卡洛斯·蒙特罗、卡米拉·科尔瓦兰和菲尔·贝克谈超加工食品与人类健康

您好，欢迎收听《柳叶刀》对话播客。

Hello, and welcome to The Lancet's in conversation with podcasts.

我是卡勒姆·戴维森，本刊编辑，也是本集的主持人。在本期节目中，我们将讨论超加工食品与人类健康，内容基于我们12月6日印刷版上发表的三篇系列文章。

I'm Callum Davidson, an editor for the journal and your host for this episode, in which we'll be discussing ultra processed foods and human health following the publication of a three paper series appearing in our December 6 print issue.

该系列文章已于11月18日在线发布，您现在就可以阅读；同时，我们在伦敦皇家医师学院举办了盛大的发布活动，现场座无虚席。

The series was published online on November 18, so you can read it now, and it had an accompanying launch event at the Royal College of Physicians in London, which was spectacularly well attended.

整个活动的录像现在都可以在线回看，我强烈推荐那些希望在深入阅读论文前先了解系列内容的听众观看。

The whole event's available to watch back online, which I'd highly recommend for those who want to get a flavor of the series before diving into the papers.

虽然这些系列文章始终是来自全球众多作者协作的成果，但本系列由圣保罗大学的卡洛斯·蒙特罗教授主导，可以说他在定义“超加工食品”这一概念以及提高公众对其对全球公共卫生威胁的认识方面发挥了关键作用。

Whilst these series are always the result of a collaborative effort by many authors from around the world, it was spearheaded by professor Carlos Montero at the University of Sao Paulo, who is fair to say has played a pivotal role in defining the very concept of ultra processed foods as well as raising awareness about the threat they pose to global public health.

您可以在系列专题页面abalonset.com上阅读蒙特罗教授的个人简介，该页面还同时提供了三篇论文、社论以及两篇配套评论。

You can read a profile of professor Montero on the series hub page, abalonset.com, alongside the three papers and editorial and two accompanying comments.

今天与我一同参与讨论的有三位优秀的嘉宾，他们各自主导了本系列中的一篇论文，我分别与他们进行了两次独立录制的对话。

Joining me today, we have three excellent guests who each led a paper in the series, and I caught up with them as part of two separately recorded conversations.

首先，我与前述的卡洛斯·蒙特罗教授进行了对话，讨论系列中的第一篇论文。

Firstly, I spoke with the aforementioned professor Carlos Montero to discuss paper one in the series.

我还与另外两位嘉宾进行了单独对话：一位是智利大学营养与食品技术研究所的卡米拉·科瓦兰教授，她共同主导了系列中的第二篇论文；另一位是悉尼大学公共卫生学院和查尔斯·珀金斯中心的澳大利亚研究委员会未来学者菲尔·贝克教授，他共同主导了第三篇论文。

I also had a separate conversation with two further guests, Camilla Corvalain, professor at the Institute of Nutrition and Food Technology at the University of Chile, who co led paper two in the series, and also professor Phil Baker, an Australian Research Council future fellow at the School of Public Health and Charles Perkins Centre at the University of Sydney, who co led on paper three.

关于第二篇和第三篇论文的更多内容，我们稍后在节目中再聊。

More on papers two and three later in the episode.

现在，让我们先深入探讨第一篇论文，与卡洛斯·蒙特罗教授对话。

For now, let's dive into paper one with professor Carlos Montero.

蒙特罗教授，欢迎您的到来。

Professor Montero, welcome.

感谢您参与我们的节目，祝贺您取得这一系列成果。

Thank you for joining us, and many congratulations on the series.

谢谢您的邀请。

Thanks for inviting me.

本系列第一篇论文的核心论点是，超加工食品取代了长期形成的饮食模式，成为全球多种饮食相关慢性病负担不断加剧的关键驱动因素。

So the central thesis at the heart of the first paper in the series is that displacement of long established dietary patterns by ultra processed foods is a key driver to the escalating global burden of multiple diet related chronic diseases.

让我们来深入剖析一下这一论点。

So let's unpack that thesis a little.

首先，我肯定你在职业生涯中已经多次被问到这个问题。

Firstly, a question I'm sure you've had to field many, many times in your career.

简单来说，什么是超加工食品？

What are ultra processed foods in sort of simple terms?

超加工食品是根据NOVA食品分类系统来定义的，对吧？

So ultra high, ultra processed foods are defined within the NOVA food classification system, right?

这个系统并不是根据营养成分来分类食品的——虽然经常有人这么做，而是根据食品加工的程度和目的。

That does not classify foods according to nutrition, it's done frequently, but according to the extent and purpose of food processing.

所以你需要阅读第一篇论文来真正理解，但我可以试着简化一下。

So then you have to read paper one really that explain, but I can try to make it simpler.

从概念上讲，超加工食品是通过食品成分和添加剂配制而成，旨在替代所有其他食品类别。

How to process foods are formal conceptually, they are defined as formulations of food substances and additives designed and marketed to substitute all other novel food groups.

这意味着新鲜食品、微加工食品和加工食品。

So this means fresh foods, this means minimally processed food and processed foods.

因此，超加工食品是一种新型产品。

So UPFs are sort of novel products.

它们大多数都非常新颖。

Most of them are very novel.

而且，工业之所以开始生产超加工食品来替代其他食物，也是因为它们经过了加工，对吧？

And they are also, why the industry start to produce UPFs to replace the other foods, they are also processed, right?

因为这样可以最大化利润。

Because they can maximize profits.

随着食品科学和技术的进步，使用非常便宜的原料制作出极具吸引力的产品成为可能。

So with the advance of food science and technology, was possible to do very attractive products with very cheap ingredients.

这就是超加工食品的商业模式，对吧？

So that's the UPF business model, right?

这是一种赚更多钱、获取更高利润的方式。

So it's a way to get more money, to make more profits.

因为它们替代了所有其他NOVA食品类别以及用这三类食品制作的菜肴和餐食，因此涵盖了种类繁多的产品，对吧？

So because they substitute all these other NOVA food groups and the dishes and meals made with these three food groups, because of this they include a huge range of products, right?

所以从汽水到替代水、茶或咖啡（这些都属于微加工食品）的产品，一直到冷冻餐食、鸡块等替代鸡肉菜肴的产品，都包括在内，对吧？

So then this goes from soda to that replace water or tea or coffee, which are minimally processed, until let's say frozen meals are chicken nuggets that substitute a chicken dish, right?

因此，这些配方被创造和设计出来，以替代其他食物并实现利润最大化。

So there are formulations created and designed to replace these other foods and to maximize profits.

这一点很重要，这个定义解释了食品行业为何偏好这样做，而不是其他食物。

This is important, this definition, because it explains why the food industry prefers to do this and not other foods.

其次，解释了为什么人们越来越购买这些产品。

Second, why people purchase this more and more.

第三，解释了为什么它们对健康有害，对吧？

And third, why they harm health, right?

但这个定义不能在超市里直接使用。

But this definition cannot be, let's say, used in a supermarket.

