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How and why ultra-processed foods harm human health

Published online by Cambridge University Press:  10 July 2023

Renata Bertazzi Levy Open the ORCID record for Renata Bertazzi Levy [Opens in a new window] ,
Mayra Figueiredo Barata ,
Maria Alvim Leite  and
Giovanna Calixto Andrade
Renata Bertazzi Levy*
Affiliation:
Preventive Medicine Department, Medical School, University of Sao Paulo, Ave. Dr Arnaldo, 455, Zip Code: 01246-903, São Paulo, SP, Brazil Center for Epidemiological Studies in Nutrition and Health, University of São Paulo (Nupens/USP), Ave. Dr Arnaldo, 715, Zip Code: 01246-90, Sao Paulo, SP, Brazil
Mayra Figueiredo Barata
Affiliation:
Preventive Medicine Department, Medical School, University of Sao Paulo, Ave. Dr Arnaldo, 455, Zip Code: 01246-903, São Paulo, SP, Brazil Center for Epidemiological Studies in Nutrition and Health, University of São Paulo (Nupens/USP), Ave. Dr Arnaldo, 715, Zip Code: 01246-90, Sao Paulo, SP, Brazil
Maria Alvim Leite
Affiliation:
Preventive Medicine Department, Medical School, University of Sao Paulo, Ave. Dr Arnaldo, 455, Zip Code: 01246-903, São Paulo, SP, Brazil Center for Epidemiological Studies in Nutrition and Health, University of São Paulo (Nupens/USP), Ave. Dr Arnaldo, 715, Zip Code: 01246-90, Sao Paulo, SP, Brazil
Giovanna Calixto Andrade
Affiliation:
Center for Epidemiological Studies in Nutrition and Health, University of São Paulo (Nupens/USP), Ave. Dr Arnaldo, 715, Zip Code: 01246-90, Sao Paulo, SP, Brazil
*
*Corresponding author: Renata Bertazzi Levy, email rlevy@usp.br
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Abstract

The analysis of food using a perspective centred on nutrients seems inadequate for understanding the dietary transition and its impact on the growth of obesity and chronic diseases. Industrial food processing is now proposed as the key to explain the relationship between food and health. The NOVA food classification considers the degree and the purpose of food processing, which includes physical, biological and chemical processes used after foods are separated from nature, and before being consumed or prepared as dishes and meals. NOVA has four food groups: (1) unprocessed and minimally processed foods; (2) processed culinary ingredients; (3) processed foods and (4) ultra-processed foods, which are formulations made mostly or entirely from substances derived from group 1 foods and additives, with little if any intact group 1 food. Many investigations linking high ultra-processed food consumption with deterioration of diets and adverse health outcomes are reinforced by prospective studies, systematic reviews and meta-analyses. There are various plausible explanations of why diets high in ultra-processed foods are harmful. Their production and consumption continue to rise worldwide. Efficient and effective public policies and actions that reduce production and consumption of ultra-processed products are needed, to protect human health now and in future.

