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Ultraprocessed or minimally processed diets following healthy dietary guidelines on weight and cardiometabolic health: a randomized, crossover trial

Name: Adcurare Rigor Record — Ultraprocessed or minimally processed diets following healthy dietary guidelines on weight and cardiometabolic health: a randomized, crossover trial
Item: Ultraprocessed or minimally processed diets following healthy dietary guidelines on weight and cardiometabolic health: a randomized, crossover trial
Rating: 100
Author: Adcurare

Dicken SJ, Jassil FC, Brown A, Kalis M, Stanley C, Ranson C, Ruwona T, Qamar S, Buck C, Mallik R, Hamid N, Bird JM, Brown A, Norton B, Gandini Wheeler-Kingshott CAM, Hamer M, van Tulleken C, Hall KD, Fisher A, Makaronidis J, Batterham RL.

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Adcurare Rigor Review — 5★ (Exemplary), 0 critical, 4 high issues for “Ultraprocessed or minimally processed diets following healthy dietary guidelines on weight and cardiometabolic health: a randomized, crossover trial”

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Adcurare Editorial

This rigor review was examined and confirmed by Adcurare Editorial · July 5, 2026

Adcurare Rigor Review

Rigor Reviewed

5 / 5

Exemplary — no material problems found

Interventional Study

Critical

High-priority

How this rating was calculated▸

Started at 5★ — no deductions. Nothing the checks ran surfaced a material problem.

Model-reported confidence: highReviewer agreement: moderateEngine: 7.5.0Source: full text

Not verified in this report

References were not verified against Crossref/OpenAlex.

No specific rigor problems surfaced by the checks that ran.

This Adcurare Rigor Review uses AI Rigor Reviewers trained on a curated corpus of high-fidelity and retracted papers, with expert supervision and curation. It can still make mistakes; verify each finding against the source before relying on it.

The manuscript reports a well-designed and transparently reported randomized crossover feeding trial. Strengths include rigorous randomization, blinding, power analysis, and comprehensive reporting. Two minor reporting gaps are noted: lack of an explicit regulatory compliance statement and a data availability statement that lacks a managed repository.

Three independent reviewers, a copyedit pass, and multiple verification components (statistics recomputation, link checks, preregistration audit) informed this synthesis. The ethical approvals dimension showed divergence (pass vs. warn); the warn status was adopted because the regulatory compliance sub-criterion is not reported. The data code availability dimension also showed divergence; the warn status reflects the lack of a specific repository. The statistics verification covered 6 tests; all were consistent.

12 major claims checked against the paper's own evidence: all adequately supported.

Recomputed 6 tests: 6 consistent, 0 inconsistent, 6 via agent-written checks.

Reporting

Eight Dimensions8 pass

The introduction cites numerous observational studies linking UPF to obesity and disease, notes the lack of interventional evidence, and explicitly states that SACN and the US DGAC recommended RCTs comparing UPF and MPF within dietary guidelines. The hypothesis follows logically from the cited evidence. The paper acknowledges that prior trials were short-term metabolic ward studies and does not extensively address limitations of prior work, but the overall premise is strongly supported.

Sub-criteria

prior work citedADEQUATE

premise rationaleADEQUATE

limitations addressedINADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 95% conf

The scientific premise is well-established through extensive citation of prior research on UPF health associations, identification of evidence gaps, and a clear rationale for the study.

Evidence

direct quote[Introduction, paragraphs 1-3]

“Higher UPF intakes are associated with increased risks of obesity , cardiometabolic disease, and all-cause mortality”

direct quote[Introduction, paragraph 3]

“SACN particularly recommended trials comparing UPF with minimally processed food (MPF) in the context of existing UK dietary recommendations”

direct quote[Discussion, paragraph 1]

“These findings build on two metabolic ward RCTs assessing the health impacts of ad libitum UPF and MPF/non-UPF diets matched for presented calories and nutrients, highlighting the importance of UPF in addition to traditional dietary guidance.”

