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Cited by 1,971Consumer Attitudes and Food LabelingNutrition, Health and Food BehaviorNutritional Studies and Diet

Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake

Open access
Hall, Kevin D., Ayuketah, Alexis, Brychta, Robert, Cai, Hongyi, Cassimatis, Thomas, Chen, Kong Y., Chung, Stephanie T., Costa, Elise +17 more·2019·Cell Metabolism
DOI 10.1016/j.cmet.2019.05.008PMC PMC7946062
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Abstract

Summary We investigated whether ultra-processed foods affect energy intake in 20 weight-stable adults, aged (mean±SE) 31.2±1.6 y and BMI=27±1.5 kg/m2. Subjects were admitted to the NIH Clinical Center and randomized to receive either ultra-processed or unprocessed diets for 2 weeks immediately followed by the alternate diet for 2 weeks. Meals were designed to be matched for presented calories, energy density, macronutrients, sugar, sodium, and fiber. Subjects were instructed to consume as much or as little as desired. Energy intake was greater during the ultra-processed diet (508±106 kcal/d; p=0.0001), with increased consumption of carbohydrate (280±54 kcal/d; p<0.0001) and fat (230±53 kcal/d; p=0.0004) but not protein (−2±12 kcal/d; p=0.85). Weight changes were highly correlated with energy intake (r=0.8, p<0.0001) with participants gaining 0.9±0.3 kg (p=0.009) during the ultra-processed diet and losing 0.9±0.3 kg (p=0.007) during the unprocessed diet. Limiting consumption of ultra-processed foods may be an effective strategy for obesity prevention and treatment.

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Crossref · 10.1016/j.cmet.2019.05.008

Cites

62 of 62 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

13 of 28 cited sources checked · 5 supported · 0 flagged · accuracy not yet measured

  • Findingcitation

    Under perfect protein leverage, protein leverage could explain at most about 50% of the observed energy intake difference between diets.

    “we calculated that protein leverage could potentially explain at most ~50% of the observed energy intake differences between the diets assuming perfect leverage”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Hall, 2019 source

      The indexed passage labeled Abstract (page not provided) defines perfect protein leverage and models its effect on energy intake. It does not report that leverage explains at most ~50% of observed energy-intake differences between diets; its quantitative estimate instead concerns about two-thirds of the rise in mean adult body weight in the US. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Interpretationreasoning

    The protein leverage hypothesis could partially explain the higher energy intake observed with the ultra-processed diet.

    “suggests that the protein leverage hypothesis could partially explain the increase in energy intake with the ultra-processed diet”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Martinez Steele et al., 2018 source
      Experimental — accuracy not yet measured
    • cites Simpson and Raubenheimer, 2005 source
  • Interpretationreasoning

    The approximately 85% higher energy density of non-beverage foods in the ultra-processed diet likely contributed to the observed excess energy intake.

    “the ~85% higher energy density of the non-beverage foods in the ultra-processed versus unprocessed diets (Table 1) likely contributed to the observed excess energy intake”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites DellaValle et al., 2005 source
    • cites Rolls, 2009 source
  • Premisecitation

    Current dietary assessment methods cannot accurately or precisely measure energy intake outside the laboratory.

    “However, current dietary assessment methods are insufficient to accurately or precisely measure energy intake outside the laboratory (Schoeller, 1990; Schoeller et al., 2013) and adherence to study diets cannot be guaranteed in free-living subjects.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites Schoeller, 1990 source
    • cites Schoeller et al., 2013 source

      The section “Might the reporting error have increased in recent years?” says self-reported energy-intake data have too much systematic error to track energy balance. The Conclusions also call self-reported intake fatally flawed, but identify other validated tools to develop for measuring intake in free-living people. The source therefore supports the claim about self-report methods, not its blanket statement about all current dietary assessment methods. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Findingown data

    HOMA-IR decreased significantly after the unprocessed diet compared with baseline.

