To evaluate the association between the consumption of NOVA food groups (classification based on the nature, extent and purpose of food processing) and the intake of energy, macro and micronutrients among school children.

Cross-sectional study. Food consumption was assessed by two 24-h dietary recalls on non-consecutive days. Energy from each NOVA food groups – ultra-processed foods, unprocessed or minimally processed foods, processed culinary ingredients and processed foods – was estimated. For analysis, the percentage of energy from ultra-processed foods and unprocessed or minimally processed foods were categorised into tertiles and associated with intake of energy, macro and micronutrients using analysis of covariance and linear regression.

Public schools in Belo Horizonte, Minas Gerais, Brazil.

School children aged 8–12 years (n 797; 406 girls; 391 boys).

Mean energy intake was 2050·18 ± 966·83 kcal/d, 25·8 % was from ultra-processed foods, 56·7 % from unprocessed or minimally processed foods, 8·9 % from processed culinary ingredients and 8·6 % from processed foods. A higher energy contribution from ultra-processed foods was negatively associated with the intake of protein, fibre, vitamin A, Fe and Zn (P < 0·001) and positively associated with total energy, lipid and Na intake (P < 0·001). Concurrently, a higher energy contribution from unprocessed or minimally processed foods was positively associated with the consumption of protein, fibre, Fe and Zn (P < 0·001) and negatively associated with total energy (P = 0·002), lipid and Na intake (P < 0·001).

In conclusion, higher ultra-processed food consumption presented a negative association with the nutrient intake profile of school children.

To evaluate the performance of an FFQ for estimating dietary contributions of NOVA groups to individuals’ diets with a specific focus on ultra-processed foods (UPF) compared with a single 24-h dietary recall (24HR).

All consumed foods and beverages assess with both a 109-item FFQ and a single 24HR were classified into one of four NOVA groups: natural or minimally processed foods (MPF), processed culinary ingredients (PCI), processed foods (PF) and UPF. The contributions of each NOVA group to daily intakes of energy, protein, fat, saturated fat, carbohydrate, fibre and Na were expressed as crude intake, energy-adjusted intake and percentage intake. Mean differences, correlation coefficients and joint classification were calculated for intakes of energy and nutrients from each NOVA group between the FFQ and the 24HR.

The Korea National Health and Nutrition Examination Survey 2016.

Adults aged 19–64 years (n 3189).

The smallest group-mean differences between the two methods were observed in UPF (2–40 %). The greatest average Pearson’s correlation coefficients between the FFQ and 24HR were shown in dietary contributions of UPF (r = 0·22–0·25 for MPF; r = 0·02–0·05 for PCI; r = 0·11–0·18 for PF; r = 0·26–0·30 for UPF). The greatest agreement in quartile classification between the FFQ and the 24HR was observed in dietary contributions of UPF (70·0–71·5 % for MPF; 64·2–68·8 % for PCI; 66·9–69·2 % for PF; 71·8–73·9 % for UPF).

The use of the FFQ for estimating absolute intake of UPF may not be encouraged in its current form, but it still may be used for relative comparisons such as quantile categorisation.

To develop a simulation framework for assessing how combinations of taxes, nutrition warning labels and advertising levels could affect purchasing of ultra-processed foods (UPF) in Latin American countries and to understand whether policies reinforce or reduce pre-existing social disparities in UPF consumption.

We developed an agent-based simulation model using international evidence regarding the effect of price, nutrition warning labels and advertising on UPF purchasing.

We estimated policy effects in scenarios representing two stages of the ‘social transition’ in UPF purchasing: (1) a pre-transition scenario, where UPF purchasing is higher among high-income households, similar to patterns in Mexico; and (2) a post-transition scenario where UPF purchasing is highest among low-income households, similar to patterns in Chile.

A population of 1000 individual agents with levels of age, income, educational attainment and UPF purchasing similar to adult women in Mexico.

A 20 % tax would decrease purchasing by 24 % relative to baseline in both the pre- and post-transition scenarios, an effect that is similar in magnitude to that of a nutrition warning label policy. A 50 % advertising increase or decrease had a comparatively small effect. Nutrition warning labels were most effective among those with higher levels of educational attainment. Labelling reduced inequities in the pre-transition scenario (i.e. highest UPF purchasing among the highest socio-economic group) but widened inequities in the post-transition scenario.

Effective policy levers are available to reduce UPF purchasing, but policymakers should anticipate that equity impacts will differ depending on existing social patterns in UPF purchasing.

To evaluate the association of the consumption of foods of the ultra-processed group (UPF) with inflammatory markers in the adolescent population in Northeastern Brazil.

A cross-sectional population-based study. Food consumption was evaluated using two 24-h dietary recalls using the NOVA classification for food processing levels. The following inflammatory markers were evaluated: adiponectin, IL-6, IL-8, C-reactive protein (CRP) and TNF-α. Multivariate linear regression was used to investigate the association between the percentage of UPF energy contribution and inflammatory markers.