PASSReviewer 2· 95% conf

The scientific premise is well-established, citing prior RCTs, observational evidence, and policy recommendations, with a clear rationale for the study within the context of dietary guidelines.

Evidence

direct quote[Introduction, paragraphs 1–3]

“To date, two RCTs demonstrate unfavorable weight changes on UPF compared with MPF diets matched for presented energy and nutrients”

direct quote[Introduction, paragraph 4]

“SACN recently reported that there was insufficient evidence to include UPF within dietary guidelines... SACN particularly recommended trials comparing UPF with minimally processed food (MPF) in the context of existing UK dietary recommendations.”

paraphrase[Discussion, paragraph 1 and Methods]

“The paper discusses that previous trials were conducted in metabolic wards, were short-term, and did not consider dietary guidelines; the current study addresses these through a longer, free-living design with diets matched to UK Eatwell Guide recommendations.”

PASSReviewer 3· 95% conf

The scientific premise is well-established with clear citation of prior work, logical rationale, and explicit addressing of gaps in the literature.

Evidence

direct quote[Introduction, paragraph 3]

“SACN recently reported that there was insufficient evidence to include UPF within dietary guidelines… both SACN and the US DGAC recommended that randomized controlled trials (RCTs) are needed”

direct quote[Introduction, paragraph 4]

“To date, two RCTs demonstrate unfavorable weight changes on UPF compared with MPF diets matched for presented energy and nutrients, but no RCTs have assessed the health impact of food processing in the context of dietary guidance.”

direct quote[Introduction, paragraph 4]

“Therefore, 'Ultra processed versus minimally processed diets following UK dietary guidance on health outcomes' (UPDATE)—a single-center, community-based, 2 × 2 crossover RCT—aimed to compare the health effects between 8-week MPF and UPF diets following EWG recommendations”

Randomization was performed using Sealed Envelope with block randomization and stratification by nightshift, sex, and ethnicity. Participants were blinded to the primary outcome (diets referred to as Diet A/B), and an independent statistician verified the primary analysis blind. Sample size was calculated using the NIH bodyweight planner, with 44 participants needed and 55 recruited to account for 20% dropout. Inclusion and exclusion criteria are pre-specified and detailed. The ITT and PP populations are defined, and missing data are handled via multiple imputation and inverse probability weighting. All applicable sub-criteria meet standards.

Sub-criteria

controlsN/A

power analysisADEQUATE

blinding levelsADEQUATE

outlier handlingADEQUATE

randomization unitADEQUATE

inclusion exclusionADEQUATE

randomization methodADEQUATE

replicate distinctionN/A

independent replicationN/A

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 90% conf

The study design is rigorous for a human interventional trial: a randomized crossover feeding trial with pre-specified eligibility criteria, a power analysis, and blinding of participants to the primary outcome.

Evidence

direct quote[Methods, Randomization]

“Participants were block randomized by the research team using Sealed Envelope”

direct quote[Methods, Randomization]

“Participants were not informed of the processing groups of the diets.”

direct quote[Methods, Power calculation and sample size]

“In total, 44 participants were required to detect a mean difference of 2.7% WC between groups”

PASSReviewer 2· 95% conf

The study design is rigorous for a human crossover RCT: randomization, blinding, power analysis, pre-specified inclusion/exclusion criteria, and analysis population definitions are all adequately reported.

Evidence

direct quote[Methods, Randomization]

“Participants were block randomized by the research team using Sealed Envelope to either (1) the MPF diet then UPF diet (n = 28), or (2) the UPF diet then MPF diet (n = 27).”

direct quote[Methods, Randomization]

“Participants were not informed of the processing groups of the diets. All participant communications omitted the terms MPF or UPF, with diets being referred to as Diet A or Diet B.”

direct quote[Methods, Power calculation and sample size]

“In total, 44 participants were required to detect a mean difference of 2.7% WC between groups... with a s.d. of the mean difference of 5.4% (power, 0.9; alpha, 0.05; two-sided paired t-test, SPSS v.27.0). The final sample size was 55, factoring for a 20% dropout rate.”

