Association of Ultra-processed Food and Unprocessed or Minimally Processed Food Consumption With Bowel Habits Among U.S. Adults

Chun-Han Lo; Longgang Zhao; Euridice Martinez Steele; Chun-Wei Pan; Jeffrey K Lee; Xuehong Zhang; Harminder Singh; N Jewel Samadder

doi:10.1016/j.cgh.2024.04.036

Association of Ultra-processed Food and Unprocessed or Minimally Processed Food Consumption With Bowel Habits Among U.S. Adults

Clin Gastroenterol Hepatol. 2024 May 15:S1542-3565(24)00448-8. doi: 10.1016/j.cgh.2024.04.036. Online ahead of print.

Authors

Chun-Han Lo¹, Longgang Zhao², Euridice Martinez Steele³, Chun-Wei Pan⁴, Jeffrey K Lee⁵, Xuehong Zhang², Harminder Singh⁶, N Jewel Samadder⁷

Affiliations

¹ Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada. Electronic address: chun-han.lo@unlv.edu.
² Channing Division of Network Medicine, Harvard Medical School, Boston, Massachusetts.
³ Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil; Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil.
⁴ Cook County Health, John H. Stroger Hospital, Chicago, Illinois.
⁵ Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California.
⁶ CancerCare Manitoba Research Institute, Winnipeg, Manitoba, Canada; Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
⁷ Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Phoenix, Arizona; Department of Clinical Genomics, Mayo Clinic, Phoenix, Arizona; Center for Individualized Medicine, Mayo Clinic, Phoenix, Arizona.

PMID: 38759823
DOI: 10.1016/j.cgh.2024.04.036

Abstract

Background & aims: Ultra-processed foods (UPFs) may have a negative impact on bowel habits. We aimed to assess the association between UPF and unprocessed or minimally processed food (MPF) intake and bowel habits among adults in the United States (U.S.).

Methods: We performed a cross-sectional study using data from the National Health and Nutrition Examination Survey (2005-2010). We used two 24-hour dietary recalls and, based on the Nova classification, calculated intakes of UPFs and MPFs. Constipation and diarrhea were defined using the Bristol Stool Form Scale and stool frequency. We performed survey-weighted logistic regression and substitution analysis to estimate the odds ratios (ORs) and 95% confidence intervals (CIs).

Results: Among 12,716 U.S. adults, there were 1290 cases of constipation and 1067 cases of diarrhea. Median UPF and MPF intakes were 26.5% and 66.2% of total grams per day, respectively. Greater UPF consumption (in % gram/d) was associated with higher odds of constipation (adjusted OR [aOR_{Q4 vs Q1}], 2.20; 95% CI, 1.76-2.74) (P_trend < .001) but not diarrhea (aOR_{Q4 vs Q1}, 0.82; 95% CI, 0.62-1.09) (P_trend = .12). Increased MPF consumption was associated with lower odds of constipation (aOR_{Q4 vs Q1}, 0.46; 95% CI, 0.370-0.57) (P_trend < .001). Associations with constipation were attenuated after adjusting for diet quality (aOR_{Q4 vs Q1}, UPF, 1.53; MPF, 0.69). Substituting 10% of UPF intake with an equivalent proportion of MPFs was associated with lower odds of constipation (aOR, 0.90; 95% CI, 0.87-0.93).

Conclusions: UPF intake was associated with higher odds of constipation, whereas the odds were lower with greater MPF consumption. The effect of food processing on bowel habits was independent of diet quality.

Keywords: Colon; Epidemiology; Nova; Nutrition.