如果你去超市，你会有疑问，我的意思是，你无法从食品本身看出它们是否以利润最大化为目标，对吧？

If you go there, you have some doubts, I mean, what are really, you don't have in the food, say they maximize profits, right?

因此，为此，NOVA体系提出了一个概念性定义和一个操作性定义。

So then for this, Nova has this conceptual definition and one operational definition.

这个操作性定义基于食品超加工的标志。

This operational definition is based on marker of food ultra processing.

这些标志物并不是超加工食品中最成问题的成分，但它们对于超加工食品的商业模式至关重要。

These markers are not the most problematic ingredients, not necessarily of UPFs, but they are essential to the UPF business model.

这意味着，如果没有这些标志物，就很难生产出超加工食品。

Meaning that without these markers, it's very difficult to make ultra processed foods.

这些标志物是食品工业独家滥用的物质，比如蛋白分离物，以及各种化妆品添加剂：着色剂、香料、乳化剂、人工甜味剂。

And these markers are food substances of exclusive industry abuse, like protein isolates, for instance, and all sorts of cosmetic additives: colorants, flavors, emulsifiers, artificial sweeteners.

这些化妆品添加剂之所以被使用，是因为如果没有它们，这种由蛋白分离物和淀粉组成的混合物，人们是不会购买的，对吧？

And these cosmetic additives, they are used because without them, this assemblage of protein isolates and starches, and people won't buy this, right?

因此，这些化妆品添加剂是这类产品中最关键的成分。

So the cosmetic additives are the most essential ingredient of these.

所以，如果你发现一种产品含有着色剂、香料、乳化剂或人工甜味剂，那它极有可能是超加工食品。

So if you find a product with colorants, flavors, emulsifiers, artificial sweeteners, it's very, very likely that it's an UPF.

因此，研究人员使用这些操作性定义来研究超加工食品对健康的影响。

So research uses these operational definitions to study the effects of UPF on health.

如果你想理解背后的发生机制，概念性定义就非常重要。

The conceptual definition is important if you want to understand what's going on.

不。

No.

这真的非常有帮助。

That's really, really helpful.

我想你刚才提到的这种操作性定义，对于我稍后在播客中与卡米拉讨论的内容也非常重要，那就是如何基于超加工食品制定政策。

And I suppose that that kind of operational definition you mentioned there is also really important for what I'll be speaking to Camilla later on in this podcast about, which is how you kind of enact policies based on UPFs.

如果你想对超加工食品征税，比如，这种操作性定义确实很关键，因为你需要对什么是超加工食品有一个非常明确的定义。

If you want to sort of tax UPFs, for example, I suppose that operational definitions kind of critical, because you need to a really strict definition of of what we're calling a UPF.

但关于这一点，我稍后和卡米拉讨论时再详细说。

But more to that when I speak to Camilla later on.

在论文中，你大量谈到这些产品显然是有意设计来取代长期存在的饮食模式的。

And in the paper, you talk a lot about, how these products are obviously intentionally designed to displace long established dietary patterns.

我读到这一点时觉得，如果你能举一些我们所描述的饮食模式的例子，会很有帮助。

And I just thought when I was reading that it would be helpful if you're able to give sort of, any examples of these sorts of dietary patterns we're describing.

是的。

Yeah.

当你看到亚洲、非洲、拉丁美洲和欧洲的长期传统饮食模式时，你会发现它们都不包含超加工食品，或者至少不会大量摄入，而是以纽瓦食品分类的一、二、三类为基础。

So when you see the long established dietary patterns in Asia, in Africa, in Latin America, in Europe, you see that all of them, they don't include UPFs, at least not in large amounts, and they are based on Nova Group one, two and three, so the other Nova Food groups.

纽瓦一类包括新鲜和未经加工的食物，比如水果和蔬菜，还有很多是经过轻微加工的，如干燥、发酵、巴氏杀菌等。

Nova Group one includes both fresh and not processed, just a few like fruits and vegetables, and many others are processed, minimally processed, like dry, fermented, pasteurized, etcetera.

因此，所有这些长期形成的饮食模式，总体上都非常健康，都是以一类、二类和三类食品为基础的。

So all these diets, long established diets, which are in general very healthy, they are made on group one, two and three.

所以，由一类、二类和三类食品构成的饮食模式，被由四类食品——即超加工食品——构成的饮食模式所取代，对吧？

So a dietary pattern made of group one, two and three is replaced by a dietary pattern made on group four, which is UPFs, right?

例如，最广为人知的例子就是地中海饮食。

So example, the most known example is the Mediterranean diet.

如果你看地中海饮食，它包含水果和蔬菜，还有橄榄油，也可以有一些谷物。

So if you see Mediterranean diet, you have fruits and vegetables, but also you have olive oil, you can have some dry cereals.

所以，这种饮食模式非常正常，但重要的是，在拉丁美洲，比如许多国家的饮食以米饭和豆类、一些蔬菜和少量肉类为主，这也是另一种基于一类、二类和三类食品的模式。

So the veterinarian diet is very normal, but what's important is that in Latin America, for instance, many countries they have a diet based on rice and beans, some vegetables, some meat, so this is another pattern made on group one, two and three.

在亚洲和非洲各地，也有类似的饮食模式。

In Asia you have similar patterns in Africa everywhere.

在超加工食品行业尚未主导食品供应的任何地方，你都能看到传统的饮食模式。

Everywhere where the UPF industry does not dominate the food supply, you have the traditional that daypart.

而我们今天所看到的，正是这种转变。

And what we see today is this change.

人们越来越多地转向这种新饮食模式，当然，不同国家处于转型的不同阶段。

People more and more, of course in different stages of the transition.

一些国家，比如美国和英国，已经完成了这一转变。

Some countries like The US, they and UK, they completed the transition.

而一些其他国家，比如中国，才刚刚开始。

Some other countries like China are just starting.

那么，支持超加工食品正在取代这些传统饮食这一观点的最有力证据是什么？

And and what's the sort of best evidence we have to support the the argument that ultra processed foods are displacing these diets?

我知道这是论文的重点，想了解详细内容的人应该去阅读相关论文，但你能概括一下最强有力的证据吗？

I know this is a huge focus of the papers, so for real details people should dive in and read the papers, but are you able to summarize what the the sort of strongest evidence?

这更容易回答。

That's easier.

是的。

Yeah.

这一点非常重要，因为如果超加工食品虽然不健康，但其消费量并未上升，那么这个问题的重要性就会小得多，对吧？

So and this is very important because if UPFs were unhealthy, but if they were not increasing, right, this will be much less important problem, right?

但你现在面临的是双重情况：它既不健康，同时又越来越普遍，对吧？

But you have these two things, it's unhealthy and at the same time it's prevailing more and more, right?

证据来自九个国家，这些国家至少进行了三次或更多次全国性的重复调查，均采用NOVA分类法及其操作定义。

So the evidence comes for nine countries which have repeated national data surveys, at least three or more, using NOVA, applying NOVA, the operational definition of NOVA.

在所有这些国家，我们都观察到超加工食品消费量的上升。

So in all these countries we see an increase.