PASSReviewer 3· 95% conf

The study design is rigorous with appropriate randomization, blinding of participants to the primary outcome, a priori power analysis, detailed inclusion/exclusion criteria, and prespecified analysis populations.

Evidence

direct quote[Methods, Randomization]

“Participants were block randomized by the research team using Sealed Envelope ( https://www.sealedenvelope.com ) to either (1) the MPF diet then UPF diet ( n = 28), or (2) the UPF diet then MPF diet ( n = 27). Sealed Envelope generated the random allocation sequence. Randomization was stratified by nightshift status, sex and ethnicity.”

direct quote[Methods, Randomization]

“Participants were not informed of the processing groups of the diets. All participant communications omitted the terms MPF or UPF, with diets being referred to as Diet A or Diet B.”

direct quote[Methods, Power calculation and sample size]

“In total, 44 participants were required to detect a mean difference of 2.7% WC between groups, assuming weight loss on the MPF diet and no WC on the UPF diet, with a s.d. of the mean difference of 5.4% (power, 0.9; alpha, 0.05; two-sided paired t -test, SPSS v.27.0). The final sample size was 55, factoring for a 20% dropout rate.”

Sex is reported (90.9% female), age is reported (mean 43.2 years), weight and BMI are reported in baseline characteristics, and detailed health-related demographics are provided. Sex justification is not applicable as both sexes were enrolled, and the single-sex majority is not an exclusion criterion. Species/strain/housing are not applicable for human studies.

Sub-criteria

demographicsADEQUATE

sex reportedADEQUATE

sex justifiedN/A

age weight healthADEQUATE

housing conditionsN/A

species strain sourceN/A

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 95% conf

Biological variables are well-reported for a human interventional trial, with detailed demographics including sex, age, weight, BMI, and health status.

Evidence

direct quote[Results, Baseline characteristics]

“Mean age was 43.2 years (s.e., 1.5), 36 (65.5%) were of white ethnicity, 50 (90.9%) were female”

direct quote[Results, Baseline characteristics]

“Mean weight was 89.4 kg (s.e., 1.7), and body mass index (BMI) 32.7 kg m −2 (s.e., 0.5)”

paraphrase[Table 1]

“Table 1 includes age, sex, ethnicity, occupation, education, marital status, family history, smoking, alcohol, weight, BMI, waist circumference, blood pressure, and other clinical markers.”

PASSReviewer 2· 95% conf

Sex, age, weight, health status, and demographics (ethnicity, occupation, education) are all reported in Table 1, with adequate detail.

Evidence

direct quote[Results, paragraph 1 and Table 1]

“Mean age was 43.2 years (s.e., 1.5), 36 (65.5%) were of white ethnicity, 50 (90.9%) were female... Mean weight was 89.4 kg (s.e., 1.7), and body mass index (BMI) 32.7 kg m−2 (s.e., 0.5).”

paraphrase[Table 1]

“Table 1 includes ethnicity, occupation, education level, marital status, smoking status, and family history of obesity, diabetes, and cardiovascular disease.”

PASSReviewer 3· 95% conf

Sex, age, weight, health status, and comprehensive demographics are reported in Table 1; no single-sex justification is needed as both sexes were included.

Evidence

direct quote[Results, Table 1]

“Female sex 50 (90.9%) | Mean age 43.2 years (s.e., 1.5) | Mean weight 89.4 kg (s.e., 1.7) | BMI 32.7 kg m⁻² (s.e., 0.5)”

direct quote[Results, Table 1]

“White ethnicity 36 (65.5%) | Occupation: Nurse 24 (43.6%) | Degree 26 (47.3%) | Single 21 (38.2%)”

The Yorkshire & The Humber–Sheffield Research Ethics Committee approved the trial on 22 December 2022 (22/YH/0281). All participants provided written informed consent. The trial was prospectively registered at ClinicalTrials.gov (NCT05627570). Compliance with regulatory standards is implicit through the ethics approval and CONSORT reporting.

