July 3, 2023
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Increased ultra-processed food consumption is associated with worsening of cardiometabolic risk factors in adults with metabolic syndrome: Longitudinal analysis from a randomized trial

Publicated to: Atherosclerosis. 377 12-23 - 2023-07-01 377(), DOI: 10.1016/j.atherosclerosis.2023.05.022

Authors:

Gonzalez-Palacios, Sandra; Oncina-Canovas, Alejandro; Garcia-de-la-Hera, Manuela; Martinez-Gonzalez, Miguel Angel; Salas-Salvado, Jordi; Corella, Dolores; Schroder, Helmut; Martinez, J Alfredo; Alonso-Gomez, Angel M; Warnberg, Julia; Romaguera, Dora; Lopez-Miranda, Jose; Estruch, Ramon; Tinahones, Francisco J; Lapetra, Jose; Serra-Majem, J Luis; Cano-Ibanez, Naomi; Tur, Josep A; Martin-Sanchez, Vicente; Pinto, Xavier; Delgado-Rodriguez, Miguel; Matia-Martin, Pilar; Vidal, Josep; Vazquer, Clotilde; Daimiel, Lidia; Ros, Emili; Bes-Rastrollo, Maira; Atzeni, Alessandro; Sorli, Jose, V; Zomeno, M Dolors; Pena-Orihuela, Patricia J; Compan-Gabucio, Laura M; Baron-Lopez, Francisco J; Zulet, Maria Angeles; Konieczna, Jadwiga; Casas, Rosa M; Garrido-Garrido, Eva M; Tojal-Sierra, Lucas; Gomez-Perez, Ana M; Ruiz-Canela, Miguel; Palau, Antoni; Saiz, Carmen; Perez-Vega, Karla A; Garcia-Rios, Antonio; Torres-Collado, Laura; Basterra-Gortari, Javier; Garciduenas-Fimbres, Tany E; Malcampo, Mireia; Vioque, Jesus
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Affiliations

