“不要無腦回避超加工食品”，這是BMJ最新研究給出的建議。

當(dāng)然，這是我的解讀。原文標(biāo)題是“超加工食品與全因死亡率及特定原因死亡率的相關(guān)性：基于人群隊列研究”，媒體報道的標(biāo)題是“超加工食品增加全因死亡率”。

為什么我會得出不一樣的結(jié)論？因為科學(xué)論文普遍存在“標(biāo)題黨”現(xiàn)象，論文里面的結(jié)論越驚悚越容易發(fā)表，而真正有價值的信息則藏在討論部分。可惜絕大多數(shù)人不會去仔細(xì)閱讀原文。

以下是該論文隱藏的最有價值的信息。

1、膳食質(zhì)量（合理膳食）才是決定性因素

The associations between ultra-processed food consumption and mortality were attenuated after we accounted for overall dietary quality.

The AHEI score but not ultra-processed food intake showed a consistent association with mortality and that further adjustment for the AHEI score attenuated the association of ultra-processed food intake with mortality.

Our data together suggest that dietary quality has a predominant influence on long term health, whereas the additional effect of food processing is likely to be limited.

當(dāng)我們考慮了整體膳食質(zhì)量的因素后，超加工食品消費(fèi)量和死亡率之間的相關(guān)性就減弱了。AHEI得分（一種評價膳食質(zhì)量的指標(biāo)）和死亡率的相關(guān)性穩(wěn)定，去掉這一因素的干擾，超加工食品與死亡率的相關(guān)性就會減弱。 我們的數(shù)據(jù)表明，膳食質(zhì)量對于長期健康而言具有決定性作用，而食品加工的影響有限。

2、煙酒是重要混雜因素

Unlike our study, which excluded alcohol from ultra-processed foods and carefully controlled for smoking status and pack years, all the above studies included alcohol in ultra processed foods and adjusted for smoking status (never, former, and current) only. That may partly explain why the associations found in our study were weaker than those in previous studies.

我們的研究直接排除了酒精飲料，同時也考慮了吸煙狀態(tài)和吸煙量的因素，而以前的很多研究將酒精飲料包含在超加工食品中，同時也只考慮吸煙狀態(tài)（從不、曾經(jīng)、正在），不考慮量（年吸煙量，pack year）。這可以一定程度上解釋，為什么我們的研究中超加工食品與健康的相關(guān)性更弱。

3、超加工食品及其研究是糊涂賬
compellin g evidence shows that nuts and (dark) chocolate, common constituents of “sweet snacks and desserts,” are inversely associated with cardiovascular diseases. We observed that dark chocolate in the subgroup “packaged sweet snacks and desserts” was associated with decreased mortality. Therefore, the diverse array of constituents contained in ultra-processed foods with heterogeneous health effects may have contributed to the discrepant findings.

The Nova classification is based on broad categories that do not capture the full complexity of food processing, leading to potential misclassification.

the food frequency questionnaires collected intake of only a limited number of pre-defined items representing the primary source of energy and nutrients in the US population and were not designed to classify foods by processing level, they may not capture the full spectrum of ultra-processed foods. Although the food frequency questionnaires used in our cohorts have been validated for foods and nutrients, they were not specifically validated for ultra-processed foods. Moreover, we classified ultra-processed foods by using the same algorithm throughout follow-up that did not account for changes in the grade of food processing over time.

已有令人信服的證據(jù)表明，黑巧克力和堅果與心血管疾病風(fēng)險呈負(fù)相關(guān)，但他們屬于“甜食和甜零食”，算作超加工食品。我們也觀察到黑巧克力和死亡率降低有關(guān)。這說明超加工食品當(dāng)中的不同產(chǎn)品有大相徑庭的健康效應(yīng)，可能導(dǎo)致超加工和健康相關(guān)性的研究出現(xiàn)不一致的結(jié)果。

NOVA分類系統(tǒng)無法完全囊括食品加工的復(fù)雜性，可能導(dǎo)致錯誤的分類。而且 食物消費(fèi)頻率調(diào)查問卷是從營養(yǎng)角度設(shè)計的，而不是根據(jù)加工方式收集數(shù)據(jù)，因此對于超加工食品既有漏掉的，也有錯殺的。 同時，隊列研究是持續(xù)很多年的數(shù)據(jù)，根本無法考慮同一食品加工水平的變化。

4、一股腦的回避超加工食品是錯誤的
we aim to rectify the potential misperception that all ultra-processed food products should be universally restricted and to avoid oversimplification when formulating dietary recommendations.
dietary guidelines should provide clear and sound food selections that are available, actionable, attainable, and affordable for the largest proportion of the population. Thus, careful deliberation is necessary when considering incorporation of ultra-processed foods into dietary guidelines.
limiting total ultra-processed food consumption may not have a substantial influence on premature death, whereas reducing consumption of certain ultra-processed food subgroups (for example, processed meat) can be beneficial.

我們的目標(biāo)是糾正一種潛在的誤解，即所有超加工食品都應(yīng)受到限制，同時我們希望避免在制定飲食建議時搞一刀切。膳食指南應(yīng)該為絕大多數(shù)人提供清晰合理的、可選擇的、可行的、經(jīng)濟(jì)上可承受的膳食建議，因此將超加工食品納入膳食指南時應(yīng)慎重考慮。籠統(tǒng)的限制超加工食品未必對健康結(jié)果帶來實質(zhì)性的影響，但限制某些超加工食品或許有益，比如加工肉類。

總結(jié)： 超加工的論文以后還會頻繁出現(xiàn)，但希望你牢記一點(diǎn)： 無論期刊多牛逼 ，無論作者多權(quán)威，只要說超加工很可怕，導(dǎo)致若干疾病風(fēng)險，100%是瞎扯。

超加工是72變的孫猴子，但永遠(yuǎn)跳不出“五指山”。這個“五指山”就是它根深蒂固的邏輯缺陷，是永遠(yuǎn)治不好的絕癥。如果你不明白這一點(diǎn)，可以看我之前寫的超加工系列解讀文章。

（網(wǎng)圖侵刪）

?飲食參考

飲食參考

解鎖美味里的奧秘

鐘凱 博士

資深食品科普段子手
果殼網(wǎng)科學(xué)顧問
中華預(yù)防醫(yī)學(xué)會健康傳播分會常委

用專業(yè)的態(tài)度和敬業(yè)精神傳播真知

用風(fēng)趣幽默的語言點(diǎn)亮健康之路

原創(chuàng)科普 良心品質(zhì) 值得擁有

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