Current Intake of Ultra-Processed Foods in the U.S. Adult Population According to Education-Level and Income

Abstract Objectives Ultra-processed food have been associated with multiple chronic diseases, yet recent data regarding its consumption in the U.S. and potential differences in intake across population groups is lacking. We determined the intake of ultra-processed food across diverse socioeconomic strata in the U.S. adult population. Methods We performed cross-sectional analysis of dietary intake among adults (>20y, N = 9759) in the National Health and Nutrition Examination Survey (NHANES) 2015–2018. Data on dietary intake was collected by 24h dietary recall. Foods were classified as ultra-processed/non ultra-processed according to the NOVA classification. We determined intake of ultra-processed food (%kcal) in the overall sample, and stratified by education (<high school, high school degree, some college, college graduate of above) and family poverty income ratio, (<130%, 130–349% and ≥ 350% of the federal poverty threshold). Multivariable linear regression was used to assess if education and income were independent predictors of ultra-processed food intake, controlling for age, sex and race/ethnicity. Results Ultra-processed foods provided 54% of energy among U.S. adults in 2015–2018. Compared to adults without a high school degree (52%kcal), high school graduates and adults with some college education consumed significantly more ultra-processed foods (57% kcal, P = 0.022 and 57.0% kcal, P = 0.009, resp.), while college graduates consumed significantly less ultra-processed foods (49% kcal, P < 0.001). Adults with a family income of 130–349% of the federal poverty threshold consumed significantly more ultra-processed foods than adults with the lowest family income (56 vs. 54% kcal, P = 0.009). However, intake did not differ significantly between adults with low and high income (52% kcal, P = 0.817). Conclusions This study uniquely describes ultra-processed food consumption across socioeconomic groups in the U.S. population and may inform policies and intervention to reduce intakes of ultra-processed foods and prevent chronic disease outcomes. Although consumption differed across education- and income levels, ultra-processed food intake is high in all socioeconomic strata. Our results highlight the need for public health efforts to reduce ultra-processed food consumption in the U.S. Funding Sources None.

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Consumption of ultra-processed foods and the risk of overweight and obesity, and weight trajectories in the French cohort NutriNet-Santé

Proceedings of The Nutrition Society ◽

10.1017/s0029665120003559 ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

Bernard Srour ◽

Marie Beslay ◽

Caroline Méjean ◽

Benjamin Allès ◽

Thibault Fiolet ◽

...

Keyword(s):

Food Intake ◽

Confidence Interval ◽

Prospective Study ◽

Food Consumption ◽

Overweight And Obesity ◽

Processed Foods ◽

Processed Food ◽

Weight Trajectories ◽

Incident Cases

AbstractIntroductionPrevious epidemiological studies have found associations between the consumption of ultra-processed foods and the risk of obesity-related outcomes, such as post-menopausal breast cancer, cardiovascular diseases, hypertension and mortality. However, only one Spanish prospective study has explored the associations between the consumption of ultra-processed foods and the risk of overweight and obesity. The aim of this study is to investigate the associations between ultra-processed food consumption and the risk of overweight and obesity, as well as the associations between ultra-processed food consumption and weight trajectories, in middle-aged adults included in the French large scale NutriNet-Santé cohort.MethodsOverall, 110260 participants aged at least 18 years from the French NutriNet-Santé cohort (2009–2019) were included. Dietary intakes were collected using repeated 24 hour dietary records, merged with a food composition database of 3300 different products. These were categorized according to their degree of processing by the NOVA classification. Associations between ultra-processed food intake and risks of overweight and obesity were assessed using multivariable Cox proportional hazard models. Associations between ultra-processed food intake and weight trajectories were assessed using multivariable linear mixed models for repeated measures with random slope and intercept. Models were adjusted for known risk factors (sociodemographic, lifestyle, and nutritional factors).ResultsUltra-processed food intake was associated with a higher risk of overweight (n = 7063 incident cases; hazard ratio for an absolute increment of 10 in the percentage of ultra-processed foods in the diet = 1.11 (95% confidence interval 1.08 to 1.14); P < 0.0001, median follow-up: 4.1y, 260304 person-years) and obesity (n = 3066 incident cases; HR = 1.09 (95% confidence interval 1.05 to 1.13); P < 0.0001, median follow-up: 8.0y 365344 person-years). Higher consumers of ultra-processed foods (4th quartile) were more likely to present an increase in body mass index over time (change of BMI/time-unit in Q4 vs Q1 = 0.04, P < 0.0001). These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet (fruits and vegetables and sugary drinks consumption, intakes of saturated fatty acids, sodium, sugar, dietary fiber or Healthy/Western patterns derived by principal component analysis) and after a large range of sensitivity analyses.ConclusionIn this large observational prospective study, higher consumption of ultra-processed foods in the diet was associated with a higher risk of overweight and obesity. Public health authorities in several countries recently started to recommend privileging unprocessed/minimally processed foods and limiting ultra-processed food consumption.

