Most of us already know that we should eat more whole grains and fiber, and less sugar, salt and saturated fat. But there’s new information in relation to our health that the processing of food — from its natural state as a plant or an animal — may matter as much as (or even more than) its nutrient composition.
Accumulating epidemiological evidence supports that higher intakes of so-called ultra-processed foods (UPFs) are associated with an increased risk of mortality, obesity, Type 2 diabetes, hypertension, cardiovascular disease, cancer and depression. UPFs are defined as formulations that have undergone intense physical and/or chemical processes and contain ingredients of exclusive industrial use (e.g., dyes, artificial flavors, emulsifiers). Examples include sodas, many industrially-produced breads, flavored yogurt and commercial salad dressings.
UPFs tend to be high in added sugar, salt and saturated fats, while being low in vitamins, minerals and fiber. Nevertheless, the link between UPFs and chronic diseases seems to be independent of nutrient intakes. Other potential pathways result from UPFs being largely composed of highly-refined ingredients (e.g., starches, fats, oils, sweeteners) and devoid of any natural intact food structure. As a result, nutrients are quickly absorbed in the upper part of the small intestine, which increases blood sugar quickly, disrupts hormonal appetite control, and leaves little nutrition for bacteria in the large intestine. This, in turn, may promote a more inflammatory gut microbiome. Certain additives that are ubiquitous in UPFs, including artificial sweeteners, emulsifiers and phosphate additives, may also disrupt the gut microbiome and promote metabolic dysregulation and inflammation.
UPFs provide, on average, 67 percent and 57 percent of the total energy intake of U.S. children and adults, respectively. Limiting their consumption is challenging, as UPFs are often the most widely available, marketed and affordable foods, especially in low-income and underserved communities. Minority and immigrant populations may face additional challenges as their traditional foods may be expensive or hard to access. Demanding work schedules and lack of affordable childcare or support from relatives may also result in limited time for food preparation and favor the consumption of ultra-processed convenience foods. Among U.S. immigrants, greater acculturation is associated with higher consumption of UPFs and lower diet quality, while adherence to traditional diets is associated with higher diet quality.
Given the omnipresence of UPFs in the U.S. food supply and the high prevalence of diet-related diseases, evidence-based dietary policies are urgently needed to create healthier food environments; to increase the availability, accessibility and affordability of healthful whole foods; and to reduce intakes of UPFs. Potential policy solutions include fiscal measures, such as taxing ultra-processed foods and subsidizing healthy whole foods; marketing restrictions; front-of-package warning labels; educational mass media campaigns; and public procurement policies.
Several countries, including Mexico and Chile, have successfully implemented national policies targeting UPFs, leading to significant reductions in intake. And members of a scientific committee are for the first time evaluating the evidence regarding UPFs and weight gain, so the upcoming Dietary Guidelines for Americans 2025-2030 may include dietary recommendations regarding UPFs.
With such comprehensive policy action, there is hope that we’re moving in the right direction to a more informed food culture and improved access to nutritious options for healthier lives.
Filippa Juul, PhD, MSc
NYU Postdoctoral Fellow and 2020 GPH alumna