A Systematic Review of Worldwide Consumption of Ultra-Processed Foods: Findings and Criticisms

Abstract

A debate is ongoing on the significance and appropriateness of the NOVA classification as a tool for categorizing foods based on their degree of processing. As such, the role of ultra-processed food (UPF) on human health is still not completely understood. With this review, we aimed to investigate the actual level of consumption of UPF across countries and target populations to determine the impact in real contexts. Suitable articles published up to March 2021 were sourced through the PubMed and SCOPUS databases. Overall, 99 studies providing data on the level of UPF consumption expressed as the percentage of total energy intake were identified, for a total of 1,378,454 participants. Most of them were published in Brazil (n = 38) and the United States (n = 15), and the 24 h recall was the most-used tool (n = 63). Analysis of the results revealed that the United States and the United Kingdom were the countries with the highest percent energy intake from UPF (generally >50%), whereas Italy had the lowest levels (about 10%); the latter was inversely associated with adherence to the Mediterranean diet. High variability was also observed based on sex, age, and body mass index, with men, young people, and overweight/obese subjects generally having higher levels of consumption compared to older subjects. Overall, our findings underline the large differences in UPF intake. Since most of the observations derived from studies conducted with food questionnaires are not specifically validated for UPF, further efforts are essential to confirm the results previously obtained and to investigate further the association between UPF consumption and health status, also considering the actual contribution within different dietary patterns, which has been less investigated to date.

Ultra-Processed Foods and Nutritional Dietary Profile: A Meta-Analysis of Nationally Representative Samples

“…), which could lead to potential selection biases and poor representativeness of a certain country. However, when compared with worldwide evaluations of UPF consumption, the presented results are reasonably consistent and comparable [47]. For instance, a study conducted on 740 Brazilian rural farmers reported that the largest caloric contribution to their diet was provided by minimally processed foods (64.7%), while UPFs contributed only minimally (5.2%); however, a higher dietary share of UPFs led to a lower intake of all macro-and micronutrients, without a distinction between healthy and unhealthy ones [48].…”

Ultra-Processed Food Consumption and Adult Mortality Risk: A Systematic Review and Dose–Response Meta-Analysis of 207,291 Participants

“…A recent prospective cohort by Ferriero et al [ 21 ] indicated an inverse association between UPFs consumption and all-cause mortality. However, according to the conclusion of a systematic review performed by Marino et al [ 11 ], since most of the observations about UPF consumption were derived from studies conducted with food questionnaires which are not explicitly validated for such foods, further efforts are essential to confirm the previously obtained results regarding consumption of UPFs and risk of mortality.…”

“…Accordingly, the consumption of UPFs accounts for approximately 25–60% of total energy intake using individual-level data [ 7 , 8 , 9 , 10 ]. UPF energy consumption was highest in the USA and the United Kingdom, while the lowest levels were found in Italy [ 11 ]. UPFs comprise a large proportion of almost all ingredients derived from foods and additives, with little or even zero whole-food content.…”

The Role of Diet Quality in Mediating the Association between Ultra-Processed Food Intake, Obesity and Health-Related Outcomes: A Review of Prospective Cohort Studies

“…Both those in favour of limiting UPFs [ 63 ], and those against the NOVA classification [ 64 , 65 , 66 ], acknowledge that the nutritional quality of UPFs is an important factor. Even some proponents of NOVA and reducing UPF intake have suggested that the saturated fat, added sugar and sodium content of UPFs is important, despite this not being a core aspect of the UPF definition [ 28 ].…”