这些国家包括中国、拉丁美洲的巴西、阿根廷、墨西哥，亚洲除了中国之外还有韩国，总共九个国家，对吧？

These countries include like China, in Latin America, Brazil, Argentina, Mexico, in Asia also besides China, South Korea, we have more nine countries, right?

在这九个国家中，包括英国和美国，你看到的是超加工食品在饮食结构中的占比正在上升。

So in these nine countries, UK, US, of course, so in these nine countries what you see is that there's an increase in the dietary share of UPF.

这意味着第四组食品正在取代第一、第二和第三组食品，对吧？

So this means group four is being, is substituting group one, two and three, right?

所以，以中国为例，超加工食品在总热量摄入中的占比在短短十五年内从3%上升到了10%，对吧？

So, but this is, in China for instance, the percentage of calories in the total diet from UPFs went from 3% to 10% in just fifteen years, years, right?

正如我所说，在英国和美国，超加工食品提供的能量占比已经超过50%，但你仍然能看到一些小幅增长。

As I said, The UK, US, where you have more than 50% of energy intake from BPF, you still see some small increases.

但这些国家并非仅限于某些类型，尽管它们是非常多样化的国家。

But this is just non countries, although are very diversified countries.

然后在第一篇论文中，我们回顾了超加工食品的销售数据。

Then in paper one we have we reviewed the evidence of sales of UPF.

所以这不是直接的消费量，而是消费量的一个替代指标。

So it's not consumption, but it's a proxy of consumption.

在这种情况下，我们有九十三个国家的数据，对吧？

So in this case we have data for nine three countries, countries, right?

接着，我们在论文中描述的发现是，2007年至2022年间，低收入国家、中低收入国家和中高收入国家的超加工食品消费量都有明显增长，而在高收入国家则趋于稳定，但稳定在每人每年200公斤的水平，也就是每人每天半公斤，对吧？

And then what we saw and what's described in paper is that there are clear increases between 2007 to 2022 in low income countries, low middle income countries, upper middle income countries, and we see a stabilization in high income countries, but at what level, at the level of 200 kilograms of UPF per person per year, which means half kilo per day per person, right?

所以当达到这个水平时，我们看到消费趋于稳定，这主要是由于含糖饮料的消费下降，被其他超加工食品的增加所抵消。

So when you arrive to this point, we see a stabilization and very much due to a decline in soda, specifically sweetened sugar beverages, and compensated with an increase in other UPFs.

这一点很重要，因为这种碳酸饮料的减少很可能源于政策，比如英国实施了征税、营销限制等措施。

And this is important because probably this decline in soda is due to policies, like UK, they have taxation, you have marketing restriction, etc.

这告诉我们，我们也需要对其他超加工食品采取同样的措施。

And this tells us that we need to do the same to the other UPFs.

如果你真的想减少摄入，因为如果不这样做，就会出现补偿效应。

If you want really to reduce, because if not, you compensate.

例如，普通碳酸饮料的减少被另一种碳酸饮料的增加所抵消。

You have, for instance, the reduction in regular soda is being compensated by an increase in that soda.

所以本质上，你并没有改变这种模式，对吧？

So in essence, you don't change that air pattern, right?

因此，你仍然面临同样的问题。

So then you still have the same problems.

而且你总是要面对一个行业，它不断试图抵消公共卫生领域所采取的每一项举措，这是一个很大的话题，我稍后会和菲尔讨论关于‘三’的议题。

And you're kind of constantly up against an industry that is trying to sort of counter every single move the public health community is able to make, which is a big topic I'll be talking to Phil about later on when we discuss the three.

是的。

Yeah.

因此，显然这篇论文的核心观点是超加工食品会导致饮食相关慢性病，我们这里所说的饮食相关慢性病具体包括哪些呢？

And so, obviously, at the heart of this paper is the notion that UPS cause diet related chronic diseases, Which diet related chronic diseases are we talking about?

是的，这很有趣，因为当我们开发NOVA分类系统时，我们试图解释巴西肥胖率的上升，而不仅仅是巴西，而是全球范围内的现象，对吧？

Yeah, that's interesting because when we developed Nova, we were trying to explain the increase in obesity in Brazil, and not only in Brazil, everywhere, right?

那么，我们原本预期会发现超加工食品与肥胖以及糖尿病之间的关联，因为糖尿病是肥胖的重要后果之一。

Well, then we were expecting to find association with obesity and also with diabetes, because diabetes is a great part, a consequence of obesity.

还有可能一些心血管疾病，因为它们也与高血压有关。

And then maybe some cardiovascular cardiovascular diseases because they are related also hypertension.

我们在巴西做了最初的一些研究。

We did the first studies in Brazil, just a few studies.

但很快，全世界许多研究团队——从西班牙、法国和英国等欧洲国家开始，随后是美国、澳大利亚、韩国和中国——都开始检验这种关联。

And very suddenly, I mean, many groups in the whole world, starting with Spain and France and UK, so European countries, but then later US and then Australia and South Korea and China, then they they start to to test this association.

毕竟，我们在每个国家都发现这种关联，并不是自然而然的，因为疾病的发生是因为人们用超加工食品替代了传统食物。

Because it's not natural that we could find association in every country, because the way disease is produced is because people change traditional foods by the UPFs.

但这些传统食物在不同国家之间差异很大，对吧？

But these traditional foods are very different from country to country, right?

因此，这些研究最初当然关注肥胖和糖尿病，但由于这些队列研究收集的数据不仅限于肥胖和糖尿病，还包括胃肠道疾病和精神疾病。

So then these studies, they start by of course researching on obesity and diabetes, but then because these cohort studies, they collect data not just on obesity and diabetes, of course, but on gastrointestinal diseases, mental diseases.

这让我们非常惊讶，因为我们发现几乎人体所有器官的疾病都受到超加工食品的影响。

And then, and this really surprised us because then we saw that almost all body organs are, diseases of all body organs are affected by UPFs.

因此，这让我们得出结论：超加工食品与我们的生理机能不相容，对吧？

So then this makes us to conclude that UPFs are not compatible with our physiology, right?

人类的生理机能能够适应不同类型的饮食，这一点我们看得出来，毕竟世界各地的饮食差异巨大。

So the human physiology that can adapt to different types of diets, I mean we see this, I mean we have a huge difference between diets all over the world.

但为什么会这样？

But, why?

因为人体是可以适应的。

Because it was possible to adapt.

所以，一个国家有一种谷物，另一个国家有另一种，两者都没问题，我们都能适应这种差异。

So then you have one type of a cereal in one country, another one, then both are okay, we adapt them for this variation.

但看起来，超加工食品触及了人体适应能力的极限。

But it looks that UPFs point to a limit of adaptation.

这个极限就是，我们无法在没有食物的情况下获得营养，对吧？

And this limit is that we cannot be nourished without foods, right?

而超加工食品在某种程度上根本算不上食物，它们不是完整食物。

And that UPFs are really not foods in a way, they are not whole foods.