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Abstract P181: Processed food intake is adversely associated with multiple indicators of cardiometabolic health in US adults: Findings from the National Health and Nutrition Examination Surveys (2005-2008)

Circulation ◽

10.1161/circ.129.suppl_1.p181 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Leah Lipsky ◽

Tonja Nansel ◽

Virginia Quick

Keyword(s):

Waist Circumference ◽

Food Intake ◽

Weight Status ◽

Cardiometabolic Health ◽

Processed Foods ◽

Processed Food ◽

C Reactive Protein ◽

Reactive Protein ◽

Former Smokers ◽

Never Smokers

Introduction: Reducing intake of ingredients characteristic of processed foods is vital to improving ideal cardiovascular dietary behaviors described in the American Heart Association 2020 Strategic Impact Goals. Hypothesis: We sought to develop an indicator of processed food intake and evaluate its hypothesized adverse relationships with biomarkers of cardiometabolic health in a nationally representative sample of US adults. Methods: Data from two 24 hour recalls were examined for US adults (>=18y) in NHANES (2005-2008). An index of processed food intake (PFI) was developed using the mean of the standardized (mean=0, standard deviation=1), energy-adjusted (per 1000 kcal) intakes of refined grains, processed meat, discretionary oils, discretionary solid fat, added sugar and sodium. We evaluated bivariate associations of PFI with demographics (sex, poverty-income ratio, education) and behavioral factors (smoking, nutritional supplement use). Multivariable linear regressions were used to examine associations of PFI with BMI (kg/m2), waist circumference (cm), and biomarkers for cardiometabolic health (total cholesterol, HDL-C, LDL-C, triglycerides, apo-b and c-reactive protein), adjusting for demographic and behavioral covariates. We tested for potential interactions between PFI and weight status, sex, and smoking. Results: PFI was higher in smokers than never smokers (p<.001). PFI was lower for those with at least a college degree than those with less education (p=.004) and for NH White vs. NH Black adults (p=.04). Adjusting for covariates, higher PFI was associated with greater BMI (p<.001) and waist circumference (p<.001), lower HDL-C (p<.001), and higher c-reactive protein (p=.01). Interactions (p<.05) were observed between PFI and sex for predicting BMI, and between PFI and smoking for predicting TC and HDL-C. The magnitude of associations was larger for female vs. male and for current and former smokers vs. non-smokers. No interactions were observed between PFI and weight status. Conclusion: Intake of components characteristic of processed foods is adversely associated with a variety of cardiometabolic biomarkers. Positive associations of PFI with BMI were greater for females vs. males, while associations of PFI with TC and HDL-C were greater for current and former smokers vs. never smokers. The nutritional value of dietary components of PFI is primarily restricted to energy, protein, and sodium, none of which are considered lacking in the diets of US adults. These findings underscore the rationale for encouraging replacing such components with foods that promote cardiovascular health including fruit, vegetables, whole grains, fish, legumes, nuts and seeds. Acknowledgment: This research was supported in part by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health.