    “After the unprocessed diet, fasting glucose and insulin levels tended to decrease compared to baseline and the homeostasis model assessment of insulin resistance (HOMA-IR) (Matthews et al., 1985) was significantly decreased compared to baseline.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Matthews et al., 1985 source
  • Classified as probably not a substantial claim. 47
  • May combine two claims. 12

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Higher eating rates can increase overall energy intake, with a 20% change in eating rate affecting energy intake by about 10-13%.

    “Previous studies have demonstrated that higher eating rates can result in increased overall energy intake”
    • Also stated in: § Appetitive measurements and eating rate · plain
      “such that a 20% change in eating rate can impact energy intake by between 10–13%”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites de Graaf and Kok, 2010 source

      The Abstract says that foods eaten quickly lead to high food intake, supporting the qualitative claim in the printed sentence. Our copy does not provide the attributed estimate that a 20% change in eating rate changes energy intake by about 10–13%. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites Forde et al., 2013 source
    • cites Forde, 2018 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Many potential negative effects of ultra-processed foods have been hypothesized to relate to high sugar, fat, and sodium and low protein and fiber.

    “Many of the potential negative effects of ultra-processed foods have been hypothesized to relate to their elevated sugar, fat, and sodium content while being low in protein, and fiber (Poti et al., 2017).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Poti et al., 2017 source

      In “Hypothesized mechanisms through nutrient content” (page unavailable), the review links potential adverse effects to high fat and refined-carbohydrate content and describes ultra-processed foods as high in added sugar and sodium. It also reports lower fiber content, but does not identify low protein as a characteristic or hypothesized mechanism. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A previous study suggested that energy expenditure was about 60 kcal lower for 6 hours after consuming processed versus unprocessed sandwiches.

    “a previous study suggesting that energy expenditure was ~60 kcal lower for 6 hours following consumption of processed versus unprocessed sandwiches (Barr and Wright, 2010)”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Barr and Wright, 2010 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Exercise can prevent changes in insulin sensitivity and glucose tolerance during overfeeding.

    “Another possible explanation is that exercise can prevent changes in insulin sensitivity and glucose tolerance during overfeeding (Walhin et al., 2013).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Walhin et al., 2013 source

      The Discussion reports that daily vigorous exercise mostly prevented the reduction in insulin sensitivity during short-term overfeeding and reduced activity. But the Results state that the glycaemic response to the oral glucose tolerance test was not systematically affected in either group, so the paper does not show that exercise prevented a change in glucose tolerance. (LLM, conf=0.90)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Ultra-processed food consumption is highly prevalent in America.

    “Overall, compared to the unprocessed diet, the measurements obtained after the ultra-processed diet were largely unchanged from baseline suggesting that these subjects likely consumed a habitual diet high in ultra-processed foods which might be expected given the high prevalence of ultra-processed food consumption in America (Martinez Steele et al., 2016).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Martinez Steele et al., 2016 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Shorter overfeeding periods have been shown to rapidly impair glucose tolerance and insulin sensitivity, though with larger energy intake differences than in this study.

    “However, shorter durations of overfeeding have previously been demonstrated to result in rapid impairments in glucose tolerance and insulin sensitivity (Lagerpusch et al., 2012; Walhin et al., 2013), albeit with greater differences in energy intake than the present study.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Lagerpusch et al., 2012 source
    • cites Walhin et al., 2013 source

      The Discussion reports reduced insulin sensitivity after seven days of overfeeding combined with reduced physical activity. But the Results state that the glycaemic response to the oral glucose tolerance test was not systematically affected, so the paper does not demonstrate impaired glucose tolerance. Our copy also cannot establish the comparison with the citing study’s energy intake. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Protein intake at lunch was 22±6 kcal/day lower during the ultra-processed diet than during the unprocessed diet.

    “Protein intake was significantly lower during the ultra-processed diet at lunch (−22 ± 6 kcal/day; p = 0.0013)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Protein intake at meals other than lunch did not differ significantly between the ultra-processed and unprocessed diets (p>0.17).