Keywords

Ultra-processed foodsFood processingNOVAHuman health
Type
Conference on ‘Architecture of food: Processing, structure and health’
Information
Proceedings of the Nutrition Society , Volume 83 , Issue 1 , February 2024 , pp. 1 - 8
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Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of The Nutrition Society

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References

Martins, APB, Levy, RB, Claro, RM et al. (2013) Increased contribution of ultra-processed food products in the Brazilian diet (1987–2009). Rev Saude Publica 47, 656–665.CrossRefGoogle ScholarPubMed
Monteiro, CA, Cannon, G, Moubarac, JC et al. (2018) The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutr 21, 5–17.CrossRefGoogle ScholarPubMed
Monteiro, CA, Cannon, G, Lawrence, M et al. (2019) Ultra-Processed Foods, Diet Quality, and Health Using the NOVA Classification System. Rome, FAO. https://www.fao.org/3/ca5644en/ca5644en.pdf (accessed February 2023).Google Scholar
Ludwig, DS (2011) Technology, diet, and the burden of chronic disease. J Am Med Assoc 305, 1352–1353.CrossRefGoogle ScholarPubMed
Monteiro, CA, Levy, RB, Claro, RM et al. (2010) A new classification of foods based on the extent and purpose of their processing. Cad Saude Publica 26, 2039–2049.CrossRefGoogle ScholarPubMed
Brasil. Ministério da Saúde (2014) Guia alimentar para a população brasileira. 2a edição; Guia alimentar para a população. Brasília: Ministério da Saúde, 156 p.Google Scholar
Monteiro, CA, Cannon, G, Levy, RB et al. (2019) Ultra-processed foods: what they are and how to identify them. Public Health Nutr 22, 936–941.Google Scholar
Juul, F, Parekh, N, Martinez-Steele, E et al. (2022) Ultra-processed food consumption among US adults from 2001 to 2018. Am J Clin Nutr 115, 211–221. Available at https://doi.org/101.093/ajcn/nqab305 (accessed February 2023).CrossRefGoogle ScholarPubMed
Cediel, G, Reyes, M, Da Costa Louzada, ML et al. (2018) Ultra-processed foods and added sugars in the Chilean diet (2010). Public Health Nutr 21, 125–133.CrossRefGoogle ScholarPubMed
Cornwell, B, Villamor, E, Mora-Plazas, M et al. (2018) Processed and ultra-processed foods are associated with lower-quality nutrient profiles in children from Colombia. Public Health Nutr 21, 142–147.CrossRefGoogle ScholarPubMed
Da Costa Louzada, ML, Ricardo, CZ, Steele, EM et al. (2018) The share of ultra-processed foods determines the overall nutritional quality of diets in Brazil. Public Health Nutr 21, 94–102.CrossRefGoogle Scholar
Marrón-Ponce, JA, Tolentino-Mayo, L, Hernández-F, M et al. (2019) Trends in ultra-processed food purchases from 1984 to 2016 in Mexican households. Nutrients 11, 1–15.Google Scholar
Vandevijvere, S, De Ridder, K, Fiolet, T et al. (2019) Consumption of ultra-processed food products and diet quality among children, adolescents and adults in Belgium. Eur J Nutr 58, 3267–3278. Available at http://link.springer.com/101.007/s00394-018-1870-3 (accessed February 2023).CrossRefGoogle ScholarPubMed
Parra, DC, Da Costa-Louzada, ML, Moubarac, JC et al. (2019) Association between ultra-processed food consumption and the nutrient profile of the Colombian diet in 2005. Salud Publica Mex 61, 147. Available at http://www.saludpublica.mx/index.php/spm/article/view/9038 (accessed February 2023).CrossRefGoogle ScholarPubMed
Rauber, F, Louzada, MdC, Steele, EM et al. (2018) Ultra-processed food consumption and chronic non-communicable diseases-related dietary nutrient profile in the UK (2008–2014). Nutrients 10, 5.CrossRefGoogle ScholarPubMed
Levy, RB, Andrade, GC, da Cruz, GL et al. (2022) Three decades of household food availability according to NOVA – Brazil, 1987–2018. Rev Saude Publica 56, 75.CrossRefGoogle ScholarPubMed
