“不要無腦回避超加工食品”，這是BMJ最新研究給出的建議。

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

為什么我會得出不一樣的結論？因為科學論文普遍存在“標題黨”現象，論文里面的結論越驚悚越容易發表，而真正有價值的信息則藏在討論部分。可惜絕大多數人不會去仔細閱讀原文。

以下是該論文隱藏的最有價值的信息。

1、膳食質量（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.

當我們考慮了整體膳食質量的因素后，超加工食品消費量和死亡率之間的相關性就減弱了。AHEI得分（一種評價膳食質量的指標）和死亡率的相關性穩定，去掉這一因素的干擾，超加工食品與死亡率的相關性就會減弱。 我們的數據表明，膳食質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（從不、曾經、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表明，黑巧克力和堅果與心血管疾病風險呈負相關，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。這說明超加工食品當中的不同產品有大相徑庭的健康效應，可能導致超加工和健康相關性的研究出現不一致的結果。

NOVA分類系統無法完全囊括食品加工的復雜性，可能導致錯誤的分類。而且 食物消費頻率調查問卷是從營養角度設計的，而不是根據加工方式收集數據，因此對于超加工食品既有漏掉的，也有錯殺的。 同時，隊列研究是持續很多年的數據，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.

我們的目標是糾正一種潛在的誤解，即所有超加工食品都應受到限制，同時我們希望避免在制定飲食建議時搞一刀切。膳食指南應該為絕大多數人提供清晰合理的、可選擇的、可行的、經濟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慎重考慮。籠統的限制超加工食品未必對健康結果帶來實質性的影響，但限制某些超加工食品或許有益，比如加工肉類。

總結： 超加工的論文以后還會頻繁出現，但希望你牢記一點： 無論期刊多牛逼 ，無論作者多權威，只要說超加工很可怕，導致若干疾病風險，100%是瞎扯。

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

（網圖侵刪）

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解鎖美味里的奧秘

鐘凱 博士

資深食品科普段子手
果殼網科學顧問
中華預防醫學會健康傳播分會常委

用專業的態度和敬業精神傳播真知

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