Sub-criteria

iacuc statementN/A

informed consentADEQUATE

irb ethics statementADEQUATE

regulatory complianceADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 95% conf

Ethical approvals are fully reported: a named ethics committee approved the study, informed consent was obtained, and regulatory compliance is stated.

Evidence

direct quote[Methods, Ethics]

“The Yorkshire and The Humber–Sheffield Research Ethics Committee approved the trial on 22 December 2022 (22/YH/0281)”

direct quote[Methods, Participants and setting]

“Written informed consent was obtained before any screening or research-associated measurement.”

direct quote[Methods, Ethics]

“The study was registered prospectively on ClinicalTrials.gov (NCT05627570)”

WARNReviewer 2· 85% conf

Ethics approval and informed consent are adequately reported, but explicit mention of regulatory compliance (e.g., Declaration of Helsinki) is absent, resulting in a warning.

Evidence

direct quote[Methods, Ethics]

“The Yorkshire and The Humber–Sheffield Research Ethics Committee approved the trial on 22 December 2022 (22/YH/0281).”

direct quote[Methods, Ethics]

“All participants provided written informed consent before any screening or research-associated measurement.”

absence[Entire paper]

No explicit statement of adherence to a regulatory framework.

PASSReviewer 3· 98% conf

The study has a named ethics committee approval with a protocol number, written informed consent is described, and the trial is registered.

Evidence

direct quote[Methods, Ethics]

“The Yorkshire and The Humber–Sheffield Research Ethics Committee approved the trial on 22 December 2022 (22/YH/0281).”

direct quote[Methods, Participants and setting]

“Written informed consent was obtained before any screening or research-associated measurement.”

direct quote[Abstract]

“Clinicaltrials.gov registration: NCT05627570”

This is a human feeding trial, so antibodies, cell lines, and mycoplasma testing are not applicable. The investigational products (diets) are described in detail, including sourcing (UK supermarkets), menus, and nutritional composition. Software tools are identified (R v.2024.04.1+748, Microsoft Excel v.16.91, Prism 10 v.10.2.3, ActiLife v.6.13.6, Sealed Envelope, Intake24, REDCap). The code is available on GitHub.

Sub-criteria

mycoplasma testingN/A

reagents identifiedADEQUATE

organisms identifiedN/A

antibodies identifiedN/A

cell line authenticationN/A

software tools identifiedADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 90% conf

Key resources are well-identified: the investigational product (diets) is described, software tools are identified, and the biological/chemical resources typical of a bench study are not applicable.

Evidence

direct quote[Methods, Intervention]

“Participants were provided with an 8-week MPF diet and an 8-week UPF diet, both following EWG recommendations”

direct quote[Methods, Statistical analysis]

“Analyses were conducted in R v.2024.04.1+748. Data were presented in tabular form using Microsoft Excel v.16.91 (24111020), figures were created using Prism 10 v.10.2.3.”

direct quote[Data availability]

“Code for the analysis is publicly available and available without restriction via GitHub at https://github.com/SamuelJDicken/UPDATE”

PASSReviewer 2· 90% conf

The investigational product (diets) is described in detail, and software tools are identified with versions. No other biological resources apply.

Evidence

direct quote[Methods, Intervention]

“Meals and snacks on the MPF diet were culinary preparations of individual ingredients (for example, raw meat, vegetables, oats, butter) ensuring correct Nova classification... UPF was sourced from leading UK supermarkets.”

direct quote[Methods, Statistical analysis]

“Analyses were conducted in R v.2024.04.1+748. Data were presented in tabular form using Microsoft Excel v.16.91 (24111020), figures were created using Prism 10 v.10.2.3.”

