Alimentos Ultraprocessados

Abstract

This first paper in a three-part Lancet Series combines narrative and systematic reviews with original analyses and meta-analyses to assess three hypotheses concerning a dietary pattern based on ultra-processed foods. The first hypothesis—that this pattern is globally displacing long-established diets centred on whole foods and their culinary preparation as dishes and meals—is supported by decades of national food intake and purchase surveys, and recent global sales data. The second—that this pattern results in deterioration of diet quality, especially in relation to chronic disease prevention—is confirmed by national food intake surveys, large cohorts, and interventional studies showing gross nutrient imbalances; overeating driven by high energy density, hyper-palatability, soft texture, and disrupted food matrices; reduced intake of health-protective phytochemicals; and increased intake of toxic compounds, endocrine disruptors, and potentially harmful classes and mixtures of food additives. The third and final hypothesis—that this pattern increases the risk of multiple diet-related chronic diseases through various mechanisms—is substantiated by more than 100 prospective studies, meta-analyses, randomised controlled trials, and mechanistic studies, covering adverse outcomes across nearly all organ systems. The totality of the evidence supports the thesis that displacement of long-established dietary patterns by ultra-processed foods is a key driver of the escalating global burden of multiple diet-related chronic diseases. Two companion papers in this Series specify policy actions and wider public health strategies to promote, protect, and support diets based on fresh and minimally processed foods and prevent their displacement by ultra-processed foods.
This is the first in a Series of three papers about ultra-processed foods and human health. All papers in the Series are available at thelancet.com/series/ultra-processed-food

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Abstract

Dietary patterns high in ultra-processed foods (UPFs) have been associated with poor diet quality and health outcomes, and are displacing healthier dietary patterns—meals and dishes prepared with fresh and minimally processed foods—in most parts of the world. In the second paper of this Series, we propose a set of government policies aimed at halting and reversing the rise of UPFs worldwide. To date, policies have mainly focused on reducing consumption of foods high in added fats, sugar, and sodium, many of which are UPFs. However, we propose that these efforts be strengthened and expanded to address a broader set of food system drivers influencing the production, marketing, and consumption of UPFs. This Series paper addresses four food policy domains that correspond to the key dimensions of food system drivers of UPF production, marketing, and consumption: UPF products, UPF food environments, UPF manufacturers, fast-food corporations, and supermarket corporations retailers, and food supply chains. For each domain, we explore policy options and focus on large-scale food system measures that target areas in greatest need of change, and their potential impacts. We also examine policies to protect, incentivise, and support dietary patterns based on fresh and minimally processed foods, particularly for lower income households. Which policy actions governments decide to prioritise will depend on each country’s level of UPF consumption, along with many other issues unique to each country. We emphasise the importance of advancing this agenda in all countries, irrespective of their development status, to promote healthier diets among populations.

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Abstract

The rise of ultra-processed foods (UPFs) in human diets is harming global public health. However, policy responses are still emerging—much like tobacco control efforts decades ago—indicating the need to understand root causes and accelerate global action. This paper, the third in a three-part Lancet Series, takes several steps to advance knowledge of these causes, and to inform a global public health response. First, we show that the UPF industry is a key driver of the problem, as its leading corporations and co-dependent actors have expanded and restructured food systems almost everywhere, in favour of ultra-processed diets. The higher profitability of UPFs compared with other types of food fuels this growth, by financially incentivising the ultra-processed business model over alternatives, and generating resources for continued expansion. Second, we highlight that the main barrier to advancing policy responses is the industry’s corporate political activities, coordinated transnationally through a global network of front groups, multi-stakeholder initiatives, and research partners, to counter opposition and block regulation. These activities include direct lobbying, infiltrating government agencies, and litigation; promoting corporate-friendly governance models, forms of regulation, and civil societies; and framing debate, generating favourable evidence, and manufacturing scientific doubt. Third, we present strategies for reducing the UPF industry’s power in food systems and for mobilising a global public health response. Reducing the UPF industry’s power involves disrupting the ultra-processed business model and redistributing resources to other types of food producers; protecting food governance from corporate interference; and implementing robust conflict of interest safeguards in policy making, research, and professional practice. Mobilising a global response includes framing UPFs as a priority global health issue; building powerful global and country-level advocacy coalitions; generating legal, research, and communication capacities to empower advocacy and drive policy change; and ensuring a just transition to low-UPF diets. A coordinated, well resourced global response is essential—one that confronts corporate power, reclaims public policy space, and restructures food systems to prioritise health, equity, and sustainability over corporate profit.