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Contribution of Ultra-processed Food to the Daily Food Intake of HIV-positive and HIV-Negative Women during Pregnancy

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0039-1695738 ◽

2019 ◽

Vol 41 (10) ◽

pp. 588-596 ◽

Cited By ~ 1

Author(s):

Clarissa de Oliveira Agostini ◽

Ester Zoche ◽

Rafaela da Silveira Corrêa ◽

Eunice Beatriz Martin Chaves ◽

Helena von Eye Corleta ◽

...

Keyword(s):

Food Intake ◽

Demographic Data ◽

Caloric Intake ◽

Hiv Positive ◽

Fisher Exact Test ◽

Processed Foods ◽

Processed Food ◽

Trans Fat ◽

Positive Group ◽

Hiv Negative

Objective To assess the daily dietary intake and energy contribution of ultra-processed foods among women who are positive and negative for the human immunodeficiency virus (HIV) during pregnancy. Methods This case–control study included 77 HIV-positive and 79 HIV-negative puerperal women between 2015 and 2016. The socioeconomic and maternal demographic data were assessed, and a food frequency questionnaire (FFQ) adapted for pregnant women was applied. The Fisher exact test and the Mann-Whitney test were applied to detect differences between the groups. Linear regression was used to assess the associations between the intake of ultra-processed food and energy, macro- and micronutrients, with values of p < 0.05 considered significant. Results The HIV-positive group was older (p < 0.001) and had lower income (p = 0.016) and level of schooling (p < 0.001) than the HIV-negative group. Both groups presented similar average food intake: 4,082.99 Kcal/day and 4,369.24 Kcal/day for the HIV-positive and HIV-negative women respectively (p = 0.258).The HIV-positive group consumed less protein (p = 0.048), carbohydrates (p = 0.028) and calcium (p = 0.001), and more total fats (p = 0.003). Ultra-processed foods accounted for 39.80% and 40.10% of the HIV-positive and HIV-negative groups' caloric intake respectively (p = 0.893). The intake of these foods was associated with a higher consumption of carbohydrates (p < 0.001), trans fat (p = 0.013) and sodium (p < 0.001), as well as lower protein (p < 0.001) and fiber intake (p = 0.022). Conclusion These findings demonstrate that the energy consumption and ultra-processed food intake were similar in both groups, which reinforces the trend toward a high intake of ultra-processed food in the general population. The intake of ultra-processed food was positively associated with the consumption of carbohydrates, trans fat and sodium, and negatively associated with the consumption of protein and fiber.

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A Study on Processed Food Intake of High School Juniors and Seniors in Korea

The FASEB Journal ◽

10.1096/fasebj.20.4.a190-a ◽

2006 ◽

Vol 20 (4) ◽

Author(s):

Jeong Ok Rho ◽

Su Jin Jung ◽

Ok Kyeong Yu

Keyword(s):

High School ◽

Food Intake ◽

Processed Food ◽

High School Juniors

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Ultra-processed Food Consumption and Incident Frailty: A Prospective Cohort Study of Older Adults (P01-012-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz028.p01-012-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Helena Sandoval-Insausti ◽

Ruth Blanco-Rojo ◽

Auxiliadora Graciani ◽

Esther Lopez-Garcia ◽

Belén Moreno-Franco ◽

...