Liu, J, Steele, EM, Li, Y et al. (2022) Consumption of ultraprocessed foods and diet quality among U.S. children and adults. Am J Prev Med 62, 252–264. Available at https://doi.org/101.016/j.amepre.20210.80.14 (accessed February 2023).Google ScholarPubMed
Martínez Steele, E, Popkin, BM, Swinburn, B et al. (2017) The share of ultra-processed foods and the overall nutritional quality of diets in the US: evidence from a nationally representative cross-sectional study. Popul Health Metr 15, 6. Available at http://pophealthmetrics.biomedcentral.com/articles/101.186/s12963-017-0119-3 (accessed February 2023).CrossRefGoogle ScholarPubMed
Moubarac, JC, Batal, M, Martins, APB et al. (2014) Processed and ultra-processed food products: consumption trends in Canada from 1938 to 2011. Can J Diet Pract Res 75, 15–21.CrossRefGoogle ScholarPubMed
Latasa, P, Louzada, MLDC, Martinez Steele, E et al. (2018) Added sugars and ultra-processed foods in Spanish households (1990–2010). Eur J Clin Nutr 72, 1404–1412. Available at http://doi.org/101.038/s41430-017-0039-0 (accessed February 2023).Google ScholarPubMed
Wang, L, Martínez Steele, E, Du, M et al. (2021) Trends in consumption of ultraprocessed foods among US youths aged 2–19 years, 1999–2018. J Am Med Assoc 326, 519–530.CrossRefGoogle ScholarPubMed
Madruga, M, Steele, EM, Reynolds, C et al. (2023) Trends in food consumption according to the degree of food processing among the UK population over 11 years. Br J Nutr 130, 476–483.CrossRefGoogle Scholar
Baker, P, Machado, P, Santos, T et al. (2020) Ultra-processed foods and the nutrition transition: global, regional and national trends, food systems transformations and political economy drivers. Obes Rev 21, 1–22.CrossRefGoogle ScholarPubMed
Martini, D, Godos, J, Bonaccio, M et al. (2021) Ultra-processed foods and nutritional dietary profile: a meta-analysis of nationally representative samples. Nutrients 13, 3390. Available at https://www.mdpi.com/2072-6643/13/10/3390 (accessed February 2023).CrossRefGoogle ScholarPubMed
Moradi, S, Entezari, MH, Mohammadi, H et al. (2022) Ultra-processed food consumption and adult obesity risk: a systematic review and dose–response meta-analysis. Crit Rev Food Sci Nutr 63, 249–260.CrossRefGoogle Scholar
Konieczna, J, Morey, M, Abete, I et al. (2021) Contribution of ultra-processed foods in visceral fat deposition and other adiposity indicators: prospective analysis nested in the PREDIMED-Plus trial. Clin Nutr 40, 4290–4300.CrossRefGoogle ScholarPubMed
Pagliai, G, Dinu, M, Madarena, MP et al. (2021) Consumption of ultra-processed foods and health status: a systematic review and meta-analysis. Br J Nutr 125, 308–318.CrossRefGoogle ScholarPubMed
Fiolet, T, Srour, B, Sellem, L et al. (2018) Consumption of ultra-processed foods and cancer risk: results from NutriNet-Santé prospective cohort. Br Med J 360, 1–11.Google ScholarPubMed
Wang, L, Du, M, Wang, K et al. (2022) Association of ultra-processed food consumption with colorectal cancer risk among men and women: results from three prospective US cohort studies. Br Med J 378, e068921.CrossRefGoogle Scholar
Zhang, S, Gan, S, Zhang, Q et al. (2022) Ultra-processed food consumption and the risk of non-alcoholic fatty liver disease in the Tianjin chronic low-grade systemic inflammation and health cohort study. Int J Epidemiol 51, 237–249.CrossRefGoogle ScholarPubMed
Lo, CH, Khandpur, N, Rossato, SL et al. (2022) Ultra-processed foods and risk of Crohn's disease and ulcerative colitis: a prospective cohort study. Clin Gastroenterol Hepatol 20, 1323–1337. Available at https://doi.org/101.016/j.cgh.20210.80.31 (accessed February 2023).CrossRefGoogle ScholarPubMed
Rey-García, J, Donat-Vargas, C, Sandoval-Insausti, H et al. (2021) Ultra-processed food consumption is associated with renal function decline in older adults: a prospective cohort study. Nutrients 13, 1–13.CrossRefGoogle ScholarPubMed
