073b9ee17d313827f83508c661b77978 pmc_9570694.pdf aee5bcb6a6c1f6987542812c890a84173248c447 pmc_9570694.pdf 172b8c63302c55017d1cea74f8554a55acd528f78583b2a772c03160d489b469 pmc_9570694.pdf Title: Does Consumption of Ultra-Processed Foods Matter for Liver Health? Prospective Analysis among Older Adults with Metabolic Syndrome Subject: Background: Non-alcoholic fatty liver disease (NAFLD) includes a spectrum of liver alterations that can result in severe disease and even death. Consumption of ultra-processed foods (UPF) has been associated with obesity and related comorbidities. However, the link between UPF and NAFLD has not been sufficiently assessed. We aimed to investigate the prospective association between UPF consumption and liver health biomarkers. Methods: We followed for 1 year 5867 older participants with overweight/obesity and metabolic syndrome (MetS) from the PREDIMED-Plus trial. A validated 143-item semi-quantitative food frequency questionnaire was used to evaluate consumption of UPF at baseline, 6, and 12 months. The degree of processing for foods and beverages (g/day) was established according to the NOVA classification system. The non-invasive fatty liver index (FLI) and hepatic steatosis index (HSI) were used to evaluate liver health at three points in time. The associations between changes in UPF consumption (percentage of total daily dietary intake (g)) and liver biomarkers were assessed using mixed-effects linear models with repeated measurements. Results: In this cohort, UPF consumption at baseline was 8.19% (SD 6.95%) of total daily dietary intake in grams. In multivariable models, each 10% daily increment in UPF consumption in 1 year was associated with significantly greater FLI ( 1.60 points, 95% CI 1.24;1.96 points) and HSI (0.43, 0.29; 0.57) scores (all p-values < 0.001). These associations persisted statistically significant after adjusting for potential dietary confounders and NAFLD risk factors. Conclusions: A higher UPF consumption was associated with higher levels of NAFLD-related biomarkers in older adults with overweight/obesity and MetS. Keywords: ultra-processed foods; liver health markers; fatty liver index; hepatic steatosis index; metabolic syndrome Author: Jadwiga Konieczna, Miguel Fiol, Antoni Colom, Miguel Ángel Martínez-González, Jordi Salas-Salvadó, Dolores Corella, María Trinidad Soria-Florido, J. Alfredo Martínez, Ángel M. Alonso-Gómez, Julia Wärnberg, Jesús Vioque, José López-Miranda, Ramon Estruch, M. Rosa Bernal-López, José Lapetra, Lluís Serra-Majem, Aurora Bueno-Cavanillas, Josep A. Tur, Vicente Martín Sánchez, Xavier Pintó, José J. Gaforio, Pilar Matía-Martín, Josep Vidal, Clotilde Vázquez, Lidia Daimiel, Emilio Ros, Maira Bes-Rastrollo, María Pascual, Jose V. Sorlí, Albert Goday, María Ángeles Zulet, Anai Moreno-Rodriguez, Francisco Jesús Carmona González, Rafael Valls-Enguix, Juana M. Janer, Antonio Garcia-Rios, Rosa Casas, Ana M. Gomez-Perez, José Manuel Santos-Lozano, F. Javier Basterra-Gortari, María Ángeles Martínez, Carolina Ortega-Azorin, Joan Bayó, Itziar Abete, Itziar Salaverria-Lete, Miguel Ruiz-Canela, Nancy Babio, Lourdes Carres and Dora Romaguera Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Sat Oct 8 09:33:04 2022 CEST ModDate: Sat Oct 8 09:44:14 2022 CEST Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 21 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1144375 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- WIRPUU+VnURWPalladioL-Bold Type 1 Custom yes yes no 10 0 NHMDOP+VnURWPalladioL Type 1 Custom yes yes no 15 0 DTIVTH+URWPalladioL-Bold Type 1 Custom yes yes no 19 0 CCJPQU+URWPalladioL-Roma Type 1 Custom yes yes no 24 0 UUKGYR+URWPalladioL-Ital Type 1 Custom yes yes no 28 0 HGMNRX+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 46 0 RHAWTP+EURM10 Type 1 Builtin yes yes no 68 0 SYASRN+CMSY10 Type 1 Builtin yes yes no 75 0 WABLSD+SFRM1000 Type 1 Custom yes yes no 85 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes no 99 0 FPOCDV+PalatinoLinotype,Italic CID TrueType Identity-H yes yes yes 114 0 FPRTIH+TimesNewRoman CID TrueType Identity-H yes yes yes 120 0 FPYKQM+TimesNewRoman,Bold CID TrueType Identity-H yes yes yes 126 0 FPONZO+TimesNewRoman,Italic CID TrueType Identity-H yes yes yes 132 0 FPOCDV+PalatinoLinotype,Bold CID TrueType Identity-H yes yes yes 138 0 FPREIM+PalatinoLinotype CID TrueType Identity-H yes yes yes 144 0 FPOCDV+PalatinoLinotype,Italic CID TrueType Identity-H yes yes yes 158 0 FPRTIH+TimesNewRoman CID TrueType Identity-H yes yes yes 164 0 FPYKQM+TimesNewRoman,Bold CID TrueType Identity-H yes yes yes 170 0 FPONZO+TimesNewRoman,Italic CID TrueType Identity-H yes yes yes 176 0 FPOCDV+PalatinoLinotype,Bold