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. To access additional data from this study, the code repository corresponding to the online version of the R statistical package, metaumbrella , can be found on GitHub at . The raw data are available on the Open Science Framework at , and a step-by-step analysis using metaumbrella usage is provided in supplementary table B. For further assistance or inquiries, please contact the corresponding author at m.lane@dealin.edu.au.

中文翻译：

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超加工食品暴露和不良健康后果：流行病学荟萃分析的总体审查


目的 评估 Nova 食品分类系统定义的超加工食品暴露与不良健康结果之间关联的现有荟萃分析证据。设计对现有荟萃分析的系统总体审查。数据来源 MEDLINE、PsycINFO、Embase 和 Cochrane 系统评价数据库，以及 2009 年至 2023 年 6 月参考文献列表的手动检索。 选择研究的资格标准 队列、病例对照和/的系统评价和荟萃分析或横断面研究设计。为了评估证据的可信度，应用预先指定的证据分类标准，分为令人信服的（“I 类”）、高度暗示性（“II 类”）、暗示性（“III 类”）、弱（“IV 类”） ，或没有证据（“V 类”）。证据的质量使用 GRADE（建议、评估、制定和评价分级）框架进行评估，分为“高”、“中等”、“低”或“极低”质量。结果 搜索确定了 45 个独特的汇总分析，包括 13 个剂量反应关联和 32 个非剂量反应关联 (n=9 888 373)。总体而言，我们发现接触超加工食品与 32 项 (71%) 健康参数之间存在直接关联，包括死亡率、癌症以及精神、呼吸、心血管、胃肠道和代谢健康结果。根据预先指定的证据分类标准，令人信服的证据（I 类）支持更多的超加工食品暴露与更高的心血管疾病相关死亡率风险之间的直接关联（风险比 1.50，95% 置信区间 1.37 至 1.63；GRADE=非常低）和 2 型糖尿病（剂量反应风险比 1.12、1.11 比 1。13；中），以及普遍焦虑结果（比值比 1.48、1.37 至 1.59；低）和合并常见精神障碍结果（比值比 1.53、1.43 至 1.63；低）的风险较高。高度提示性（II 类）证据表明，更多地接触超加工食品与事件全因死亡（风险比 1.21、1.15 至 1.27；低）、心脏病相关死亡率（风险比 1.66、1.51 至 1.66、1.51 至1.84；低）、2 型糖尿病（比值比 1.40、1.23 至 1.59；非常低）和抑郁结果（风险比 1.22、1.16 至 1.28；低），以及普遍不良睡眠相关结果的风险较高（比值比 1.41） ，1.24 至 1.61；低）、喘息（风险比 1.40、1.27 至 1.55；低）和肥胖（比值比 1.55、1.36 至 1.77；低）。在其余 34 项汇总分析中，21 项被评为有提示性或弱强度（III-IV 级），13 项被评为无证据（V 级）。总体而言，使用 GRADE 框架，22 项汇总分析被评为低质量，其中 19 项被评为质量极低，4 项被评为中等质量。结论 更多地接触超加工食品与不良健康结果的风险较高相关，特别是心脏代谢、常见精神障碍和死亡结果。这些发现为制定和评估使用基于人口的公共卫生措施的有效性提供了理论依据，以瞄准和减少饮食中超加工食品的暴露，以改善人类健康。他们还为紧急机械研究提供信息和支持。系统审评注册PROSPERO CRD42023412732。 要访问本研究的其他数据，可以在 GitHub 上找到与 R 统计包在线版本 metaumbrella 相对应的代码存储库： 。原始数据可在开放科学框架上获取： ，补充表 B 中提供了使用元伞使用的逐步分析。如需进一步帮助或询问，请通过 m.lane@dealin.edu.au 联系相应作者。