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Abstract

The present commentary contains a clear and simple guide designed to identify ultra-processed foods. It responds to the growing interest in ultra-processed foods among policy makers, academic researchers, health professionals, journalists and consumers concerned to devise policies, investigate dietary patterns, advise people, prepare media coverage, and when buying food and checking labels in shops or at home. Ultra-processed foods are defined within the NOVA classification system, which groups foods according to the extent and purpose of industrial processing. Processes enabling the manufacture of ultra-processed foods include the fractioning of whole foods into substances, chemical modifications of these substances, assembly of unmodified and modified food substances, frequent use of cosmetic additives and sophisticated packaging. Processes and ingredients used to manufacture ultra-processed foods are designed to create highly profitable (low-cost ingredients, long shelf-life, emphatic branding), convenient (ready-to-consume), hyper-palatable products liable to displace all other NOVA food groups, notably unprocessed or minimally processed foods. A practical way to identify an ultra-processed product is to check to see if its list of ingredients contains at least one item characteristic of the NOVA ultra-processed food group, which is to say, either food substances never or rarely used in kitchens (such as high-fructose corn syrup, hydrogenated or interesterified oils, and hydrolysed proteins), or classes of additives designed to make the final product palatable or more appealing (such as flavours, flavour enhancers, colours, emulsifiers, emulsifying salts, sweeteners, thickeners, and anti-foaming, bulking, carbonating, foaming, gelling and glazing agents).

Keywords: Food classification; Food processing; NOVA; Ultra-processed food.

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Abstract

We investigated whether ultra-processed foods affect energy intake in 20 weight-stable adults, aged (mean ± SE) 31.2 ± 1.6 years and BMI = 27 ± 1.5 kg/m2. Subjects were admitted to the NIH Clinical Center and randomized to receive either ultra-processed or unprocessed diets for 2 weeks immediately followed by the alternate diet for 2 weeks. Meals were designed to be matched for presented calories, energy density, macronutrients, sugar, sodium, and fiber. Subjects were instructed to consume as much or as little as desired. Energy intake was greater during the ultra-processed diet (508 ± 106 kcal/day; p = 0.0001), with increased consumption of carbohydrate (280 ± 54 kcal/day; p < 0.0001) and fat (230 ± 53 kcal/day; p = 0.0004), but not protein (-2 ± 12 kcal/day; p = 0.85). Weight changes were highly correlated with energy intake (r = 0.8, p < 0.0001), with participants gaining 0.9 ± 0.3 kg (p = 0.009) during the ultra-processed diet and losing 0.9 ± 0.3 kg (p = 0.007) during the unprocessed diet. Limiting consumption of ultra-processed foods may be an effective strategy for obesity prevention and treatment. 

Keywords: diet quality; energy balance; energy intake; processed food; weight gain; weight loss.

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Abstract

Background: Consumption of ultra-processed foods (UPFs) plays a potential role in the development of obesity and other diet-related noncommunicable diseases (NCDs), but no studies have systematically focused on this. This study aimed to summarize the evidence for the association between UPFs consumption and health outcomes.

Methods: A comprehensive search was conducted in PubMed, Embase, and Web of Science to identify all relevant studies. Epidemiological studies were included, and identified studies were evaluated for risk of bias. A narrative review of the synthesized findings was provided to assess the association between UPFs consumption and health outcomes.

