

数据源

MEDLINE、PsycInfo、EMBASE和Cochrane系统评价数据库，以及2009年至2023年6月参考文献列表的人工检索。

选择研究的资格标准

队列、病例对照和/或横断面研究设计的系统评价和荟萃分析。为了评估证据的可信度，采用了预先指定的证据分类标准，分为令人信服（“ I类”）、高度暗示性（“ II类”）、暗示性（“ III类”）、弱（“ IV类”）或无证据（“ V类”）。使用GRADE（建议、评估、开发和评价的分级）框架对证据的质量进行评估，分为“高”、“中等”、“低”或“非常低”质量。

结果

搜索确定了45个独特的合并分析，包括13个剂量-反应关联和32个非剂量-反应关联（n=9888373）。总体而言，暴露于超加工食品与32个（71%）健康参数之间存在直接关联，包括死亡率、癌症、精神、呼吸、心血管、胃肠和代谢健康结果。根据预先指定的证据分类标准，有说服力的证据（I类）支持较高的超加工食品暴露与较高的心血管疾病相关死亡事件风险之间的直接关联（风险比1.50，95%置信区间1.37至1.63；级=非常低）和2型糖尿病（剂量-反应风险比1.12，1.11至1.13；中度），以及普遍焦虑结果的较高风险（优势比1.48，1.37至1.59；低）和合并的常见精神障碍结局（优势比1.53，1.43至1.63；低）。高度提示性（II类）证据表明，更多地接触超加工食品与更高的事故全因死亡率风险直接相关（风险比1.21，1.15至1.27；低），心脏病相关死亡率（风险比为1.66，1.51至1.84；低）、2型糖尿病（优势比1.40，1.23至1.59；非常低）和抑郁结局（风险比1.22，1.16至1.28；低），以及普遍不良睡眠相关结果的较高风险（优势比1.41，1.24至1.61；低）、喘息（风险比1.40、1.27至1.55；低）和肥胖（优势比1.55，1.36至1.77；低）。在剩余的34个汇总分析中，21个被评为提示性或弱强度（III-IV类），13个被评为无证据（V类）。总体而言，使用GRADE框架，22个汇总分析被评为低质量，19个被评为极低质量，4个被评为中等质量。

结论

更多地接触超加工食品与不良健康后果的高风险相关，尤其是心脏代谢、常见精神障碍和死亡后果。这些发现为开发和评估使用基于人群和公共卫生措施的有效性提供了理论基础，以针对和减少超加工食品的饮食暴露，从而改善人类健康。他们还为紧急机制研究提供信息和支持。

系统评价注册

普洛斯彼罗CRD42023412732。

英文原文如下：

Abstracts

OBJECTIVE  To evaluate the existing meta-analytic evidence of associations between exposure to ultra-processed foods, as defined by the Nova food classification system, and adverse health outcomes.

DESIGN  Systematic umbrella review of existing meta-analyses.

DATA SOURCES  MEDLINE, PsycINFO, Embase, and the Cochrane Database of Systematic Reviews, as well as manual searches of reference lists from 2009 to June 2023.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES  Systematic reviews and meta-analyses of cohort, case-control, and/or cross sectional study designs. To evaluate the credibility of evidence, pre-specified evidence classification criteria were applied, graded as convincing ("class I"), highly suggestive ("class II"), suggestive ("class III"), weak ("class IV"), or no evidence ("class V"). The quality of evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework, categorised as "high," "moderate," "low," or "very low" quality.

RESULTS  The search identified 45 unique pooled analyses, including 13 dose-response associations and 32 non-dose-response associations (n=9 888 373). Overall, direct associations were found between exposure to ultra-processed foods and 32 (71%) health parameters spanning mortality, cancer, and mental, respiratory, cardiovascular, gastrointestinal, and metabolic health outcomes. Based on the pre-specified evidence classification criteria, convincing evidence (class I) supported direct associations between greater ultra-processed food exposure and higher risks of incident cardiovascular disease related mortality (risk ratio 1.50, 95% confidence interval 1.37 to 1.63; GRADE=very low) and type 2 diabetes (dose-response risk ratio 1.12, 1.11 to 1.13; moderate), as well as higher risks of prevalent anxiety outcomes (odds ratio 1.48, 1.37 to 1.59; low) and combined common mental disorder outcomes (odds ratio 1.53, 1.43 to 1.63; low). Highly suggestive (class II) evidence indicated that greater exposure to ultra-processed foods was directly associated with higher risks of incident all cause mortality (risk ratio 1.21, 1.15 to 1.27; low), heart disease related mortality (hazard ratio 1.66, 1.51 to 1.84; low), type 2 diabetes (odds ratio 1.40, 1.23 to 1.59; very low), and depressive outcomes (hazard ratio 1.22, 1.16 to 1.28; low), together with higher risks of prevalent adverse sleep related outcomes (odds ratio 1.41, 1.24 to 1.61; low), wheezing (risk ratio 1.40, 1.27 to 1.55; low), and obesity (odds ratio 1.55, 1.36 to 1.77; low). Of the remaining 34 pooled analyses, 21 were graded as suggestive or weak strength (class III-IV) and 13 were graded as no evidence (class V). Overall, using the GRADE framework, 22 pooled analyses were rated as low quality, with 19 rated as very low quality and four rated as moderate quality.

CONCLUSIONS  Greater exposure to ultra-processed food was associated with a higher risk of adverse health outcomes, especially cardiometabolic, common mental disorder, and mortality outcomes. These findings provide a rationale to develop and evaluate the effectiveness of using population based and public health measures to target and reduce dietary exposure to ultra-processed foods for improved human health. They also inform and provide support for urgent mechanistic research.

SYSTEMATIC REVIEW REGISTRATION  PROSPERO CRD42023412732.

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