Keyword(s):

Older Adults ◽

Cohort Study ◽

Food Intake ◽

Food Consumption ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Community Dwelling ◽

Alcoholic Beverages ◽

Processed Foods ◽

Processed Food

Abstract Objectives Ultra-processed food intake has been associated with chronic conditions. The aim of this study was to assess the relationship between ultra-processed food intake and incident frailty in community-dwelling older adults. Methods Prospective cohort study with 1822 individuals aged ≥60 who were recruited during 2008–2010 in Spain. At baseline, food consumption was obtained using a validated computerized face-to-face dietary history. Ultra-processed foods were identified according to the nature and extent of their industrial processing (NOVA classification). In 2012, incident frailty was ascertained based on Fried's criteria. Statistical analyses were performed with logistic regression and adjusted for the main potential confounders. Results After a mean follow-up of 3.5 years, 132 cases of frailty were identified. The odds ratios (95% confidence interval) for frailty across increasing quartiles of the percentage of total energy intake from ultra-processed foods were: 1.00, 1.52 (0.78–2.96), 2.98 (1.62–5.50), and 3.67 (2.00–6.73); p for linear trend: <0.001. Results were similar when food consumption was expressed as gram per day/body weight. Regarding ultra-processed food groups, the highest versus the lowest tertiles of consumption of yogurts and fermented milks, cakes and pastries, as well as non-alcoholic beverages (instant coffee and cocoa, packaged juices, and other non-alcoholic drinks, excluding soft drinks) were also significantly related to incident frailty. Conclusions Consumption of ultra-processed foods is strongly associated with frailty risk in older adults. Funding Sources Data collection was funded by the following grants: FIS PI16/1512; PI16/1460; PI16/609; PI17/1709 (State Secretary of R + D and FEDER/FSE), the ATHLOS project (EU H2020-Project ID: 635316), the SALAMANDER project (PCIN-2016-145), and the CIBERESP, Instituto de Salud Carlos III, Madrid, Spain.

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Ultra-processed food consumption and obesity in the Australian adult population

Nutrition and Diabetes ◽

10.1038/s41387-020-00141-0 ◽

2020 ◽

Vol 10 (1) ◽

Cited By ~ 1

Author(s):

Priscila Pereira Machado ◽

Eurídice Martinez Steele ◽

Renata Bertazzi Levy ◽

Maria Laura da Costa Louzada ◽

Anna Rangan ◽

...

Keyword(s):

Physical Activity ◽

Food Consumption ◽

Abdominal Obesity ◽

Physical Activity Level ◽

Adult Population ◽

The Body ◽

Activity Level ◽

Processed Foods ◽

Processed Food ◽

Increased Risk

Abstract Background Rapid simultaneous increases in ultra-processed food sales and obesity prevalence have been observed worldwide, including in Australia. Consumption of ultra-processed foods by the Australian population was previously shown to be systematically associated with increased risk of intakes of nutrients outside levels recommended for the prevention of obesity. This study aims to explore the association between ultra-processed food consumption and obesity among the Australian adult population and stratifying by age group, sex and physical activity level. Methods A cross-sectional analysis of anthropometric and dietary data from 7411 Australians aged ≥20 years from the National Nutrition and Physical Activity Survey 2011–2012 was performed. Food consumption was evaluated through 24-h recall. The NOVA system was used to identify ultra-processed foods, i.e. industrial formulations manufactured from substances derived from foods and typically added of flavours, colours and other cosmetic additives, such as soft drinks, confectionery, sweet or savoury packaged snacks, microwaveable frozen meals and fast food dishes. Measured weight, height and waist circumference (WC) data were used to calculate the body mass index (BMI) and diagnosis of obesity and abdominal obesity. Regression models were used to evaluate the association of dietary share of ultra-processed foods (quintiles) and obesity indicators, adjusting for socio-demographic variables, physical activity and smoking. Results Significant (P-trend ≤ 0.001) direct dose–response associations between the dietary share of ultra-processed foods and indicators of obesity were found after adjustment. In the multivariable regression analysis, those in the highest quintile of ultra-processed food consumption had significantly higher BMI (0.97 kg/m2; 95% CI 0.42, 1.51) and WC (1.92 cm; 95% CI 0.57, 3.27) and higher odds of having obesity (OR = 1.61; 95% CI 1.27, 2.04) and abdominal obesity (OR = 1.38; 95% CI 1.10, 1.72) compared with those in the lowest quintile of consumption. Subgroup analyses showed that the trend towards positive associations for all obesity indicators remained in all age groups, sex and physical activity level. Conclusion The findings add to the growing evidence that ultra-processed food consumption is associated with obesity and support the potential role of ultra-processed foods in contributing to obesity in Australia.