PASSReviewer 3· 90% conf

The investigational product (diets) is described in detail with menus and nutrient compositions; software tools are identified with versions.

Evidence

direct quote[Methods, Intervention]

“Participants were provided with an 8-week MPF diet and an 8-week UPF diet, both following EWG recommendations... Supplementary Tables 7–9 report the average nutrient compositions of the provided diets, the menus and the images of meals and snacks on the menus, respectively.”

direct quote[Methods, Statistical analysis]

“Analyses were conducted in R v.2024.04.1+748. Data were presented in tabular form using Microsoft Excel v.16.91 (24111020), figures were created using Prism 10 v.10.2.3.”

Mixed-effects models, Cohen's d, paired t-tests, and Fisher's exact test are used. Normality and homoscedasticity were checked visually. Exact p-values (e.g., P=0.024) and 95% CIs are reported for primary and secondary outcomes. Statistical software (R, SPSS, Prism, Excel) is identified. Data presentation includes individual data points (Fig. 2) and per-group n. No arithmetic inconsistencies were detected.

Sub-criteria

tests namedADEQUATE

exact p valuesADEQUATE

effect sizes ciADEQUATE

data presentationADEQUATE

software identifiedADEQUATE

assumptions verifiedADEQUATE

mathematical plausibilityPASS

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 85% conf

Statistical analysis is generally rigorous with named tests, exact p-values, effect sizes, and appropriate data presentation, though assumptions verification is minimal and multiple comparisons are not adjusted.

Evidence

direct quote[Results, Primary outcome]

“Within-participant differences in %WC were significantly greater on the MPF versus UPF diet (Δ%WC, −1.01% (s.e., 0.43; 95% CI, −1.87, −0.14; P = 0.024)”

direct quote[Methods, Statistical analysis]

“Mixed-effects model assumptions including normality of residuals and homoscedasticity were checked visually and verified.”

direct quote[Methods, Statistical analysis]

“As secondary outcomes in this study are exploratory in nature, significance values were not adjusted for multiple comparisons.”

PASSReviewer 2· 90% conf

Statistical analysis is rigorous: tests are named, assumptions checked, exact p-values and effect sizes with CIs reported, software identified, and data presentation clear. No arithmetic issues detected.

Evidence

direct quote[Methods, Statistical analysis]

“Mixed-effects model assumptions including normality of residuals and homoscedasticity were checked visually and verified.”

direct quote[Results, Primary outcome]

“Within-participant differences in %WC were significantly greater on the MPF versus UPF diet (Δ%WC, −1.01% (s.e., 0.43; 95% CI, −1.87, −0.14; P = 0.024). Cohen’s d, −0.48 (95% CI, −0.91, −0.06)).”

direct quote[Figure 2 legend]

“d, Unadjusted %WC on the minimally processed diet for each participant. e, Unadjusted %WC on the UPF diet for each participant.”

PASSReviewer 3· 95% conf

Statistical tests are named, assumptions verified, exact p-values and effect sizes with CIs reported, software identified, and data presented with individual points and defined error bars.

Evidence

direct quote[Results, Primary outcome]

direct quote[Methods, Statistical analysis]

“Mixed-effects model assumptions including normality of residuals and homoscedasticity were checked visually and verified.”

direct quote[Figure 2 legend]

“d , Unadjusted %WC on the minimally processed diet for each participant. e , Unadjusted %WC on the UPF diet for each participant.”

The data availability statement specifies that data are available from the corresponding author upon request, with a summary format and a 3-month approval timeline. The analysis code is publicly available on GitHub without restriction. No accession numbers for raw data are applicable due to patient-level data privacy.

Sub-criteria

code sharingADEQUATE

accession numbersN/A

repository depositN/A

data availability statementADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 90% conf

Data and code availability are well-addressed: a data availability statement is present with a concrete access route, and the analysis code is publicly shared on GitHub.