你没有食物的基质，因为正如我所说，它们是食物成分的配方，因此是重新构建的。

You don't have the food matrix, because as I said, they are formulations of parts of foods, so they are reconstructed.

它们离原本应该对应的东西已经太远了，确实如此。

They're so far from the original thing they're supposed Exactly.

它已经不再是原来的东西了，是的。

To It's no longer something, yeah.

这种做法已经实现了。

And this is done.

为什么要做这种事？

Why this is done?

因为这样做，你就无需使用多种完整食物，而只需专注于大豆、甘蔗、玉米和小麦这四种高产作物，对吧？

Because by doing this, you don't need to use whole food and several foods, but you can just concentrate on soy, sugarcane, corn, wheat, and from these four crops, I mean, that are very productive crops, right?

所以它们成本很低。

So then they are low cost.

因此，通过用这些廉价作物的成分重新构建新型食品，你就做到了这一点。

So with this reconstruction of new novel foods from these components of cheap crops, then you do this.

这对工业来说太棒了，因为工业能够降低成本，从而以以前无法想象的方式提高利润，对吧？

So it's wonderful for industry, because the industry was able to reduce the cost and then increase profits in a way that was unbelievable before, right?

但问题是，这会让你生病。

But the problem is that this makes you sick.

是的。

Yeah.

所以这就是问题所在。

So that's the problem.

绝对如此。

Absolutely.

而且这一点，我认为系列文章中的配套社论很好地指出了这一点，提到了一些你描述过的公司，它们正在对这些超加工食品所依赖的基本原料进行加工。

And this is something that I think the accompanying editorial for the for the series brings out really nicely, picks up on some of the companies you described that are doing this kind of processing of the really the fundamental ingredients that go into these these UPS.

我认为很多人可能并不了解这一点，我们经常听到关于销售这些超加工食品的零售商，一想到超加工食品，就会想到各种销售它们的快餐连锁店，但实际上，背后还有一整套产业在对这些食品的基本成分进行精炼。

Think I that's something that a lot of people wouldn't necessarily be aware of, we hear a lot about the sort of retailers who sell us the UPS, you think of UPS, and you think of, you know, various fast food chains that sell them, but actually, there's this this whole industry behind, you know, refining the very fundamentals that go into these food.

我认为，在饮食相关研究领域，一个非常具有挑战性的问题是，要确切地确定这些慢性疾病究竟是如何发生的机制。

I suppose something that must be very challenging in in the field of kind of diet related research is really pinning down the mechanisms by which these these sorts of chronic diseases are actually occurring.

那么，对于这些与饮食相关的慢性疾病和超加工食品背后的机制，我们目前有多少了解呢？

So how much would you say we have a kind of good understanding of the mechanisms behind these diet related chronic diseases and UPFs?

这些机制研究其实都是最近才出现的，因为在我们明确观察到超加工食品与数十种疾病相关之后，自然科学才开始试图探究其背后的机制。

Well, is, all these mechanistic studies are very recent, because after we observe that no doubt that UPFs are associated with dozens of diseases, then natural science tries to see how, what are the mechanisms.

我认为，目前对于肥胖以及与肥胖相关的其他慢性疾病的机制，我们已经非常清楚了。

I think the mechanisms are very well known right now regarding obesity and other chronic diseases related to obesity.

这涉及两个方面，有一项研究证实了这一点：超加工食品导致肥胖有两个特性。

And this is, there are two things, and there's one trial showing this, that there are two attributes of UPFs that cause obesity.

一个是能量密度。

One is energy density.

超加工食品是高能量密度的产品。

So UPFs are high energy dense products.

为什么会这样？

And why is that?

因为在生产超加工食品的过程中，你会去除水分，因为你希望产品有更长的保质期，同时也会去除纤维。

Because in the process of making UPFs, you remove water because you want a long duration product, and you remove fiber also.

并且会添加大量的糖和脂肪，比如棕榈油，这些都很便宜。

And use a lot of sugar and fat, palm oil for instance, which are very cheap.

因此，高能量密度是超加工食品制造过程中的固有特性。

So then the high energy density is intrinsic to the manufacture of UPFs.

举个例子，当你采用以米饭和豆类、意大利面配酱料，或任何其他长期存在的饮食模式为主的饮食时，通常每克含有大约1.5千卡，对吧？

And to have an idea, I mean, when you have a diet based on rice and beans or pasta and sauce or any of these long established dietary patterns, you have usually 1.5, around these, kilocalories per gram, right?

1.5。

1.5.

因为你有水分、纤维等不含热量的成分。

Because you have water, you have fiber, etcetera, that has no calories.

而当你转向典型的超加工饮食时，每克则含有三到四千卡。

That When you go to a typical ultra processed diet, you have three or four kilocalories per gram.

这意味着，在相同体积下，你摄入的热量是两倍。

So this means for the same volume you are consuming two times more calories.

而调节我们能量平衡的一部分因素就是食物的体积。

And a part of what regulates our energy balance is this, is the volume.

所以当你吃一顿正餐时，比如你放一些米饭、豆子、蔬菜，然后你看一眼，觉得这样就可以了，我会感到满足，对吧？

So when you have a lunch and you have proper food, right, so you put the food, you put some rice, some beans, vegetables, and then you look and say, okay, this is okay for me, I'll be satisfied, right?

而我们就是这样被训练去这样做的。

And this, and we are trained in a way to do this.

但如果你去麦当劳，点一杯奶昔、一个带培根和奶酪的汉堡，所有这些，再加一份甜点——那根本不是真正的冰淇淋。

But if you go to a McDonald's and then you take one milkshake, one burger with bacon and cheese, all of these, and then you have a dessert, a ice cream that's really not an ice cream.

但当你吃这些的时候，它们提供的热量是两倍，而我们并没有被训练去这样吃。

But when you have this, besides, they bring you two times more, and we are not trained so to do this.

所以其中一个因素是能量过剩。

So one one component is energy debt.

另一个非常重要的因素是超适口性。

The other one, which is very important, is hyper palatability.

因为这些是经过配方设计的，行业能够研究是什么让人们对食物感到愉悦。

So because these are formulations, the industry is able to study, to investigate what makes people happy with food.

什么样的质地、颜色、风味、包装更吸引人，甚至包括吃的时候发出的声音。

What type of texture, what color, what flavor, what package is more interesting, and even what sound you have.

因此，这正是超加工食品的典型特征，因为它们被设计成让人过量食用，而要让人过量食用，就必须拥有最佳的颜色、质地和风味。

So then this is typical of ultra processed foods, because they are made to be over consuming, And to be over consuming they have to have the best color, the best texture, the best flavor.

所以当所有这些因素结合在一起时，它们就变得令人无法抗拒。

So when you put all of these together, they become irresistible.

实际上，这就像烟草一样，对吧？

And actually, it's like tobacco, right?

烟草也是如此，烟草行业在推出新香烟之前，会进行所有实验，看看哪一款让人无法抗拒，哪一款可以大卖。

So tobacco also, the tobacco industry, before having a new cigarette, they do all the experiments to see now this one people cannot resist and this is one we will sell.