São Luís, Maranhão, Brazil.

The sample consisted of 391 male and female adolescents, aged from 17 to 18 years.

The average daily energy consumption by adolescents was 8032·9 kJ/d, of which 26·1 % originated from UPF. The upper tertile (T3) of UPF consumption presented higher intake of simple carbohydrates, lipids, saturated fat, and Na and lower protein intake. Individuals in T3 presented higher serum leptin and CRP levels (P < 0·05). Adolescents with UPF energy consumption ≥30·0 % (tertile 3 of UPF) had a 79 % (exp (0·58) = 1·79) increase in IL-8 levels when compared with adolescents in tertile 1 of UPF (P = 0·013).

The association between the consumption of UPF, poor quality diet and pro-inflammatory markers have important harmful effects that can be observed as early as in adolescence.

To investigate the association between ultra-processed food (UPF) consumption and internalising symptoms (IS) among adolescents.

It is a cross-sectional study. Paper-pencil survey was completed in classroom with information on UPF consumption, IS and selected covariates. IS were assessed with the Internalizing Symptoms sub-scale from the Social Behaviour Questionnaire (IS-SBQ). UPF was evaluated with a FFQ extracted from the Brazilian National School Health Survey. Crude and adjusted association between UPF and IS was investigated with structural equation models.

São Paulo, SP, Brazil.

A total of 2680 students, Mage = 14·85; (95 % CI 14·81, 14·88).

UPF consumption was associated with higher scores in IS in the crude (β = 0·14; P < 0·001) and adjusted (β = 0·12; P < 0·001) models. The higher the consumption of UPF, the higher is the IS score. The following variables were associated with a lower risk of UPF consumption: male sex, public school and having more meals with parents. The change in the magnitude of the standardised score was almost negligible, but the model was significantly improved with the inclusion of covariates.

Our results provide evidence about the positive association between UPF consumption and IS among adolescents. The association, despite its low magnitude, remained significant after adjusting for potential confounders. These results are relevant considering the increase in UPF consumption worldwide and in low- and middle-income countries. Also, our study emphasises the importance of a healthy diet with a reduction in UPF consumption among adolescents.

This study aimed to verify the association between socio-economic and demographic characteristics and dietary patterns (DP) of children assisted by the Conditional Cash Transfer Program, Bolsa Família Program (BFP).

This is a cross-sectional study. DP were defined using a principal component analysis. The association of the predictive variables and DP was modelled using multilevel linear regression analysis.

This study was conducted in six municipalities from the State of Alagoas, Brazil.

The participants were children aged 6–24 months who were assisted by the BFP.

A total of 1604 children were evaluated. Four DP were identified (DP1, DP2, DP3 and DP4). DP1 is composed of traditional Brazilian food. DP2 is formed mostly from ultra-processed foods (UPF). DP3 consists of milk (non-breast) with added sugar, while DP4 consists of fresh and minimally processed foods. Caregivers with higher age and education (β = −0·008; (95 % CI −0·017, −0·000); β = −0·037; (95 % CI −0·056, −0·018), respectively) were negatively associated with DP2. We observed a negative association between households with food insecurity (β = −0·204; (95 % CI −0·331, −0·078)) and DP4 and a positive association between caregivers with higher age and education (β = 0·011; (95 % CI (0·003; 0·019); β = 0·043; (95 % CI 0·025, 0·061), respectively) and DP4.

This study identified the association between socio-economic inequities and DP early in life, with an early introduction of UPF, in children assisted by BFP in the State of Alagoas.

To examine the relationship between the dietary quality of Canadian children and adults and household food insecurity status.

Dietary intake was assessed with one 24-h recall. Households were classified as food secure or marginally, moderately or severely food insecure based on their responses to the Household Food Security Survey Module. We applied multivariable analyses of variance to determine whether % energy from ultra-processed foods, fruit and vegetable intake, Healthy Eating Index (HEI) scores, macronutrient composition and micronutrient intakes per 1000 kcal differed by food insecurity status after accounting for income, education and region. Analyses were run separately for children 1–8 years and 9–18 years and men and women 19–64 years of age.

Ten provinces in Canada.

Respondents to the 2015 Canadian Community Health Survey-Nutrition, aged 1–64 years, with complete food insecurity data and non-zero energy intakes, N 15 909.

Among adults and children, % energy from ultra-processed foods was strongly related to severity of food insecurity, but no significant trend was observed for fruit and vegetable intake or HEI score. Carbohydrate, total sugar, fat and saturated fat intake/1000 kcal did not differ by food insecurity status, but there was a significant negative trend in protein/1000 kcal among older children, a positive trend in Na/1000 kcal among younger children and inverse associations between food insecurity severity and several micronutrients/1000 kcal among adults and older children.

With more severe household food insecurity, ultra-processed food consumption was higher, and diet quality was generally lower among both adults and children.

To examine how socio-demographic characteristics and diet quality vary with consumption of ultra-processed foods (UPF) in a cross-sectional nationally representative survey of Australian adults.