CID TrueType Identity-H yes yes yes 182 0 FPLKXB+Arial CID TrueType Identity-H yes yes yes 188 0 FPREIM+PalatinoLinotype CID TrueType Identity-H yes yes yes 194 0 SYVAVM+VnURWPalladioL-Italic Type 1 Custom yes yes no 234 0 Jhove (Rel. 1.22.1, 2019-04-17) Date: 2023-06-21 02:32:03 CEST RepresentationInformation: pmc_9570694.pdf ReportingModule: PDF-hul, Rel. 1.12.1 (2019-04-17) LastModified: 2022-10-27 02:16:48 CEST Size: 1144375 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 477 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Background Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@44c8afef Item: Title: Methods Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7b69c6ba Children: Item: Title: Study Overview and Population Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@46daef40 Item: Title: Dietary Habits and Nutrient Intake Assessments Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@12f41634 Item: Title: Dietary Data Processing-Based Classification and Ultra-Processed Foods Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@13c27452 Item: Title: Socio-Demographic, Lifestyle, Anthropometric, and Clinical Variables Assessment Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@262b2c86 Item: Title: Outcome Assessment: Liver Health Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@371a67ec Item: Title: Statistical Analyses Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@5ed828d Item: Title: Results Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@50d0686 Item: Title: Discussion Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7a3d45bd Item: Title: Conclusions Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1e7c7811 Item: Title: References Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77ec78b9 Info: Title: Does Consumption of Ultra-Processed Foods Matter for Liver Health? Prospective Analysis among Older Adults with Metabolic Syndrome Author: Jadwiga Konieczna, Miguel Fiol, Antoni Colom, Miguel Ángel Martínez-González, Jordi Salas-Salvadó, Dolores Corella, María Trinidad Soria-Florido, J. Alfredo Martínez, Ángel M. Alonso-Gómez, Julia Wärnberg, Jesús Vioque, José López-Miranda, Ramon Estruch, M. Rosa Bernal-López, José Lapetra, Lluís Serra-Majem, Aurora Bueno-Cavanillas, Josep A. Tur, Vicente Martín Sánchez, Xavier Pintó, José J. Gaforio, Pilar Matía-Martín, Josep Vidal, Clotilde Vázquez, Lidia Daimiel, Emilio Ros, Maira Bes-Rastrollo, María Pascual, Jose V. Sorlí, Albert Goday, María Ángeles Zulet, Anai Moreno-Rodriguez, Francisco Jesús Carmona González, Rafael Valls-Enguix, Juana M. Janer, Antonio Garcia-Rios, Rosa Casas, Ana M. Gomez-Perez, José Manuel Santos-Lozano, F. Javier Basterra-Gortari, María Ángeles Martínez, Carolina Ortega-Azorin, Joan Bayó, Itziar Abete, Itziar Salaverria-Lete, Miguel Ruiz-Canela, Nancy Babio, Lourdes Carres and Dora Romaguera Subject: Background: Non-alcoholic fatty liver disease (NAFLD) includes a spectrum of liver alterations that can result in severe disease and even death. Consumption of ultra-processed foods (UPF) has been associated with obesity and related comorbidities. However, the link between UPF and NAFLD has not been sufficiently assessed. We aimed to investigate the prospective association between UPF consumption and liver health biomarkers. Methods: We followed for 1 year 5867 older participants with overweight/obesity and metabolic syndrome (MetS) from the PREDIMED-Plus trial. A validated 143-item semi-quantitative food frequency questionnaire was used to evaluate consumption of UPF at baseline, 6, and 12 months. The degree of processing for foods and beverages (g/day) was established according to the NOVA classification system. The non-invasive fatty liver index (FLI) and hepatic steatosis index (HSI) were used to evaluate liver health at three points in time. The associations between changes in UPF consumption (percentage of total daily dietary intake (g)) and liver biomarkers were assessed using mixed-effects linear models with repeated measurements. Results: In this cohort, UPF consumption at baseline was 8.19% (SD 6.95%) of total daily dietary intake in grams. In multivariable models, each 10% daily increment in UPF consumption in 1 year was associated with significantly greater FLI ( 1.60 points, 95% CI 1.24;1.96 points) and HSI (0.43, 0.29; 0.57) scores (all p-values < 0.001). These associations persisted statistically significant after adjusting for potential dietary confounders and NAFLD risk factors. Conclusions: A higher UPF consumption was associated with higher levels of NAFLD-related biomarkers in older adults with overweight/obesity and MetS. 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