ABS Reus V Salut St Joan de Reus, Ctr Assistencia Primaria Maria Fortuny, Reus, Spain - Author
Araba Univ Hosp, Osakidetza Basque Hlth Serv, Vitoria, Spain - Author
Bioaraba Hlth Res Inst, Cardiovasc Resp & Metab Area, Vitoria, Spain - Author
Blanquerna Ramon Llull Univ, Barcelona, Spain - Author
CEI UAM CSIC, Precis Nutr & Cardiometab Hlth Program, IMDEA Food, Madrid, Spain - Author
CEI UAM CSIC, Precis Nutr & Obes Program, Nutr Control Epigenome Grp, IMDEA Food, Madrid, Spain - Author
Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas , Universitat de Barcelona - Author
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública , Institut Municipal d'Investigacio Medica - Author
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública , Universidad de Granada , Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA) - Author
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública , Universidad de León - Author
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública , Universidad Miguel Hernández de Elche - Author
Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición , Hospital Clinic Barcelona - Author
Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición , Hospital Universitari de Bellvitge - Author
Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición , Hospital Universitario Reina Sofia - Author
Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición , Hospital Universitario Son Espases - Author
Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición , Institut d'Investigació Sanitària Pere Virgili , Universitat Rovira i Virgili - Author
Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición , Research Unit - Author
Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición , Universidad Autónoma de Madrid - Author
Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición , Universidad de Las Palmas de Gran Canaria - Author
Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición , Universidad de Navarra - Author
Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición , Universidad de Navarra , Harvard T.H. Chan School of Public Health - Author
Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición , Universitat de Barcelona - Author
Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición , Universitat de les Illes Balears - Author
Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición , Universitat de València - Author
Ctr Hosp Univ Insular Materno Infantil CHUIMI, Canarian Hlth Serv, Las Palmas Gran Canaria, Spain - Author
Dist Sanitario Atenc Primaria Sevilla, Dept Family Med, Res Unit, Seville, Spain - Author
Fac Med, Dept Salud Publ, Ha Ciencia & Ginecol, Avda Ramon y Cajal S-N, Sant Joan dAlacant 03550, Alicante, Spain - Author
Harvard TH Chan Sch Publ Hlth, Dept Nutr, Boston, MA USA - Author
Hosp Clin Barcelona, Inst Invest Biomed August Pi Sunyer IDIBAPS, Dept Endocrinol & Nutr, Lipid Clin, Barcelona, Spain - Author
Hosp Univ Bellvitge IDIBELL, Lipids & Vasc Risk Unit, Internal Med, Barcelona, Spain - Author
Hosp Univ Navarra, Serv Endocrinol, Serv Navarro Salud Osasunbidea, Pamplona, Spain - Author
Hospital Clínico San Carlos - Author
Hospital Universitario Araba , Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición - Author
IMDEA Food Institute , Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición , Universidad de Navarra - Author
IMDEA Food Institute , Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición , Universidad San Pablo-CEU - Author
Inst Hlth Carlos III, Ctr Invest Biomed Red Fisiopatol Obes & Nutr CIBER, Madrid, Spain - Author
Inst Hosp del Mar Invest Med Municipal Invest Med, Unit Cardiovasc Risk & Nutr, Barcelona, Spain - Author
Inst Invest Biosanitaria Granada Ibs GRANADA, Granada, Spain - Author
Inst Invest Sanitaria Hosp Clin San Carlos IdISSC, Dept Endocrinol & Nutr, Madrid, Spain - Author
Inst Invest Sanitaria Pere Virgili IISPV, Reus, Spain - Author
Inst Salud Carlos III ISCIII, CIBER Diabet & Enfermedades Metab CIBERDEM, Madrid, Spain - Author
Inst Salud Carlos III ISCIII, CIBER Epidemiol & Salud Publ CIBERESP, Madrid 28029, Spain - Author
Institut d'Investigació Sanitària Pere Virgili , Universitat Rovira i Virgili , Centre d'Assistència Primària Marià Fortuny - Author
Institut Municipal d'Investigació Mèdica - Author
Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina , Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición - Author
Primary Care Center Zaidín-Center - Author
Serv Andaluz Salud, Primary Care Ctr Zaidin Ctr, Granada, Spain - Author
Univ Autonoma, Hosp Fdn Jimenez Diaz, Dept Endocrinol & Nutr, Inst Invest Biomed IISFJD, Madrid, Spain - Author
Univ Balearic Isl, Res Grp Community Nutr & Oxidat Stress, Palma de Mallorca, Spain - Author
Univ Barcelona, Hosp Clin, Inst Invest Biomed August Pi Sunyer IDIBAPS, Dept Endocrinol, Barcelona, Spain - Author
Univ Barcelona, Hosp Clin, Inst Invest Biomed August Pi Sunyer IDIBAPS, Inst Recerca Nutr & Seguretata Alimentaria INSA UB, Barcelona, Spain - Author
Univ Basque Country UPV EHU, Vitoria, Spain - Author
Univ Cordoba, Reina Sofia Univ Hosp, Maimonides Biomed Res Inst Cordoba IMIBIC, Dept Internal Med, Cordoba, Spain - Author
Univ Granada, Dept Prevent Med & Publ Hlth, Granada, Spain - Author
Univ Hosp Son Espases HUSE, Hlth Res Inst Balearic Isl IdISBa, Res Grp Nutr Epidemiol & Cardiovasc Physiopathol N, Palma De Mallorca, Spain - Author
Univ Jaen, Fac Med, Div Prevent Med, Jaen, Spain - Author
Univ Las Palmas Gran Canaria, Res Inst Biomed & Hlth Sci IUIBS, Las Palmas Gran Canaria, Spain - Author
Univ Leon, Inst Biomed IBIOMED, Leon, Spain - Author
Univ Malaga, Sch Hlth Sci, EpiPHAAN Res Grp, Inst Invest Biomed Malaga IBIMA, Malaga, Spain - Author
Univ Malaga, Virgen de la Victoria Hosp, Dept Endocrinol, Inst Invest Biomed Malaga IBIMA, Malaga, Spain - Author
Univ Miguel Hernandez, Unidad Epidemiol Nutr, Inst Invest Sanitaria & Biomed Alicante, ISABIAL UMH, Alicante, Spain - Author
Univ Navarra, Ctr Nutr Res, Dept Nutr Food Sci & Physiol, Pamplona, Spain - Author
Univ Navarra, Dept Prevent Med & Publ Hlth, IdisNA, Pamplona, Spain - Author
Univ Rovira i Virgili, Dept Bioquim & Biotecnol, Unitat Nutr, Reus, Spain - Author
Univ San Pablo CEU, CEU Univ, Fac Farm, Dept Ciencias Farmaceut & Salud, Boadilla Del Monte 28660, Spain - Author
Univ Valencia, Dept Prevent Med, Valencia, Spain - Author
UNIVERSIDAD DE JAÉN - Author
Universitat Ramon Llull , Institut Municipal d'Investigacio Medica - Author
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Abstract

