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Ultra-processed foods and food additives in gut health and disease – Nature.com

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Abstract

Ultra-processed foods (UPFs) and food additives have become ubiquitous components of the modern human diet. There is increasing evidence of an association between diets rich in UPFs and gut disease, including inflammatory bowel disease, colorectal cancer and irritable bowel syndrome. Food additives are added to many UPFs and have themselves been shown to affect gut health. For example, evidence shows that some emulsifiers, sweeteners, colours, and microparticles and nanoparticles have effects on a range of outcomes, including the gut microbiome, intestinal permeability and intestinal inflammation. Broadly speaking, evidence for the effect of UPFs on gut disease comes from observational epidemiological studies, whereas, by contrast, evidence for the effect of food additives comes largely from preclinical studies conducted in vitro or in animal models. Fewer studies have investigated the effect of UPFs or food additives on gut health and disease in human intervention studies. Hence, the aim of this article is to critically review the evidence for the effects of UPF and food additives on gut health and disease and to discuss the clinical application of these findings.

Key points

  • Ultra-processed foods (UPFs) are widely consumed in the food chain, and epidemiological studies indicate an increased risk of gut diseases, including inflammatory bowel disease, colorectal cancer and possibly irritable bowel syndrome.

  • A causal role of food processing on disease risk is challenging to identify as the body of evidence, although large, is almost entirely from observational cohorts or case–control studies, many of which measured UPF exposure using dietary methodologies not validated for this purpose and few were adjusted for the known dietary risk factors for those diseases.

  • Food additives commonly added to UPFs, including emulsifiers, sweeteners, colours, and microparticles and nanoparticles, have been shown in preclinical studies to affect the gut, including the microbiome, intestinal permeability and intestinal inflammation.

  • Although a randomized controlled trial demonstrated that consumption of UPF resulted in increased energy intake and body weight, no studies have yet investigated the effect of UPFs, or their restriction, on gut health or disease.

  • Few studies have investigated the effect of dietary restriction of food additives on the risk or management of gut disease, although multicomponent diets have shown some initial promise.

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Fig. 1: Different effects of emulsifiers, sweeteners, colours and nanoparticles on the microbiome, mucosal barrier and inflammation in the gut.

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Acknowledgements

The authors acknowledge research funding from The Leona M. and Harry B. Helmsley Charitable Trust. The funder had no role in the design, performance or approval of this Review.

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The authors contributed equally to all aspects of the manuscript.

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Kevin Whelan.

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Competing interests

K.W. has received research grants related to diet and gut health and disease from government agencies, including the Medical Research Council and National Institute of Health Research, charities, including Crohn’s & Colitis UK, The Helmsley Charitable Trust, Kenneth Rainin Foundation, and commercial funders, including Almond Board of California, Danone, and International Nut and Dried Fruit Council. K.W. has received speaker fees from Danone. K.W. is the holder of a joint patent to use volatile organic compounds as biomarkers in irritable bowel syndrome (PCT/GB2020/051604). A.S.B. is funded through a fellowship from The Helmsley Charitable Trust. J.O.L. has received research grants related to diet and gut health and disease from The Helmsley Charitable Trust. B.C. is supported by a starting grant from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (ERC-2018-StG-804135), a Chaire d’Excellence from IdEx Université de Paris (ANR-18-IDEX-0001), an Innovator Award from the Kenneth Rainin Foundation, an award from the Fondation de l’Avenir (AP-RM-21-032), ANR grants EMULBIONT (ANR-21-CE15-0042-01) and DREAM (ANR-20-PAMR-0002) and the national programme “Microbiote” from INSERM. B.C. reports honorarium and consulting fees from Nestlé, Procter and Gamble, and Qiagen.

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Nature Reviews Gastroenterology & Hepatology thanks Andrew Chan, Gerhard Rogler and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Review criteria An online literature search was performed using the Medline database for studies investigating mechanisms (for example, in vitro, animal studies), associations from observational studies (for example, case–control, cohort), and causal or effectiveness outcomes from intervention studies (for example, randomized controlled trials) in relation to ultra-processed food and food additives in gut health and disease. All studies that addressed the aim of this Review were potentially eligible, and strengths and limitations of study design that influence interpretation of the outcome are discussed.

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Whelan, K., Bancil, A.S., Lindsay, J.O. et al. Ultra-processed foods and food additives in gut health and disease.
Nat Rev Gastroenterol Hepatol (2024). https://doi.org/10.1038/s41575-024-00893-5

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  • Accepted: 05 January 2024

  • Published: 22 February 2024

  • DOI: https://doi.org/10.1038/s41575-024-00893-5

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