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Self-Reported Measures of Discretionary Salt Use Accurately Estimated Sodium Intake Overall but not in Certain Subgroups of US Adults from 3 Geographic Regions in the Salt Sources Study

Journal of Nutrition ◽

10.1093/jn/nxz110 ◽

2019 ◽

Vol 149 (9) ◽

pp. 1623-1632 ◽

Cited By ~ 3

Author(s):

Zerleen S Quader ◽

Lixia Zhao ◽

Lisa J Harnack ◽

Christopher D Gardner ◽

James M Shikany ◽

...

Keyword(s):

High School ◽

Blood Pressure ◽

Sodium Intake ◽

Adult Population ◽

Cross Sectional ◽

Convenience Sample ◽

High School Degree ◽

Nonsignificant Difference ◽

Healthy People 2020 ◽

Study Participants

ABSTRACT Background Excess sodium intake can increase blood pressure, and high blood pressure is a major risk factor for cardiovascular disease. Accurate population sodium intake estimates are essential for monitoring progress toward reduction, but data are limited on the amount of sodium consumed from discretionary salt. Objectives The aim of this study was to compare measured sodium intake from salt added at the table with that estimated according to the Healthy People 2020 (HP 2020) methodology. Methods Data were analyzed from the 2014 Salt Sources Study, a cross-sectional convenience sample of 450 white, black, Asian, and Hispanic adults living in Alabama, Minnesota, and California. Sodium intake from foods and beverages was assessed for each participant through the use of 24-h dietary recalls. Estimated sodium intake from salt used at the table was assessed from self-reported frequency and estimated amounts from a previous study (HP 2020 methodology). Measured intake was assessed through the use of duplicate salt samples collected on recall days. Results Among all study participants, estimated and measured mean sodium intakes from salt added at the table were similar, with a nonsignificant difference of 8.9 mg/d (95% CI: −36.6, 54.4 mg/d). Among participants who were non-Hispanic Asian, Hispanic, had a bachelor's degree or higher education, lived in California or Minnesota, did not report hypertension, or had normal BMI, estimated mean sodium intake was 77–153 mg/d greater than measured intake (P < 0.05). The estimated mean sodium intake was 186–300 mg/d lower than measured intake among participants who were non-Hispanic black, had a high school degree or less, or reported hypertension (P < 0.05). Conclusions The HP 2020 methodology for estimating sodium consumed from salt added at the table may be appropriate for the general US adult population; however, it underestimates intake in certain population subgroups, particularly non-Hispanic black, those with a high school degree or less, or those with self-reported hypertension. This study was registered at clinicaltrials.gov as NCT02474693.

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Associations Between Ultra-Processed Food Intake and Cardiometabolic Health Among Diverse U.S. Adults 50 or Older

Innovation in Aging ◽

10.1093/geroni/igab046.196 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 51-51

Author(s):

Tali Elfassy ◽

Filippa Juul ◽

Robert Mesa ◽

Latha Palaniappan ◽

Malathi Srinivasan ◽

...

Keyword(s):