    “but was not significantly different from other meals (p > 0.17)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Sodium intake was significantly greater during the ultra-processed diet than during the unprocessed diet (5.8±0.2 vs 4.6±0.2 g/d).

    “sodium intake was significantly increased during the ultra-processed versus the unprocessed diet (5.8±0.2 g/d vs. 4.6±0.2 g/d; p<0.0001)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Total fiber intake did not differ significantly between the ultra-processed and unprocessed diets (48.5±2.3 vs 45.8±2.3 g/d; p=0.41).

    “there were no significant differences in consumption of total fiber (48.5±2.3 g/d vs. 45.8±2.3 g/d; p=0.41)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Neither diet order nor sex had significant effects on the energy intake difference between diets.

    “Neither the order of the diet assignment (p=0.64) nor sex (p=0.28) had significant effects on the energy intake differences between the diets.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The linear decrease in energy intake during the ultra-processed diet tended to differ from the unprocessed diet (p=0.051).

    “that tended to be different from the unprocessed diet (p=0.051)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Uric acid decreased after the ultra-processed diet compared with baseline.

    “Uric acid decreased after the ultra-processed diet compared with baseline.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Triglycerides decreased significantly from baseline after both diets.

    “Triglycerides and HDL cholesterol were significantly decreased compared to baseline after both diets.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Total cholesterol decreased after the unprocessed diet compared with baseline.

    “The unprocessed diet led to reduced adiponectin, total cholesterol, hsCRP, and total T3, whereas free T4 and free fatty acids were increased compared to baseline.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Liver fat did not change significantly after the unprocessed diet (0.95±0.1%; p=0.24).

    “liver fat was not significantly changed after the unprocessed diet (0.95±0.1%; p=0.24)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Participants tended to have greater 24-hour energy expenditure during the ultra-processed diet (51±27 kcal/d; p=0.06).

    “subjects tended to have greater 24hr energy expenditure during the ultra-processed diet (51±27 kcal/d; p=0.06)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Fat-free mass tended to decrease during the unprocessed diet (0.6±0.3 kg; p=0.08).

    “and decrease during the unprocessed diet (0.6±0.3 kg; p=0.08)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Free fatty acids increased after the unprocessed diet compared with baseline.

    “The unprocessed diet led to reduced adiponectin, total cholesterol, hsCRP, and total T3, whereas free T4 and free fatty acids were increased compared to baseline.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Fat-free mass tended to increase during the ultra-processed diet (0.5±0.3 kg; p=0.09).

    “fat-free mass tended to increase during the ultra-processed diet (0.5±0.3 kg; p=0.09)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Total T3 decreased after the unprocessed diet compared with baseline.

    “The unprocessed diet led to reduced adiponectin, total cholesterol, hsCRP, and total T3, whereas free T4 and free fatty acids were increased compared to baseline.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    During the unprocessed diet, energy intake was nominally higher than DLW energy expenditure by 116±111 kcal/d, but this difference was not statistically significant (p=0.31).

    “energy intake was nominally higher than energy expenditure by DLW by 116±111 kcal/d, but this difference was not statistically significant (p=0.31)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    24-hour urinary C-peptide excretion tended to be higher during the ultra-processed diet than during the unprocessed diet (38.9±2.8 vs 30.9±2.8 nmol/d; p=0.052).

    “insulin secretion measured by 24-hour urinary C-peptide excretion (38.9±2.8 nmol/d vs. 30.9±2.8 nmol/d; p=0.052)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Liver fat did not change significantly after the ultra-processed diet (1.1±0.2%; p=0.74).

    “or the ultra-processed diet (1.1±0.2%; p=0.74)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    HDL cholesterol decreased significantly from baseline after both diets.

    “Triglycerides and HDL cholesterol were significantly decreased compared to baseline after both diets.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Baseline liver fat was 1.2±0.1%.