因此，高能量密度和高愉悦性，有充分的证据表明它们确实如此。

So then high energy density and hyperplotability, there's good evidence that they are.

但请注意，这些都与肥胖有关。

But look, this is for obesity.

那精神疾病呢？

What about mental diseases?

在关于精神疾病的队列研究中，这一点非常明确：抑郁症、焦虑症，甚至痴呆症、帕金森病，这些疾病都与超加工食品有关。

In this cohort studies on mental diseases, which is very clear, depression, anxiety, even dementia, Parkinson's disease, all these diseases are associated with UPF.

在这些研究中，他们控制了肥胖和BMI，对吧？

And in these studies they control for obesity, for BMI, right?

但你仍然有患病风险。

And still you have a risk.

所以这并不是通过肥胖引起的，那是因为什么？

So it's not through your obesity, it's through what?

那么我们现在进入假设领域，这些研究还很新，但似乎有证据表明，当你摄入超加工食品时，你肠道微生物组中的细菌和微生物会受到影响。

Well then we are in the field of hypothesis, and these are very new studies, but it looks, there is evidence that when you consume UPFs, the bacteria and the microorganism you have in your microbiome, they affected.

它们每天都会受到影响，因为如果你改变饮食，你的微生物组可以在两三天内发生变化，因为这些微生物的生命周期非常短，对吧？

And they are affected day by day because, I mean, if you change your diet, your microbiome can change in two, three days because these microorganisms, they have a very short life, right?

所以你改变了细菌、病毒、真菌的组成，它们也随之发生变化。

So then you change the mix of bacteria, virus, fungi, they also change.

而且看起来，它们的变化方式会引发身体的低度炎症。

And it looks that they change in a way to create what we call a low grade inflammation in the body.

这是因为大脑和肠道之间存在关联。

And it looks at this because we have a relationship between brain and the gut.

这些细菌似乎会产生短链脂肪酸等物质，这些物质对于向大脑传递关于食物状况的信息至关重要。

And it looks that these bacterias, they influence, they produce components like short chain fatty acids that are very important to inform the brain about what's going on with the food.

因此，关于精神疾病，我们仍不清楚这是否是一种途径。

And so we still don't know exactly, in terms of mental diseases this could be an away.

比如克罗恩病，这种情况更容易理解，因为超加工食品中普遍存在乳化剂，你需要乳化剂来使蛋白质分离物和淀粉保持在一起，对吧？

We have Crohn's disease for instance, this is easier because emulsifiers in UPFs, which is very present, because you need emulsifiers because you want to keep these protein isolates and starches together, right?

因此你需要乳化剂。

Then you need the emulsifiers.

这些乳化剂会破坏你肠道内的一些保护屏障，因为它们就像洗涤剂一样，对吧？

These emulsifiers, they sort of destroy some protection you have in the gut, because they are like detergents, right?

这看起来就是克罗恩病的机制。

And this looks the mechanism for Crohn's disease.

但这将是未来二三十年的研究议程。

But this is a research agenda for the next twenty, thirty years.

确实如此。

Absolutely.

我认为你在论文中很好地指出了一点：尽管显然我们还有大量未知需要探索，距离完全理解所有这些机制还很遥远，但现有的证据已经足够充分，足以支持我们现在就开始采取行动，以减少其危害——我们不需要等到拥有完整图景才行动，而那可能永远都不会到来。

And I think a point you make really nicely in the papers as well is that although obviously, there's a huge amount more to learn, and we're far from having a full understanding of all of these mechanisms, there's there's clearly a sufficient body of evidence to justify taking action now to start minimizing the harms, we don't need to wait until we have we might never have a full picture, but.

是的，因为有些人说：不，不，我们必须先弄清楚机制。

Yeah, because there are people that say, no no, we need to know the mechanism.

以肥胖为例，现在我们知道高能量密度和高成瘾性就是其机制。

So for instance, in this case of obesity, okay, now we know that the high energy density and hyperpollatability are the mechanisms.

那么解决方案是什么？

Well, what's the solution?

我的意思是，你去要求产业界：请生产不那么诱人的产品，开始使用全食物、新鲜食材，不要去除水分——但这就是超加工食品商业模式的秘密，对吧？

I mean, you look for the industry, say please do less palatable products, start to use whole foods, fresh foods, do not remove the water, but this is the secret of the UPF business model, right?

所以你不能指望他们会这么做。

So you cannot expect they do this.

质地也是同样的道理。

The same thing for texture.

现在有一项试验正在进行，研究人员正在制作质地更粗糙的超加工饮食，因为这些产品通常很柔软。

There is now a trial going on where the researchers are making ultra processed diets with more texture, because they are soft products.

超加工食品，这是另一个让你每分钟摄入更多能量的事实，对吧？

The UPFs, this is another fact that makes you eat more energy per minute, right?

那么，他所做的，就是创造了一种质地不同的超加工饮食。

So then what he did, I mean he created an ultra processed diet with a different texture.

他添加了一些纤维之类的东西，让你吃得慢一点，对吧？

He put some fiber or something to make you eat slowly, right?

然后，是的，看起来质地确实是解释人们摄入超过所需能量的原因之一，但同样，当你转向产业界，要求他们别再生产这么多柔软产品时，问题就来了，因为正是这些柔软特性让人们喜欢这些产品，并摄入超过所需的能量。

And then, yeah, okay, it looks that texture is something that explains why people have more energy than they need, but again, you look for the industry and say, please don't do more of these soft products, but this is what makes people like these products and eat more than they need.

所以，所有这些成分改良和机制研究，都指向了一种不可行的改良方式。

So again, all these reformulations, these studies on mechanism, they inform a type of reformulation that's not feasible.

但这正是研究人群和现实生活的流行病学家，与在实验室工作的人之间的区别，因为在实验室里，你可以做任何事。

But that's the difference between epidemiologists that work with population, with the real life, and people that work in labs, because in the lab you can do anything.

但我的意思是，他们并没有考虑到，哦，我发现了这一点，这该如何转化为实际行动？如果他们认真思考两分钟，就会明白，哦，抱歉，这根本不可能，我虽然做出了一个非常重要的发现，但它完全不切实际。

But I mean, but they do not take into account, okay, I discovered this, how this will be translated to action that could, and then if they think for two minutes, they'll see, oh, sorry, it's impossible, I I did a very important discovery, but it's completely unusual.

是的。

Yeah.

我的意思是，希望这个系列能帮助打破这些壁垒，把人们凝聚到一个共同的目标上来。

I mean, hopefully that's something the series can do in kind of helping to, I mean, break down some of those silos and bring people together towards a kind of common cause.

我觉得你很好地说明了，没有任何一个单独的群体——任何关注健康的人——能够独自解决这个问题。

I think you do a good job of sort of, yeah, showing how it's no one no one group of kind of, people with an interest in health are gonna be able to solve this problem.

这需要一个协调一致的努力。

It's gonna need to be a coordinated effort.

那么，在你看来，支持超加工食品与慢性病之间关联的最有力证据是什么？

So what is the best evidence then, in your view, to support this association between ultra processed foods and chronic diseases?

