Plain language summary
The demand for food items with longer shelf-life and improved palatability has led to other natural or artificial ingredients being added to processed foods, which may, to some extent, impact the nutritional quality of these foods, which are often characterized by high sugar, fat, and salt contents. The aim of this study was to investigate the actual level of consumption of ultra-processed food (UPF) across countries and target populations to determine the impact in real contexts. This study is a review of 99 unique studies with a total of 1,378,454 subjects. Results showed high levels of UPF consumption, especially in some countries and in specific target groups (i.e., children and adolescents). Even though several studies reported a positive association between UPF and obesity and cardiometabolic health, findings do not show such a clear-cut association. Authors conclude that 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.
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.
Methodological quality
Jadad score
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Not applicable
Allocation concealment
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