    “Baseline liver fat was 1.2±0.1%”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Adiponectin decreased after the unprocessed diet compared with baseline.

    “The unprocessed diet led to reduced adiponectin, total cholesterol, hsCRP, and total T3, whereas free T4 and free fatty acids were increased compared to baseline.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Free T4 increased after the unprocessed diet compared with baseline.

    “The unprocessed diet led to reduced adiponectin, total cholesterol, hsCRP, and total T3, whereas free T4 and free fatty acids were increased compared to baseline.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    hsCRP decreased after the unprocessed diet compared with baseline.

    “The unprocessed diet led to reduced adiponectin, total cholesterol, hsCRP, and total T3, whereas free T4 and free fatty acids were increased compared to baseline.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Fasting glucose tended to decrease after the unprocessed diet compared with baseline.

    “After the unprocessed diet, fasting glucose and insulin levels tended to decrease compared to baseline and the homeostasis model assessment of insulin resistance (HOMA-IR) (Matthews et al., 1985) was significantly decreased compared to baseline.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The ultra-processed and unprocessed meals differed substantially in the ratio of omega-6 to omega-3 fatty acids (about 11:1 vs 5:1).

    “and the ratio of omega-6 to omega-3 fatty acids (~11:1 vs. 5:1)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Fasting insulin tended to decrease after the unprocessed diet compared with baseline.

    “After the unprocessed diet, fasting glucose and insulin levels tended to decrease compared to baseline and the homeostasis model assessment of insulin resistance (HOMA-IR) (Matthews et al., 1985) was significantly decreased compared to baseline.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Average daily glucose measured by continuous glucose monitoring tended to be slightly higher during the ultra-processed diet than during the unprocessed diet (99.1±1.3 vs 96.0±1.3 mg/dl; p=0.10).

    “average daily glucose levels measured by continuous glucose monitoring (CGM) (99.1±1.3 mg/dl vs. 96.0±1.3 mg/dl; p=0.10) tended to be slightly higher”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Respiratory chamber measurements of energy expenditure were not significantly different from DLW measurements during the unprocessed diet (−70±75 kcal/d; p=0.36).

    “and not significantly different during the unprocessed diet (−70±75 kcal/d; p=0.36)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Respiratory chamber measurements of energy expenditure were 191±73 kcal/d lower than DLW measurements during the ultra-processed diet.

    “The respiratory chamber measurements of energy expenditure were 191±73 kcal/d lower than the DLW measurements during the ultra-processed diet (p=0.02)”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    Participants were randomized to a diet sequence and crossed over to the alternate diet after two weeks.

    “Subjects were randomly assigned to either the ultra-processed or unprocessed diet for 2 weeks followed immediately by the alternate diet for the final 2 weeks”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    The lack of a run-in period complicates interpretation of baseline blood measures, and diet comparisons were potentially confounded by differences in energy intake and weight changes.

    “The lack of a run-in period complicates the interpretation of the baseline blood measures in comparison to those obtained at the end of each test diet and all such diet comparisons were potentially confounded by the substantial differences in energy intake and corresponding weight changes.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    When total body water differed by more than 5% from 73% of DXA fat-free mass, N was adjusted to agree with DXA data.

    “In cases where the individual values for the total body water, N, differed by > 5% from that calculated as 73% of the fat-free mass determined by DXA within a few days of the dose, N was adjusted to agree with the DXA data.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Subjects were blinded to their continuous glucose readings.

    “Subjects were blinded to their glucose readings.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The study protocol was approved by the NIDDK Institutional Review Board and registered at ClinicalTrials.gov (NCT03407053).

    “The study protocol was approved by the Institutional Review Board of the National Institute of Diabetes & Digestive & Kidney Diseases (ClinicalTrials.gov Identifier NCT03407053).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The study was powered to detect a 125-150 kcal/d difference in mean ad libitum energy intake over each 14-day test diet period in 20 subjects with 0.8 power and a 0.05 Type I error probability.