嗯，研究任何慢性病的饮食因素——不仅仅是超加工食品，而是任何饮食特征——最有力的证据都是长期、高质量的队列研究。

Well, the best evidence on when you study diet in any chronic disease, not just UBF, any any diet attribute, are long term high quality cohort studies.

因此，你必须以非常严谨的方式评估你的暴露因素，可能是超加工食品，也可能是红肉，或者其他任何东西。

So you have to assess in a very good way your exposure, could be UPF, could be red meat, could be anything.

然后你必须跟踪人们至少五年，最好是十年或十五年，因为慢性病需要时间才会显现，对吧？

Then you have to follow people for at least five years, ideally ten years or fifteen years, because a chronic disease takes time to appear, right?

所以唯一可行的设计就是队列研究。

So the only design that's possible are cohort studies.

因此，在这个系列中，我们对全球不同国家开展的所有此类队列研究进行了系统性综述，这些研究评估了饮食并跟踪了人们五到十年，以观察摄入更多超加工食品的人是否更容易患上各种慢性病，对吧？

So then in the series we did a systematic review on all cohort studies done in different countries that did this, and they assessed diet and followed people for five, ten years to see if people eating more UPFs, they have higher risk of any chronic diseases, right?

于是我们找到了104项研究。

So then we found 104 studies.

在104项研究中，有92项发现了超加工食品摄入与某些慢性疾病之间的关联，包括肾脏病、胃肠道疾病、肥胖、代谢疾病、心血管疾病等，以及全因死亡率，这一点非常重要。

Among the 104 'ninety two we found an association between consuming UPF and some chronic diseases, kidney, gastrointestinal, obesity, metabolic, cardiovascular, etcetera, and all cause mortality, which is very important.

接着，我们按照推荐的做法进行了分析：我们选取了所有至少有四项研究的慢性病结局，因为仅凭一项研究是无法得出结论的，对吧？

Then what we did, which is recommended, what we did, we took all the outcomes, all the chronic diseases for which we had at least four studies, because you cannot conclude anything with one study, right?

所以，只要有四项研究，我们就进行荟萃分析。

So four studies, and then we did a meta analysis.

荟萃分析就是将四项、十项、二十项或二十五项研究的数据综合起来，进行整体总结。

So a meta analysis is you take the four or 10 or 20 or 25 studies and then you do a summary of all these studies.

因为有时候单个研究可能会显示出异常结果，但当你把四个、十个或二十个研究综合起来看时，就会对结果更有信心。

Because sometimes you have one that shows something outlier, but when you take it together, four or 10 or 20 studies, you feel much more comfortable with the result.

然后我们找到了15个结果，每个都有至少四项研究，其中12个结果显示出明确的关联性，即总体关联。

And then we found 15 outcomes with four more studies, and we found for 12 of them an association, one summary association.

我认为这是最有力的证据。

I think this is the best evidence.

但这些当然是观察性研究。

But these of course are observational studies.

所以这里一个重要问题是合理性，因为你看到的只是统计上的关联，即使控制了混杂因素等，归根结底仍然是观察性研究，对吧？

So one important thing is that in this case is the plausibility, because what you see is just a statistical association, although control for confounders, etc, at the end of the day is an observational study, right?

因此，如果你有 plausible 机制的证据，就会更有信心说：这不仅仅是统计关联，而确实是因果关系。

So then if you have evidence on plausible mechanism, then you feel more comfortable to say no, this is not just a statistical, this is really a causal association.

于是我们据此进行评估，根据潜在机制审查各项研究，对于每项结果，几乎都发现了某种潜在机制。

So then we apply this, we review the studies according to the potential mechanism, and for each outcome, for almost all outcomes, we found some potential.

就像我之前说的，高能量密度、高加工程度、质地，或对肠道菌群的影响，因此我们得出了这些结论。

Like I told you before, high energy density, high probability, and texture, or effect on microbiome, so then we have this.

因此，我们有理由相信超加工食品与慢性疾病之间存在因果关系。

So that's why we feel comfortable to say that there's a causal association between UPFs and chronic diseases.

但正如我之前所说，我们做的研究越多，就越能确信超加工食品会影响人体所有这些器官。

But of course, as I said before, the more we do research, the more we'll be confident that UPFs affect all these body organs.

但我们今天所掌握的信息已经足以支持采取全球公共卫生行动。

But what we know today is enough justify a global public health action.

非常感谢蒙特罗教授抽出时间。

Thank you so much professor Montero for your time.

提醒一下，您可以在《柳叶刀》官网的系列主页上阅读关于卡洛斯·蒙特罗的精彩专访。

A reminder that you can read a great profile of first Carlos Montero available on the series hub page at the lancet.com.

接下来，我将与带领系列第二和第三篇论文的卡米拉·科瓦兰教授和菲尔·贝克教授进行对话。

Next then to my conversation with professors Camilla Corvalan and Phil Baker who led papers two and three in the series.

在我录制的英国，现在是晚上7点，时间恰到好处。

Here in The UK where I'm recording, it's an acceptable 7PM.

而在卡米拉加入我们的圣地亚哥，现在是下午4点，也是一个相当适宜交谈的时间。

And in, Santiago from where Camilla's joining us, it's a reasonably sociable four PM.

菲利普从墨尔本附近加入我们，那里现在是早上6点，情况可不一样。

The same cannot be said for Phil who joins us from near Melbourne at, I believe, 6AM.

是这样吗，菲利普？

Is that right, Phil?

是的。

That's right.

抱歉。

Sorry.

真的很抱歉。

Really sorry.

没关系。

That's okay.

不多说了，菲利普有咖啡了。

Without further ado, Phil's got coffee.

我们开始进入系列内容吧。

Let's dive into the series.

接下来我们来看第二篇论文，它聚焦于遏制并逆转超加工食品生产、营销和消费增长的政策。

So moving on to the second paper, this focuses on policies to halt and reverse the rise in ultra processed food production, marketing, and consumption.

你们指出了食品系统的四个不同维度，认为政策应针对这些方面，分别是超加工食品、食品环境、超加工食品制造商和零售商，以及食品供应链。

You identify these four distinct dimensions of food systems towards which you think policies should be targeted, and these are ultra processed food products, food environments, EPF manufacturers and retailers, and food supply chains.

接下来我们逐一讨论这些方面，许多国家已经出台了旨在减少高脂肪、高糖和高盐食品消费的政策。

So dealing with these in term, many countries already have policies in place that focus on decreasing the consumption of foods high in fats, sugars, and salts.

你们建议如何扩展这些政策，以同时针对超加工食品？

How do you propose expanding these policies to also target ultra processed food products?

首先，即使在针对高糖、高盐和高脂肪食品时，我们也缺乏太多强制性政策。

So, well, the the first thing is that even for targeting foods that are high in sugar, salt, and fat, we don't have so many mandatory policies.

但我们在CDS中试图强调的关键点是，仅仅针对营养成分是不够的。

But the key point that we try to maybe in the CDS is that just targeting nutrients, it's not going to be enough.