Adjibade, M, Julia, C, Allès, B et al. (2019) Prospective association between ultra-processed food consumption and incident depressive symptoms in the French NutriNet-Santé cohort. BMC Med 17, 1–13.CrossRefGoogle ScholarPubMed
Li, H, Li, S, Yang, H et al. (2022) Association of ultraprocessed food consumption with risk of dementia. Neurology 99, 1056–1066.CrossRefGoogle ScholarPubMed
Gomes Gonçalves, N, Vidal Ferreira, N, Khandpur, N et al. (2022) Association between consumption of ultraprocessed foods and cognitive decline. JAMA Neurol 80, 142–150.CrossRefGoogle Scholar
Suksatan, W, Moradi, S, Naeini, F et al. (2022) Ultra-processed food consumption and adult mortality risk: a systematic review and dose–response meta-analysis of 207,291 participants. Nutrients 14, 1–17.Google Scholar
Moradi, S, Kermani, MAH, Bagheri, R et al. (2021) Ultra-processed food consumption and adult diabetes risk: a systematic review and dose–response meta-analysis. Nutrients 13, 1–13.CrossRefGoogle Scholar
Wang, M, Du, X, Huang, W et al. (2022) Ultra-processed foods consumption increases the risk of hypertension in adults: a systematic review and meta-analysis. Am J Hypertens 35, 892–901.CrossRefGoogle ScholarPubMed
Zhang, T, Gan, S, Ye, M et al. (2021) Association between consumption of ultra-processed foods and hyperuricemia: TCLSIH prospective cohort study. Nutr Metab Cardiovasc Dis 31, 1993–2003.CrossRefGoogle ScholarPubMed
Hall, KD, Ayuketah, A, Brychta, R et al. (2019) Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake. Cell Metab 30, 67–77. Available at https://doi.org/101.016/j.cmet.20190.50.08 (accessed February 2023).CrossRefGoogle ScholarPubMed
Srour, B, Fezeu, LK, Kesse-Guyot, E et al. (2019) Ultraprocessed food consumption and risk of type 2 diabetes among participants of the NutriNet-Santé prospective cohort. JAMA Intern Med 180, 283. Available at https://doi.org/101.001/jamainternmed.20195.942 (accessed February 2023).CrossRefGoogle Scholar
Levy, RB, Rauber, F, Chang, K et al. (2021) Ultra-processed food consumption and type 2 diabetes incidence: a prospective cohort study. Clin Nutr 40, 3608–3614. Available at https://doi.org/101.016/j.clnu.20201.20.18 (accessed February 2023).CrossRefGoogle ScholarPubMed
Llavero-Valero, M, Escalada-San Martín, J, Martínez-González, MA et al. (2021) Ultra-processed foods and type-2 diabetes risk in the SUN project: a prospective cohort study. Clin Nutr 40, 2817–2824.CrossRefGoogle ScholarPubMed
Duan, MJ, Vinke, PC, Navis, G et al. (2022) Ultra-processed food and incident type 2 diabetes: studying the underlying consumption patterns to unravel the health effects of this heterogeneous food category in the prospective lifelines cohort. BMC Med 20, 1–11.CrossRefGoogle ScholarPubMed
Piernas, C & Popkin, B (2011) Food portion patterns and trends among U.S. children and the relationship to total eating. J Nutr 141, 1159–1164.CrossRefGoogle ScholarPubMed
Steenhuis, IHM & Vermeer, WM (2009) Portion size: review and framework for interventions. Int J Behav Nutr Phys 6, 58–65.CrossRefGoogle ScholarPubMed
Albar, SA, Alwan, NA, Evans, CEL et al. (2014) Is there an association between food portion size and BMI among British adolescents? Br J Nutr 112, 841–851.CrossRefGoogle ScholarPubMed
Mallarino, C, Gómez, LF, González-Zapata, L et al. (2013) Advertising of ultra-processed foods and beverages: children as a vulnerable population. Rev Saude Publica 47, 1006–1010.CrossRefGoogle ScholarPubMed
Lobstein, T, Jackson-Leach, R, Moodie, ML et al. (2013) Child and adolescent obesity: part of a bigger picture. Lancet 385, 2510–2520. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4593763/pdf/nihms724468.pdf.CrossRefGoogle Scholar
