Consumption of Ultra-Processed Foods Trending Down But Still High
Ultra-processed foods (UPFs) are back in the news
following the publication of two papers this year, both using dietary 24-hour recall data from the Canadian Community Health Survey (CCHS). One paper compared the intake of UPFs and the nutrition profile of the diet between 2004 and 2015 (sample size of 33,924 for the 2004 survey and 20,080 for the 2015 survey; breastfeeding children excluded) (1). The other paper looked at a cross-section of the 2015 UPF consumption data (sample size of 13,608, aged 19 years or older) with associated health effects (2).
In 2019 the PEN® Team wrote two Trending Topics:
The studies reviewed in these past Trending Topics (from the U.K. and France), along with the new Canadian analyses, all have in common an agreement that UPFs have low overall nutritional quality and that the high UPF consumption is of concern. UPFs are often characterized as convenient and hyper-palatable with attractive packaging (1).
How Was ‘Ultra-Processed Foods’ Defined?
The reported food and drink data by survey participants in both 2005 and 2014 (1,2) was classified into four categories according to NOVA classification
, an internationally recognized system of classifying ingredients related to industrial food processing, based on a thesis presented by researchers at Brazil’s University of São Paolo over 10 years ago (3). Category 4, UPF, was the focus of the studies:
- Unprocessed or minimally processed foods including fresh, frozen or dry fruit, vegetables, nuts, legumes and plain meats and milk
- Processed culinary ingredients including sugar, salt, butter and vegetables oils
- Processed foods like canned fruits and vegetables, artisanal breads and cheeses
- Ultra-processed foods (UPFs) including industrial breads, reconstituted meat products, commercial and soft drinks, confectionary, commercial baked goods, crackers and other salty snacks, sauces, spreads and salad dressings and fast-food and frozen dishes.
What Did the CCHS Analyses Find?
The good news is that some UPF types, particularly beverages, declined between 2004 and 2015 (1). That said, the overall share of UPFs (including soft drinks) in Canada remained high in 2015 and contributed 46% of total daily energy for the overall population (as compared to 48% in 2004) with the highest for children and adolescents at 50% in 2015 (1,2). The high levels of UPF intake estimated in this study (1) are in line with previously reported estimates based on population-representative nutrition data from Canada and other high income nations (42% of total energy intake in Australia to about 57% in the United Kingdom) (1). For adults aged 55 or older, the intake of UPFs shifted upwards from about 42% of total usual energy in 2004 to 45% in 2015 (1). High UPF consumption was associated with less formal education, living in rural areas, people born in Canada and with Indigenous identity (2).
The researchers estimated the association between UPF consumption and morbidities (both self-reported) using multivariable logistic regression models on the 2015 data. They found that Canadian adults consuming the highest amounts of UPFs as a proportion of their energy intake had (2):
- 31% higher odds of obesity
- 37% higher odds of diabetes
- 60% higher odds of high blood pressure, compared to those consuming the least amount.
(Note: making conclusions about causal relationships from cross-sectional analyses should be done with caution.)
What Should Happen Next?
As practitioners, we should continue to promote national healthy eating guideline
recommendations to limit the consumption of highly processed foods and drinks. Repeat analysis of UPF intake over time could also help to inform polices targeting the food environment, such as access to UPFs in publicly funded spaces, labelling and taxation initiatives to guide consumer choice. These analyses can also be used to target public health consumer messaging and media literacy components within nutrition-related programs. Continued research on the associations between UPF intake and risk of morbidities is also needed to better understand whether these relationships are causal and if so how health related behaviours could be modified.
See Additional Content:
- Polsky JY, Moubarac JC, Garriguet D. Consumption of ultra-processed foods in Canada. Health Rep. 2020 Nov 18;31(11):3-15. doi: 10.25318/82-003-x202001100001-eng. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/33205938/
- Nardocci M, Polsky J, Moubarac JC. How ultra-processed foods affect health in Canada. Report prepared for Heart and Stroke. Montréal: TRANSNUT, Department of Nutrition, University of Montreal; June 2019. Available from: https://www.heartandstroke.ca/-/media/pdf-files/canada/media-centre/hs-moubarc-study-june-27-2019.ashx?rev=8ac040d6d03a41209fc6d8353ed325b3&hash=81A02F9268388596BD7089AA9C22419D
- Monteiro CA. Nutrition and health. The issue is not food, nor nutrients, so much as processing. Public Health Nutr. 2009;12(5):729–31. Available from: https://pubmed.ncbi.nlm.nih.gov/19366466/