我们确实需要扩展范围，将添加剂也纳入考虑。

We really need to expand to include also additives.

这意味着我们不仅关注减少高脂肪、高糖和高盐食品的消费，也非常关注减少整个超加工食品类别的消费。

That means that we are not only interested in decreasing the consumption of foods with high content of fat, sugar, and salt, but also we are very interested in decreasing the consumption of the entire group of ultra processed foods.

更重要的是，我认为这意味着仅针对食品的政策是不够的。

More importantly, I think this implies that policies that are only target to food.

因此，例如，配方改良将完全不够。

So for example, reformulation will be totally insufficient.

我们需要纳入其他类型的政策，真正涵盖整个食品系统，包括食品环境、食品供应链和食品企业。

We will need to include other kinds of policies that really includes the entire food system, including food environments, food supply change, and food corporations.

有没有哪些国家已经开始尝试扩大政策范围，以涵盖超加工食品产品？

And are there any examples of countries that have already begun the process of trying to expand policies to to also capture UPF products?

是的。

Yeah.

在这一系列研究中，我们提到，前进的一种方式是修改现有的营养成分模型，这些模型传统上基于营养素，现在也应纳入一些超加工食品的指标，例如非营养性甜味剂。

Well, in the series, what we mentioned is that a way to move forward is actually to modify the existing nutrient profile models that traditionally have been based on on nutrients to also include some UPF marker, for example, non nutritive sweeteners.

拉丁美洲地区已经有一个包含非营养性甜味剂的营养成分模型。

And the Latin American region has a nutrient profile model that already includes non nutritive sweeteners.

我们有一些根据该模型实施的政策实例。

And we have some examples of policies have been implemented following that profile.

例如，在哥伦比亚，你可以找到包装正面的警示标签，帮助识别含有非营养性甜味剂的食物。

For example, in Colombia, you can find front of package labelers that are warming labels that will allow you to identify foods that have non nutritive sweeteners.

我们还有智利的例子，该国根据营养素模型对所有被认为不健康的食品实施了全面的营销限制。

We have examples also from Chile in which they have incorporated very comprehensive marketing restrictions for all the foods that are considered unhealthy based on nutrient profile models.

此外，巴西的学校供餐计划也是一个很好的例子，它基于本地生产的农产品为儿童提供新鲜食品，同时严格限制超加工食品的供应。事实上，拉丁美洲许多国家正在取得进展，逐步扩大政策以真正针对这些问题。

And also, a nice example comes from the school feeding program in Brazil that allows to provide fresh food to children based on locally produced products, but also with the very important restriction on the provision of ultra So really, a number of countries basically in the Latin American region making progress and expanding their policies to actually target.

看来拉丁美洲在这一领域确实是全球领先的地区。

It does seem like Latin America really is the kind of world leading region in this regard.

智利在这么多不同政策上都走在了前列，这确实令人欣慰。

Zoo seems to be ahead of the curve in in so many of these different policies, which is really great to see.

我想你已经大致回应了第二个观点，即关于食品环境以及为什么你认为单纯的食品改良并不足够。

I think you've already sort of addressed the the second point there on food environments and why you don't believe sort of food reformulation is is quite enough.

那么，转向更广泛的食品体系和供应链，你认为如果目标是防止超加工食品饮食增加，政策应针对哪些方面？

So turning instead then to the broader food system and supply chains, where do you think policy policy should be targeted if the aim is to prevent an increase in UPF diets?

我们能否具体谈谈低收入和中等收入国家？

And and could we talk sort of specifically to low and middle income countries?

我们应该采取哪些政策来确保这些地区不会出现增加？

Which policies ought ought we be taking up to to ensure there isn't an increase in these regions?

是的。

Yeah.

因此，本系列还指出，为了防止超加工食品的生产、营销和消费在那些尚未以超加工食品为主要热量来源的国家增加，我们可以采取一些措施。

So so we, this series, also suggest that in order to to prevent the increase of ultra processed food production, marketing, and consumption in in countries in which this is not already the primarily source of of calories, we can take some actions.

基本上，我们建议在贸易政策中特别优先考虑公共健康，尤其是在这些贸易协定中。

Basically, we suggest that we should be thinking on trade regulations in particular to prioritize public health on on some of these trade agreements.

同时，应考虑限制投资者保护措施，或取消投资者与国家争端解决机制，以保护国内农业市场。

And also thinking in restricting investor protections or removing investor state dispute mechanisms with the goal of safeguarding domestic agriculture market.

我们还建议，在农业层面也可以采取一些措施。

We also suggest that there are some actions that can be taken at the level of the agriculture.

因此，与其直接实施补贴来促进廉价原料用于超加工食品的生产，不如重新思考补贴的方向。

So rather than just jumping into implement subsidies that we promote the production of cheap ingredients for ultra processed food.

这些经济体可以考虑调整补贴，以促进更多样化和本地生产的食品。

These economies could think in deriving their subsidies to promote more diverse and locally produced foods.

最后，我们认为与环境领域存在非常紧密的合作关系。

And finally, we think that there is very strong partnership with the environmental space.

有一些主要专注于保护环境的法规，这些法规将对食品系统产生积极影响。

There are regulations that are primarily focused on protecting the environment that will have a positive effect on the food systems.

在这里，我们谈到对一次性塑料征税、限制包装或水资源使用规定。

Here we talk about taxes on single use plastics or restrictions on packaging or water use regulations.

我们认为，所有这些在食品供应链层面采取的措施，对于低收入和中等收入国家的政策讨论都具有重要意义。

We think that all these actions that are more at the food supply level would be very relevant to be incorporated in the discussion of of of policies in low, middle income countries.

你关于环境研究领域交叉点的见解也非常精彩，因为我认为这些强大的跨国超加工食品企业同时也是全球主要的污染者和超加工食品消费的主要推动者。

That's a really great point you make as well about the sorts of, intersection with the, environmental kind of field of research, because I think these these sort of powerful transnational UPF corporations are amongst some of the the the kind of major polluters globally as well as primary drivers of EPF consumption.

所以，你刚才提到的一些政策，我们稍后在与菲尔讨论第三篇论文时还会再回来探讨。

So how can policies you've sort of spoken to it a little there, and we'll be coming back to it when we speak to Phil about paper three.

但如何设计政策来限制这种强大的影响力呢？

But how can policies be designed to limit this power given how great it is?

你知道，你面对的是世界上最具实力的一些公司。

You know, you're you're up against some of the most powerful companies in the world.

哪些类型的政策有可能成功？

What what sorts of policies stand the chance of success?

嗯，我们首先应该做几件事。

Well, there are there are a few things that we should start by by doing.

当然，其中一些比其他的更容易实现。

Of course, some of them are easier than others.

我认为第一点是我们应该停止将自我监管视为一种选择。

The first one I think is that we should stop considering self regulation as as an option.

事实上，所有证据都表明，我们必须转向强制性措施。

Really, all the evidence shows that we need to move you to mandatory action.