Using a 24-h recall, this cross-sectional analysis of dietary and socio-demographic data classified food items using the NOVA system, estimated the percentage of total energy contributed by UPFs and assessed diet quality using the Dietary Guideline Index (DGI–2013 total and components). Linear regression models examined associations between socio-demographic characteristics and diet quality with percentage of energy from UPF.

Australian Health Survey 2011–2013.

Australian adults aged ≥ 19 years (n 8209).

Consumption of UPF was higher among younger adults (aged 19–30 years), adults born in Australia, those experiencing greatest area-level disadvantage, lower levels of education and the second lowest household income quintile. No significant association was found for sex or rurality. A higher percentage of energy from UPF was inversely associated with diet quality and with lower DGI scores related to the variety of nutritious foods, fruits, vegetables, total cereals, meat and poultry, fish, eggs, nuts and seeds, legumes/beans, water and limits on discretionary foods, saturated fat and added sugar.

This research adds to the evidence on dietary inequalities across Australia and how UPF are detrimental to diet quality. The findings can be used to inform interventions to reduce UPF consumption and improve diet quality.

This study aimed to characterise the availability, the nutritional composition and the processing degree of industrial foods for 0–36-month-old children according to the neighbourhoods affluence.

A cross-sectional exploratory study.

All food products available in retail stores for children aged 0–36 months were analysed. Data collection took place in two neighbourhoods, comparing two different sociodemographic districts (high v. low per capita income), Campanhã and Foz do Douro in Porto, Portugal.

A total of 431 commercially processed food products for children aged 0–36 months which are sold in 23 retail stores were identified. Food products were classified according to their processing degree using the NOVA Food Classification System.

For NOVA analysis, of the 244 food products that were included 82 (33·6 %) were minimally processed, 25 (10·2 %) processed and 137 (56·1 %) ultra processed. No food product was classified as a culinary ingredient. The products included mostly cereals, yogurts, prevailed in high-income neighbourhoods for the 0–6-month-old group. It was observed that some categories of ultra-processed food (UPF) presented higher amounts of energy, sugars, saturated fat and salt than unprocessed/minimally processed products.

The high availability of UPF offered for 0–36-month-old children should be considered when designing interventions to promote a healthy diet in infancy.

Dietary advice about the potential health risks of unhealthy foods or diets has historically been communicated in terms of nutrients. Recent evidence has shown that the processing of food itself is independently attributable to harmful outcomes, particularly a new category of foods described to be ‘ultra-processed’. Dietary guidelines (DG) are a key policy tool to translate and communicate nutrition research; however, there is little research exploring whether and how the harms of food processing are communicated and rationalised in dietary advice.

Nineteen publicly available DG were thematically analysed to explore: (1) the diversity of terms used to refer to processed foods and (2) the underlying explanations and rationales provided to reduce consumption of processed foods.

International.

Sample of national dietary guidelines.

Seventeen different descriptive terms were used to refer to processed foods, with many countries using a large variation of terms within their DG. Six rationales to reduce consumption of processed foods were identified, which were grouped into four overarching domains: harmful outcomes (disease risk, environmental risk); food quality (food quality, nutrient content); diet quality and food environment.

The rationales provided to reduce the consumption of processed foods reflect upstream and downstream determinants of health. However, the persistence of nutrient-based rationales indicate that most DG do not apply an upstream understanding of the issues with ultra-processing. Further, the diversity of terms and foods referenced in DG suggest that the concept of ultra-processing is subject to multiple interpretations.

To determine the association between ultra-processed food (UPF) intake and all-cause mortality in a representative sample of Spanish population.

Prospective cohort design in which follow-up lasted from baseline (1991) to mortality date or 31 December 2017, whichever was first. Dietary information was collected using a validated frequency questionnaire and categorised following the NOVA classification according to the extent of food processing. The association between consumption of UPF and mortality was analysed using Cox models. Isoenergetic substitution models were constructed to compare the health effects of the NOVA groups.

Cohort from the Diet and Risk of Cardiovascular Diseases (CVD) in Spain (DRECE) study, representative of the Spanish population

Totally, 4679 subjects between 5 and 59 years old.

Average consumption of UPF was 370·8 g/d (24·4 % of energy intake). After a median follow-up of 27 years, 450 deaths occurred. Those who consumed the highest amount of UPF had higher risk of mortality. For every 10 % of the energy intake from UPF consumption, an increase of 15 % in the hazard of all-cause mortality was observed (HR 1·15; (95 % CI 1·03, 1·27); P-value = 0·012). Substitution of UPF with minimally processed foods was significantly associated with a decreased risk of mortality.

An increase in UPF consumption was associated with higher risk of all-cause mortality in a representative sample of the Spanish population. Moreover, the theoretical substitution of UPF with unprocessed or minimally processed foods leads to a decrease in mortality. These results support the need to promote diets based on unprocessed or minimally processed foods.