    “This study was powered to detect a difference in mean ad libitum energy intake over each 14-day test diet period (the primary endpoint) of 125–150 kcal/d in 20 subjects with probability (power) of 0.8 with a Type I error probability of 0.05.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The DXA method used in this study tends to underestimate changes in body fat.

    “the dual energy X-ray absorptiometry (DXA) methodology used to measure body composition in our study tends to underestimate body fat changes (Pourhassan et al., 2013)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Pourhassan et al., 2013 source

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Weight changes during each 14-day diet period were calculated by linear regression to minimize the influence of body fluid fluctuations.

    “To minimize the influence of fluctuations in body fluids, weight changes during each 14-day diet period were calculated by linear regression.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In mixed diets, metabolizable energy falls by about 7.2 kcal for each gram of total or insoluble fiber consumed, while soluble fiber intake does not consistently change metabolizable energy.

    “Metabolizable energy content of mixed diets has been shown to decrease at a rate of ~7.2 kcal per gram of total or insoluble fiber intake, whereas intake of soluble fiber (as supplemented during the ultra-processed diet) does not consistently affect metabolizable energy (Baer et al., 1997).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Baer et al., 1997 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The subjects likely habitually ate a diet high in ultra-processed foods.

    “Overall, compared to the unprocessed diet, the measurements obtained after the ultra-processed diet were largely unchanged from baseline suggesting that these subjects likely consumed a habitual diet high in ultra-processed foods which might be expected given the high prevalence of ultra-processed food consumption in America (Martinez Steele et al., 2016).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Fluid shifts may affect the accuracy and precision of the measured body fat changes.

    “Such fluid shifts may also affect the accuracy and precision of the measured body fat changes (Lohman et al., 2000; Muller et al., 2012).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Lohman et al., 2000 source
    • cites Muller et al., 2012 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Most laboratory-based studies of food intake are much shorter than 28 days, often a single day with one or two meals.

    “While the 28-day duration of our study was relatively modest, most laboratory-based studies of food intake are typically much shorter in duration, often occurring within a single day of testing with one or two meals (Gibbons et al., 2014).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Gibbons et al., 2014 source

  • May combine two claims.

    Interpretationreasoning

    The higher respiratory quotient during the ultra-processed diet was likely due to differences in food quotient during chamber days and to differences in energy intake and energy balance before the chamber stays.

    “This was likely due to differences in food quotient between ultra-processed and unprocessed diet periods during the chamber days along with differences in energy intake and energy balance on the days prior to the chamber stays.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Eliminating ultra-processed foods from the diet decreases energy intake and causes weight loss, while a diet high in ultra-processed food increases energy intake and causes weight gain.

    “In conclusion, our data suggest that eliminating ultra-processed foods from the diet decreases energy intake and results in weight loss whereas a diet with a large proportion of ultra-processed food increases energy intake and leads to weight gain.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study was not designed to identify the cause of the observed differences in energy intake.

    “Our study was not designed to identify the cause of the observed differences in energy intake.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The study did not address how cost and convenience influence consumer choices between ultra-processed and unprocessed meals because meals were free and not chosen by subjects.

    “Because the meals were prepared and presented at no cost to our subjects, and they could not choose their meals or their mode of presentation, our study did not address how consumer choices between ultra-processed versus unprocessed meals may be influenced by cost and convenience.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    During the unprocessed diet, subjects ate about 46 g/d of total fiber, mostly insoluble (~77%), which would lower metabolizable energy by about 330 kcal/d and approximately reconcile energy balance calculations with measured changes in body energy stores.

    “Given that subjects consumed ~46 g/d of total fiber during the unprocessed diet, the vast majority of which was insoluble (~77%), the expected decrease in metabolizable energy amounts to ~330 kcal/d thereby bringing the energy balance calculations into approximate alignment with the measured changes in body energy stores.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Baer et al., 1997 source

  • May combine two claims.

    Study design and conductnone given

    The study did not include a weight-maintenance run-in period or a washout period between test diets.