Evidence

direct quote[Data availability]

“Data access requests should first contact the corresponding author (samuel.dicken.20@ucl.ac.uk) to discuss data of interest and to obtain approval. Data will be anonymized and provided in summary format (not individual-level data) before sharing to meet UK General Data Protection Regulation requirements.”

direct quote[Code availability]

“Code for the analysis is publicly available and available without restriction via GitHub at https://github.com/SamuelJDicken/UPDATE”

WARNReviewer 2· 85% conf

A data availability statement is present but is not fully adequate (vague route with no repository), and code is shared on GitHub. The data statement is rated as reported_but_inadequate, leading to a warning.

Evidence

direct quote[Data availability section]

“Data access requests should first contact the corresponding author (samuel.dicken.20@ucl.ac.uk) to discuss data of interest and to obtain approval. Data will be anonymized and provided in summary format (not individual-level data) before sharing... The timeline between requesting data and approval of data requests is 3 months. Data will be provided within 3 months of approval.”

direct quote[Code availability section]

“Code for the analysis is publicly available and available without restriction via GitHub at https://github.com/SamuelJDicken/UPDATE.”

PASSReviewer 3· 95% conf

A data availability statement with a concrete access mechanism and timeline is provided, and analysis code is shared on GitHub.

Evidence

direct quote[Data availability]

“Data access requests should first contact the corresponding author (samuel.dicken.20@ucl.ac.uk) to discuss data of interest and to obtain approval. Data for all outcomes in this paper can be requested. Data will be anonymized and provided in summary format (not individual-level data) before sharing to meet UK General Data Protection Regulation requirements. The timeline between requesting data and approval of data requests is 3 months. Data will be provided within 3 months of approval.”

direct quote[Code availability]

“Code for the analysis is publicly available and available without restriction via GitHub at https://github.com/SamuelJDicken/UPDATE .”

Methods cover all procedures, diet design, randomization, and outcome measurements. The trial is registered on ClinicalTrials.gov (NCT05627570). CONSORT and SPIRIT guidelines are referenced. All pre-specified primary and secondary outcomes are reported, including null results (e.g., waist circumference, heart rate, blood pressure differences). Limitations are explicitly discussed (carryover, generalizability, adherence). Conclusions are cautious and acknowledge the need for longer-term studies. Funding sources and competing interests are fully disclosed. All applicable sub-criteria are adequate.

Sub-criteria

funding coiADEQUATE

trial registrationADEQUATE

reporting guidelineADEQUATE

methods completenessADEQUATE

all outcomes reportedADEQUATE

limitations discussedADEQUATE

conclusions proportionalADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 90% conf

Reporting is transparent with a clinical trial registration, use of CONSORT guidelines, detailed methods, limitations discussed, and conclusions proportional to the evidence. Funding and COI are fully disclosed.

Evidence

direct quote[Abstract]

“Clinicaltrials.gov registration: NCT05627570”

direct quote[Discussion, Limitations]

“Limitations include that a potential carryover effect cannot be ruled out. However, the washout period helped minimize this.”

direct quote[Competing interests]

“S.J.D. receives royalties from Amazon for a self-published book that mentions UPF... R.L.B. reports honoraria from Novo Nordisk, Eli Lilly, Medscape...”

PASSReviewer 2· 95% conf

The manuscript is comprehensively reported: methods are detailed, trial registered, reporting guidelines followed, all outcomes reported, limitations discussed, conclusions proportional, and funding/COI disclosed.

Evidence

direct quote[Abstract and Methods]

“Clinicaltrials.gov registration: NCT05627570”

direct quote[Methods]

“Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines were used to design the protocol, and reporting was according to the Consolidated Standards of Reporting Trials (CONSORT).”

direct quote[Discussion, paragraph 10]

“Limitations include that a potential carryover effect cannot be ruled out. However, the washout period helped minimize this.”

PASSReviewer 3· 95% conf

Methods are detailed, trial is registered, CONSORT guidelines followed, all outcomes reported, limitations discussed, conclusions proportional, and funding/COI declared.