Marchese, L, Livingstone, KM, Woods, JL et al. (2022) Ultra-processed food consumption, socio-demographics and diet quality in Australian adults. Public Health Nutr 25, 94–104.CrossRefGoogle ScholarPubMed
Dunford, EK, Miles, DR & Popkin, B (2023) Food additives in ultra-processed packaged foods: an examination of US household grocery store purchases. J Acad Nutr Diet 123, 889–901.CrossRefGoogle ScholarPubMed
Zinöcker, MK & Lindseth, IA (2018) The Western diet–microbiome–host interaction and its role in metabolic disease. Nutrients 10, 1–15.CrossRefGoogle ScholarPubMed
Steele, EM & Monteiro, CA (2017) Association between dietary share of ultra-processed foods and urinary concentrations of phytoestrogens in the US. Nutrients 9, 209.CrossRefGoogle Scholar
Buckley, JP, Kim, H, Wong, E et al. (2019) Ultra-processed food consumption and exposure to phthalates and bisphenols in the US national health and nutrition examination survey, 2013–2014. Environ Int 131, 1050–1057. Available at https://linkinghub.elsevier.com/retrieve/pii/S0160412019317416 (accessed February 2023).CrossRefGoogle ScholarPubMed
Zhang, Y, Huang, M, Zhuang, P et al. (2018) Exposure to acrylamide and the risk of cardiovascular diseases in the national health and nutrition examination survey 2003–2006. Environ Int 117, 154–163. Available at https://www.sciencedirect.com/science/article/pii/S0160412017322183 (accessed February 2023).CrossRefGoogle ScholarPubMed
Fardet, A. (2016) Minimally processed foods are more satiating and less hyperglycemic than ultra-processed foods: a preliminary study with 98 ready-to-eat foods. Food Funct 7, 2338–2346. Available at http://doi.org/101.039/C6FO00107F (accessed February 2023).CrossRefGoogle ScholarPubMed
UNC. University of North Carolina (2020) Global Food Research Program. Available at https://globalfoodresearchprogram.web.unc.edu/ (accessed February 2023).Google Scholar
Brasil (2020) Resolução no 6, de 8 de maio de 2020, sobre o atendimento da alimentação escolar aos alunos da educação básica no âmbito do Programa Nacional de Alimentação Escolar – PNAE. Diário Oficial da União.Google Scholar
France (2019) Recommendations concerning diet, physical activity and sedentary behaviour for adults. Santé publique, 62. Available at www.santepubliquefrance.fr (accessed May 2023).Google Scholar
Israel (2019) Nutritional Recommendations: The Israeli Ministry of Health. Jerusalem: Ministry of Health, 29. Available at https://health.gov.il/PublicationsFiles/dietaryguidelinesEN.pdf (accessed May 2023).Google Scholar
Ecuador (2020) Documento Técnico de las Guías Alimentarias Basadas en Alimentos (GABA) del Ecuador. Quito: Ministerio de Salud Pública del Ecuador y la Organización de las Naciones Unidas para la Alimentación y la Agricultura, 1–240. Available at https://doi.org/104.060/ca9928es (accessed May 2023).Google Scholar
Chile (2022) Guías alimentarias para Chile. Chile: Ministerio de Salud Subsecretaría de Salud Pública División de Políticas Públicas Saludables y Promoción Departamento de Nutrición y Alimentos 2, 108.Google Scholar
Uruguay (2016) Guía Alimentaria para la Población Uruguaya. Montevideo: Ministerio de SALUD. Depto de Comunicación y Salud, 52.Google Scholar
World Health Organization (2015) Nutrient Profile Model. vol. 32. Washington, DC: PAHO.Google Scholar
Mexico (2020) Modificación a la Norma Oficial Mexicana NOM-051-SCFI/SSA1-2010, Especificaciones generales de etiquetado para alimentos y bebidas no alcohólicas preenvasados (Amendment to Official Mexican Standard NOM-051-SCFI/SSA1-2010, General labelling specifications. Ciudad de México: Diario Oficial de la Federacion.Google Scholar