这才是实现有力回应的唯一途径。

That's the only way to have a a powerful response.

但我们也有机会开始监测这些企业的市场权力。

But we also have the opportunity of of starting to to monitor the market power of these corporations.

我们应该评估它们生产的食品质量、产品组合，并探讨限制其市场营销投资的可能性，或根据其健康产品所占比例调整其享受的税收优惠。

We should be assessing the quality of the food products that they produce, their portfolio, and may maybe discussing the the possibility of restricting the the investment on marketing or actually tax reduction that they receive the marketing of their products, depending on the percentage of products that are healthy.

我们还可以考虑限制零售商销售某些超加工食品的可得性，甚至限制销售这些超加工食品的零售商的选址。

We also have the opportunity of thinking on the possibility of limiting the availability of some ultra processed foods in retailers or even the location of some retailers that sell these ultra processed foods.

最后，我们应该防止企业过度集中。

Finally, we should be preventing corporate concentration.

我们知道，只有少数几家公司负责生产所有这些产品。

We know that there are only a few corporations that are responsible for the production of all these products.

在这方面，我们有所有这些反垄断法规，应该更严格地执行。

And there, we have all these antitrust regulations that we should be enforcing more more strongly.

当然，这些公司背后还有强大的政治力量，而菲尔是这方面的专家，可以详细谈谈。

So, of course, there is also all the political power behind these corporations, and and Phil is the expert for talking about that.

当然。

Absolutely.

我们很快就会请菲尔来谈这个问题。

We'll be coming to Phil on that very shortly.

这里面有一个很好的数据。

And there's a great figure in there.

我认为是第三篇论文，它探讨了少数公司权力集中的问题。

I think it's paper three that's sort of on on the topic of concentration of power amongst a few companies.

我认为第三篇论文中的图二非常出色，直观地展示了这一点。

I think it's figure two in the third paper is fantastic for showing for showing that's pictorially.

我们已经讨论了很多关于超加工食品需求如何由其固有特性驱动，这些特性使其被设计为消费并取代更健康的食物。

So we've talked a lot about how demand for EPFs is driven by their sort of inherent qualities that they're designed to be consumed and to replace these healthier foods.

但还有其他潜在的社会因素推动消费，包括社会经济和性别不平等。

But there are also underlying social factors which drive consumption, and these include both sort of socioeconomic and gender inequalities.

那么，我们如何设计配套政策，充分考虑这些深层驱动因素，更好地促进健康饮食呢？

So how can these, how how can we design complementary policies that better promote healthy diets with these underlying drivers in mind?

是的。

Yeah.

我们在CVS中对此讲得非常清楚。

We we make this very, very clear on on the CVS.

在那些超加工食品是家庭主要热量来源的国家，改善饮食尤其是弱势群体的饮食，是一个挑战。

There is a challenge of of of improving diets, particularly among vulnerable populations in countries where UPF, it's the primary source of calories for those families.

这意味着政府同时需要负责提供低加工、新鲜制作的餐食，这些餐食要方便、保质期长，并且对这些家庭来说价格可负担。

This means that governments simultaneously need to be responsible of providing a minimally processed and fresh prepared meals that are convenient, that are of long duration, and that are affordable for those families.

我们提出了一些措施。

And we suggest some actions.

其中一些与采购计划相关，我们可以建立代金券或现金转移机制。

Some are related to procurement programs in which we could establish vouchers or cash transfer.

我们可以对某些超加工食品征税，这些食品并不健康，然后用这些税收收入来资助这类项目。

We could implement taxes for some of the ultra processed foods that are healthy and use those revenues for funding these kind of programs.

我们还有潜力扩展我们已建立的商业体系类型。

We also have the potential of expanding the type of commercial systems that we have established.

我们需要更多关注社区和本地企业家为保护其饮食所建立的解决方案，评估如何扩大或推广这些举措，以让家庭获得这些资源。

We need to look more on some of the solutions that communities and local entrepreneurs have established to protect their diets and evaluate how we can expand those initiatives or scale them up to provide access to the families.

我想再次强调，巴西的学校供餐计划就是一个非常具体的例子，该计划确保接受补助的儿童能获得他们所能得到的最好的食物。

And again, I want to remark that there are very concrete examples of programs such as the school feeding program in Brazil, in which they ensure that those children that are meetings receive really food that is the best food that they can receive.

他们通过不将政府资金用于超加工食品来实现这一点。

They do this by not spending governmental money in ultra processed food.

他们用于超加工食品的支出不超过10%。

The amount that they can spend on ultra processed food is less than 10%.

其余的支出则必须用于天然食品和本地生产的食品。

And then the rest of the expenditure needs to be done on natural foods and also locally produced foods.

因此，有一些采购计划正在朝着正确的方向发展，这正是我们在系列中所强调的。

So there are examples of procurement programs that are moving into the right direction and that's what we highlight in the series.

第二篇论文中有一些非常出色的小组讨论，深入探讨了这些例子，我建议读者去那里查看。

You've got some great panels in that second paper, which really go into detail on those, those examples, so I would direct readers there.

接下来，我们转向菲尔。

Turning then to Phil.

因此，系列中的第三篇也是最后一篇论文，探讨了推动超加工食品在人类饮食中兴起及其相关危害的根本原因，重点关注这些产品的政治和经济维度。

So the third and final paper in the series examines the root causes driving the rise of ultra processed foods and human diets and the subsequent associated harms focusing on the political and economic dimensions of these products.

那么首先，个人的意志力和责任感在超加工食品在我们饮食中兴起的过程中起到了多大作用？

So first of all then, to what extent does individual willpower and responsibility play a role in the rise of UPFs in our diets?

是的。

Yeah.

很好的问题。

Great question.

这一点我们在第三篇论文中强调过，超加工食品的兴起并非由个人意志力或责任感的下降所决定。

And this is something that we emphasized in paper three, that the rise of ultra processed foods is not determined by any decline in individual willpower and or responsibility.

如果你看一下第三篇论文中的图一，我们会展示全球人均超加工食品消费量的显著差异，这些差异并不反映各国之间个人责任感的差异。

If you look at figure one in paper three, we show the remarkable differences in terms of per capita consumption of UPFs around the world, and this does not reflect any differences in individual responsibility between countries.

实际上，当你观察许多超加工食品消费量高的国家时，这种超加工食品消费的上升往往伴随着责任感增强的指标。

And actually, when you look at a lot of countries of high UPF consumption, that rise in UPFs has occurred alongside, indicators of increasing responsibility.

如果你看一下烟草消费的下降，例如，这些不同国家之间一定存在某种因素解释了超加工食品消费的差异。

If you look at the decline in, you know, tobacco consumption, for example, There is something about these different countries that explains these differences in ultra processed food consumption.

在论文中，我们认为这与这些社会的组织方式有关。

And in the paper, we argue that this has something to do with the way these societies are organized.

比如，澳大利亚、美国和英国是全球超加工食品消费率最高的国家。

So, you know, Australia, The United States, The UK have the highest rates of UPF consumption in the world.

为什么会这样？

Like, why is that?