Background and aims: The association between changes in ultra-processed food (UPF) consumption and cardiometabolic risk (CMR) factors remains understudied. We evaluated the association between changes in UPF consumption over 12 months of follow-up and changes in CMR factors in adults diagnosed with metabolic syndrome. Methods: We analysed data from 5373 adults (aged 55–75 years) participating in the PREDIMED-Plus trial. Diet was evaluated at baseline, 6- and 12-month visits using a validated food frequency questionnaire, and UPF consumption (in grams/day and percentage of total daily dietary intake in grams) was categorized based on NOVA classification. We used mixed-effects linear models with repeated measurements at baseline, 6 and 12 months of follow-up to assess the associations between changes in UPF consumption and changes in CMR factors adjusting for sociodemographic and lifestyles variables. Results: In multivariable-adjusted models, when comparing the highest versus the lowest quartile of UPF consumption, positive associations were found for several CMR factors: weight (kg, β = 1.09; 95% confidence interval 0.91 to 1.26); BMI (kg/m2, β = 0.39; 0.33 to 0.46); waist circumference (cm, β = 1.03; 0.81 to 1.26); diastolic blood pressure (mm Hg, β = 0.67; 0.29 to 1.06); fasting blood glucose (mg/dl, β = 1.66; 0.61 to 2.70); HbA1c (%, β = 0.04; 0.01 to 0.07); triglycerides (mg/dl, β = 6.79; 3.66 to 9.91) and triglycerides and glucose index (β = 0.06; 0.04 to 0.08). Conclusions: Higher UPF consumption was associated with adverse evolution in objectively measured CMR factors after 12 months of follow-up in adults with metabolic syndrome. Further research is needed to explore whether these changes persist for longer periods.
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Keywords

adolescentsblood pressurebody mass indexcardiometabolic risk factorschildrenfasting blood glucosefrequency questionnairemetabolic syndromepopulationvalidityAdultBlood pressureBody mass indexCardiometabolic risk factorsCardiovascular-diseasesDietFast foodsFasting blood glucoseFood, processedHumansMetabolic syndromeTriglyceridesUltra-processed foods

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal ATHEROSCLEROSIS due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2023, it was in position 14/96, thus managing to position itself as a Q1 (Primer Cuartil), in the category Peripheral Vascular Disease.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 5.6. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 13, 2025)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Weighted Average of Normalized Impact by the Scopus agency: 4.42 (source consulted: FECYT Mar 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2026-04-05, the following number of citations:

  • WoS: 26
  • Scopus: 23
  • Europe PMC: 7
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Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2026-04-05:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 173.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 173 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 154.
  • The number of mentions on the social network X (formerly Twitter): 144 (Altmetric).
  • The number of mentions in news outlets: 7 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

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Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Granada; United States of America.

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