Food Intake ◽

Asian American ◽

Cardiometabolic Health ◽

Processed Foods ◽

Racial Groups ◽

Processed Food ◽

Dietary Recommendations ◽

Logistic Regression Models ◽

Adjusted Logistic Regression ◽

Obesity Hypertension

Abstract Asian American (AA) diets are naturally adapted to the NOVA dietary recommendations, favoring minimally processed foods. Yet the relationship between dietary intake and metabolic health, among AAs is largely unknown. We examined the association between ultra-processed foods and cardiometabolic health (obesity, hypertension, high cholesterol, and diabetes), among US adults 50 or older reporting a single ethnicity, using the National Health and Nutrition Examination Survey (2001-2018). From multivariable adjusted logistic regression models, the highest compared to the lowest quartile of ultra-processed food intake was associated with obesity only, among AAs (OR: 2.15, 95% CI: 1.04, 4.45), followed by non-Hispanic blacks (OR: 1.73, 95% CI: 1.40, 2.14), non-Hispanic whites (OR: 1.41, 95% CI: 1.19, 1.68), and Hispanics (OR: 1.34, 95% CI: 1.08, 1.65). AAs are more likely than other ethnic/racial groups to be obese when consuming ultra-processed foods. Cultural adaptation of current North American-focused dietary recommendations should drive AA preventive dietary recommendations.

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Consumption of industrial processed foods and risk of premenopausal breast cancer among Latin American women: the PRECAMA study

BMJ Nutrition, Prevention & Health ◽

10.1136/bmjnph-2021-000335 ◽

2022 ◽

pp. e000335

Author(s):

Isabelle Romieu ◽

Neha Khandpur ◽

Aikaterini Katsikari ◽

Carine Biessy ◽

Gabriela Torres-Mejía ◽

...

Keyword(s):

Breast Cancer ◽

Food Intake ◽

Latin American ◽

Oestrogen Receptor ◽

Meat Products ◽

Population Based ◽

Processed Foods ◽

Processed Food ◽

Premenopausal Breast Cancer ◽

Increased Risk

Ultra-processed food intake has been linked to an increased risk of breast cancer in Western populations. No data are available in the Latin American population although the consumption of ultra-processed foods is increasing rapidly in this region.We evaluated the association of ultra-processed food intake to breast cancer risk in a case–control study including 525 cases (women aged 20–45 years) and 525 matched population-based controls from Chile, Colombia, Costa Rica and Mexico. The degree of processing of foods was classified according to the NOVA classification.Overall, the major contributors to ultra-processed food intake were ready-to-eat/heat foods (18.2%), cakes and desserts (16.7%), carbonated and industrial fruit juice beverages (16.7%), breakfast cereals (12.9%), sausages and reconstituted meat products (12.1%), industrial bread (6.1%), dairy products and derivatives (7.6%) and package savoury snacks (6.1%). Ultra-processed food intake was positively associated with the risk of breast cancer in adjusted models (OR T3-T1=1.93; 95% CI=1.11 to 3.35). Specifically, a higher risk was observed with oestrogen receptor positive breast cancer (ORT3-T1=2.44, (95% CI=1.01 to 5.90, P-trend=0.049), while no significant association was observed with oestrogen receptor negative breast cancer (ORT3-T1=1.87, 95% CI=0.43 to 8.13, P-trend=0.36).Our findings suggest that the consumption of ultra-processed foods might increase the risk of breast cancer in young women in Latin America. Further studies should confirm these findings and disentangle specific mechanisms relating ultra-processed food intake and carcinogenic processes in the breast.

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Ultra-Processed Foods, Nutrition and Pregnancy: Characteristics of Food Consumption by HIV-Positive Women during Pregnancy

Reproductive Medicine Gynaecology & Obstetrics ◽

10.24966/rmgo-2574/100072 ◽

2021 ◽

Vol 6 (1) ◽

pp. 1-2

Author(s):

Clarissa De Oliveira Agostini ◽

Keyword(s):

Food Intake ◽

Hiv Positive ◽

Processed Foods ◽

Physiological Changes ◽

Processed Food ◽

Daily Food Intake ◽

Hiv Positive Women ◽

Daily Food ◽

Nutritional Needs ◽

Hiv Negative

This article aims to provide a commentary on the article “Contribution of Ultra-processed Food to the Daily Food Intake of HIV-positive and HIV-Negative Women during Pregnancy”. Pregnancy causes physiological changes in the woman’s body, modifying her nutritional needs, as well as food intake.

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