    “Our study did not include a weight-maintenance run-in period or a washout period between test diets.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The presented meals were matched on sugar, fat, sodium, protein, and fiber to investigate whether other aspects of ultra-processed diets contribute to excess energy intake.

    “However, we attempted to match these nutritional variables in the presented meals to investigate whether other aspects of ultra-processed diets contribute to excess energy intake.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Subjects were blinded to daily weight and continuous glucose measurements.

    “They wore loose fitting clothing throughout the study and were blinded to daily weight and continuous glucose measurements.”
    Quote in the paperNot a substantial claim
55 of 55

  • The paper relies on this without support.

    Before this trial, no causal link between ultra-processed food intake and human obesity had been established, and no randomized controlled trial had tested whether reducing or increasing ultra-processed foods affects health.

    “no causal relationship between ultra-processed food consumption and human obesity has yet been established”
    “there has never been a randomized controlled trial demonstrating any beneficial effects of reducing ultra-processed foods or deleterious effects of increasing ultra-processed foods in the diet”

  • The authors state this as an assumption.

    The mean of the measured chamber periods was representative of the 24-hour period.

    “All chamber measurement periods were >23 hours and we extrapolated the data to represent 24hr periods by assuming that the mean of the measured periods was representative of the 24hr period.”

  • The authors state this as an assumption.

    Within-subject energy intake correlations were zero.

    “Using the conservative assumption that within-subject energy intake correlations were zero, over the 14-day diet period each subject was expected to have a mean energy intake with a standard error of about 130–160 kcal/d and the mean energy intake difference between the study diets was therefore estimated to have a standard error of about 190–230 kcal/d.”

  • The paper relies on this without support.

    Adherence to study diets cannot be guaranteed in free-living subjects.

    “However, current dietary assessment methods are insufficient to accurately or precisely measure energy intake outside the laboratory (Schoeller, 1990; Schoeller et al., 2013) and adherence to study diets cannot be guaranteed in free-living subjects.”
4 of 4

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Authors
Hall, K. D., Ayuketah, A., Brychta, R., Cai, H., Cassimatis, T., Chen, K. Y., Chung, S. T., Costa, E., Courville, A., Darcey, V., Fletcher, L. A., Forde, C. G., Gharib, A. M., Guo, J., Howard, R., Joseph, P. V., McGehee, S., Ouwerkerk, R., Raisinger, K., Rozga, I., Stagliano, M., Walter, M., Walter, P. J., Yang, S., & Zhou, M.
Affiliations
  • National Institute of Diabetes and Digestive and Kidney Diseases (US)
  • National Institutes of Health (US)
  • Singapore Institute for Clinical Sciences (SG)
  • National Institute of Nursing Research (US)
Corresponding author
Hall, Kevin D.
ORCID
Venue
Cell Metabolism
Publisher
Elsevier BV
Published
2019-07
Volume
30
Issue
1
Pages
67-77.e3
ISSN
1550-4131 (ISSN-L)
DOI
10.1016/j.cmet.2019.05.008
PMC
PMC7946062
OpenAlex
W2946281272
Cited by
1,971
References
64
Citations by year
2026: 311 · 2025: 316 · 2024: 288 · 2023: 254 · 2022: 272 · 2021: 233 · 2020: 218 · 2019: 75
FWCI
183.71
Type
journal article
Language
en
Update notices
Open access
Licence
Locations
  • Cell Metabolism (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Socio-Environmental Systems Modeling (acceptedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Funders
National Institute of Diabetes and Digestive and Kidney Diseases
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Consumer Attitudes and Food Labeling
  • Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
Keywords
ultra-processed foods, energy intake, weight gain, ad libitum food intake, obesity prevention, obesity treatment, carbohydrate intake, dietary fat intake, protein intake
MeSH terms
Adult, Body Composition, Energy Intake, Dietary Fiber, Eating, Energy Metabolism, Female, Humans, Inpatients, Male, Weight Gain

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