Uruguay (2018) Reglamento técnicos MERCOSUR contenidos en la Resolución de Grupo Mercado Común no 45/17 de 19 de diciembre de 2017, sus modificativas y reglamentarias. Montevideo: Ministerio de Salud Pública.Google Scholar
Peru (2018) Aprueban Manual de Advertencias Publicitarias en el marco de lo establecido en la Ley No 30021, Ley de promoción de la alimentación saludable para niños, niñas y adolescentes, y su Reglamento aprobado por Decreto Supremo No 017-2017-SA. Diario Oficial El Peruano.Google Scholar
Ecuador (2018) Ministerio de Salud Pública. Reglamento sanitario sustitutivo de etiquetado de alimentos procesados para el consumo humano, No 00005103. Registro Oficial. Ministerio de Salud Pública 318, 1–9.Google Scholar
Reyes, M, Garmendia, ML, Olivares, S et al. (2019) Development of the Chilean front-of-package food warning label. BMC Public Health 19, 1–11.CrossRefGoogle ScholarPubMed
Mialon, M & Da Silva Gomes, F (2019) Public health and the ultra-processed food and drink products industry: corporate political activity of major transnationals in Latin America and the Caribbean. Public Health Nutr 22, 1898–1908.CrossRefGoogle ScholarPubMed
Mialon, M, Khandpur, N, Amaral, L et al. (2021) Arguments used by trade associations during the early development of a new front-of-pack nutrition labelling system in Brazil. Public Health Nutr 24, 766–774. Available at https://www.cambridge.org/core/product/identifier/S1368980020003596/type/journal_article (accessed May 2023).CrossRefGoogle Scholar
Mialon, M, Cediel, G, Jaime, PC et al. (2021) A consistent stakeholder management process can guarantee the ‘social license to operate’: mapping the political strategies of the food industry in Brazil. Cad Saude Publica 37, 1–19.CrossRefGoogle Scholar
Pereira, TN, Gomes, FDS, Carvalho, CMP et al. (2022) Regulatory measures for the protection of adequate and healthy diet in Brazil: a 20-year analysis. Cad Saude Publica 37, e00153120. Available at http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102311X2021001305008&tlng=t (accessed May 2023).CrossRefGoogle Scholar
Broadcasting Authority Ireland (2013) BAI Children's Commercial Communications Code. 1–25.Google Scholar
France (2016) LOI no 2016-1771 du 20 décembre 2016 relative à la suppression de la publicité commerciale dans les programmes jeunesse de la télévision publique. J Off Répub Fr, Texte 1 sur 179.Google Scholar
The UK Code of Broadcast Advertising (2010) The BCAP Code. London: UK Code Broadcast Advert.Google Scholar
Portugal. Portugal Code (2019) Proposed amendments to the Marketing Code, establishing restrictions on the marketing of certain food and beverage products directed at minors. [Internet]. Lisbon: Government of Portugal. Available at http://app.parlamento.pt/webutils/docs/doc.pdf?path=6148523063446f764c3246795a5868774d546f334e7a67774c336470626d6c7561574e7059585270646d467a4c31684a53556b76644756346447397a4c334271624445794d43315953556c4a4c6d527659773d3d&fich=pjl120-XIII.doc&Inline=true (accessed February 2023).Google Scholar
Global Food Research Program (2020) Sugary drink taxes around the world. Available at https://globalfoodresearchprogram.web.unc.edu/ (accessed February 2023).Google Scholar
Taillie, LS, Reyes, M, Colchero, MA et al. (2020) An evaluation of Chile's law of food labeling and advertising on sugar-sweetened beverage purchases from 2015 to 2017: a before-and-after study. PLoS Med 17, 1–22.CrossRefGoogle ScholarPubMed
Arantxa Cochero, M, Rivera-Dommarco, J, Popkin, BM et al. (2017) In Mexico, evidence of sustained consumer response two years after implementing a sugar-sweetened beverage tax. Health Aff 36, 564–571.Google Scholar
Vandevijvere, S, Jaacks, LM, Monteiro, CA et al. (2019) Global trends in ultraprocessed food and drink product sales and their association with adult body mass index trajectories. Obes Rev 20, 10–19.CrossRefGoogle ScholarPubMed