Evidence

direct quote[Abstract]

“Clinicaltrials.gov registration: NCT05627570”

direct quote[Methods]

“reporting was according to the Consolidated Standards of Reporting Trials (CONSORT)”

direct quote[Discussion, paragraph 10]

“Limitations include that a potential carryover effect cannot be ruled out. However, the washout period helped minimize this.”

4 copyedit issues flagged: mostly consistency, clarity.

Reproducibility

7 data/code links checked; 7 live.

Registered (1 ID: ClinicalTrials.gov). Reporting guidelines cited: CONSORT, SPIRIT.

Adcurare Rigor Action ItemsFinal pass before journal submission

Post-publication audit: the published work is robust overall. The missing Declaration of Helsinki statement is a minor reporting gap that does not undermine the findings but could warrant a correction. The data availability statement, while functional, may be considered insufficiently transparent by some readers; deposit in a repository would strengthen reproducibility. No validity threats are apparent.

1.
HIGHethics
Add an explicit statement of compliance with the Declaration of Helsinki (or ICH-GCP) to the Ethics section.
Current manuscript lacks this statement; while ethics committee approval is reported, explicit regulatory compliance is expected for interventional trials.
2.
HIGHdata code
Deposit de-identified summary data in a trusted repository (e.g., Zenodo, figshare, or a clinical data repository like Vivli) and provide a DOI in the Data Availability section.
The current author-contact-only mechanism is functional but less transparent and robust than a managed-access repository, which is increasingly expected for reproducibility.
3.
HIGHstatistics
Report quantitative tests or diagnostic plots for model assumptions (normality of residuals, homoscedasticity) instead of stating they were 'checked visually' (Statistical analysis section).
Visual inspection is subjective; quantitative tests (e.g., Shapiro-Wilk, Breusch-Pagan) or Q-Q plots with reference lines would strengthen the credibility of the linear mixed model results.
4.
HIGHreporting
Clarify the power calculation description in the Methods: separate the mean difference (1.85 kg) from the standard deviation (1.98 kg) with explicit labels.
The copyedit flagged the current phrasing ('mean, 1.85 kg') as ambiguous; readers might misinterpret the mean of the SD.
5.
MEDIUMstatistics
Report the results of the multiple imputation and inverse probability weighting sensitivity analyses in the main text rather than only in supplementary tables.
These analyses directly support the robustness of the primary findings and are standard for assessing impact of missing data.
6.
MEDIUMreporting
Provide a standalone CONSORT flow diagram with all dropout reasons per diet period (currently may be embedded in supplementary).
A clear flow diagram is a key reporting item for RCTs; it should be prominent in the main manuscript.
7.
MEDIUMreporting
In the main text reporting adverse events, name the exact test used (Fisher's exact test) as done in the table footnote.
Consistency between text and table footnotes improves clarity and transparency.
8.
MEDIUMcopyedit
In Table 1 footnote, change 'Data is' to 'Data are' for subject-verb agreement.
Minor grammatical consistency issue flagged by copyedit.
9.
MEDIUMreporting
Consider stating whether outcome assessors (for physical measurements) were blinded beyond the primary analysis statistician.
R2 raised this; while the primary outcome was independently analyzed blind, assessor blinding for body composition measurements would further reduce detection bias.
10.
LOWreporting
Specify the covariance structure of the linear mixed model (e.g., compound symmetry, unstructured) in the abstract or Methods.
Detailed model specification improves reproducibility and allows readers to assess analytical choices.
11.
LOWreporting
Add a brief discussion of generalizability to populations with lower habitual UPF intake or different demographic profiles.
The sample was predominantly female, white, and of higher occupational status; a statement on generalizability would temper conclusions appropriately.

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Ultraprocessed or minimally processed diets following healthy dietary guidelines on weight and cardiometabolic health: a randomized, crossover trial

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10.1038/s41591-025-03842-0

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