Food processing and cardiometabolic risk in overweight and obese adults: a prospective study in the NutriNet-Brazil cohort

Abstract

Introduction: Obesity is both a disease itself and a risk factor for several other chronic conditions. Its prevalence has been exponentially increasing in Brazil and worldwide. Despite efforts, no country has effectively controlled the obesity epidemic to date. Increasingly robust evidence has highlighted the link between high consumption of ultra-processed foods and a greater risk of obesity. However, there is growing discussion regarding the importance of care among overweight individuals. Yet, there are still gaps in understanding how food processing affects the health of people living with obesity. Objective: To explore prospective associations between food processing and cardiometabolic health in adults living with overweight and obesity. Methods: The project will consist of a systematic literature review and two primary data studies. The systematic review will summarize the studies that have already evaluated the role of ultra-processed foods in the morbidity and mortality of people living with overweight and obesity and systematically elucidate the most important gaps. The search will be conducted in indexed article databases. Article selection will be performed by two independent evaluators. The ROBINS-I scale will be used to assess study quality. The primary data studies will be conducted in the NutriNet Brasil cohort composed of adults from all regions of Brazil. The study involves self-administered online questionnaires every 3 months, including a 24-hour recall specifically designed to capture food processing. Multivariate Cox proportional hazards models will be employed to assess risks, with age as the primary temporal reference variable. The relationship between the consumption of minimally processed plant-based foods, ultra-processed foods, and the combination of these dietary patterns with the risk of developing type 2 diabetes and high blood pressure in individuals with overweight and obesity will be investigated.