Results: 20 studies (12 cohort and 8 cross-sectional studies) were included in the analysis, with a total of 334,114 participants and 10 health outcomes. In a narrative review, high UPFs consumption was obviously associated with an increased risk of all-cause mortality, overall cardiovascular diseases, coronary heart diseases, cerebrovascular diseases, hypertension, metabolic syndrome, overweight and obesity, depression, irritable bowel syndrome, overall cancer, postmenopausal breast cancer, gestational obesity, adolescent asthma and wheezing, and frailty. It showed no significant association with cardiovascular disease mortality, prostate and colorectal cancers, gestational diabetes mellitus and gestational overweight.

Conclusions: This study indicated a positive association between UPFs consumption and risk of several health outcomes. Large-scale prospective designed studies are needed to confirm our findings.

Keywords: Health; Noncommunicable diseases; Systematic review; Ultra-processed foods.

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Abstract

Introduction

The public health effects of industrial food processing are being widely researched, in response to observational evidence linking ultra processed food (UPF) consumption with a range of poor health outcomes. While there has been global debate regarding whether UPF should be incorporated into dietary guidelines for the public (in addition to existing nutrient recommendations) there is a limited understanding of the degree to which consumers prioritize food processing attributes, relative to nutrient attributes (e.g., sugar, sodium, saturated fat) when making decisions about food and health. This study investigates how perceptions of UPFs relate to the criteria that consumers prioritize when evaluating food healthfulness, including both nutrient-based and non-nutrient-based attributes.

Methods

An online survey was conducted in 2022 with a sample of 671 adults residing in a northeastern U.S. state. The survey assessed perceptions of UPFs, including efforts to reduce UPF consumption, and the importance assigned to various nutrient (sugar, fat, sodium, and food groups) and non-nutrient (kitchen ingredients, minimal processing, and production practices) criteria in determining food healthfulness. Demographic variables included age, gender, income, education, race/ethnicity, and presence of children in the household. Multivariate logistic regression analyzed associations between UPF perceptions and healthfulness criteria, reported as adjusted odds ratios (AORs).

Results

A slight majority (52%) of respondents were familiar with the term “ultra-processed foods,” with awareness significantly higher among females (p < 0.05). Twenty-one percent of respondents selected all nutrient criteria as indicators of healthfulness, while 79.1% selected at least one non-nutrient criterion. Respondents actively trying to reduce UPF consumption (33.5%) were less likely (p < 0.05) to prioritize nutrient-based criteria and more likely to prioritize non-nutrient factors, including kitchen ingredients (AOR: 1.6, 95% CI: 1.1–2.4), processing (AOR: 3.0, 95% CI: 2.0–4.5), and production practices (AOR: 1.8, 95% CI: 1.2–2.6).

Discussion

Findings suggest that perceptions of UPFs shape how consumers define healthy food, with many favoring non-nutrient criteria related to processing and production over conventional nutrient profiles. This shift in consumer perspective highlights the importance of incorporating processing-related information into public health communication and food labeling strategies.

Keywords: ultra processed food, food labeling, healthfulness perceptions, nutrition labeling, nutrition education, NOVA classification, clean eating, consumer nutrition.

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Abstract

Ultra-processed foods (UPFs) are highly refined formulations of non-nutritive compounds containing elevated amounts of sugar, fat, sodium, food additives, and dietary emulsifiers. Consumption of UPF is robustly linked to a range of non-communicable diseases, including obesity, type 2 diabetes, cardiovascular disease, and mental disorders in adults. While substantial research highlights the negative health impacts of UPFs in adulthood, their effects on brain development during critical periods of biological vulnerability, pregnancy, childhood, and adolescence, remain underexplored. During pregnancy, significant metabolic and physiological adaptations occur to support fetal growth, making maternal diet quality essential for optimal perinatal outcomes. Poor maternal nutrition, including high UPF consumption, has been associated with an increased risk of hypertensive disorders, gestational diabetes, and adverse birth weights, potentially predisposing offspring to metabolic health disorders later in life. Similarly, in early childhood, inadequate nutrition is a key risk factor for developmental impairments, influencing cognitive function and long-term health outcomes. Adolescence, another critical stage of brain maturation, is particularly susceptible to the effects of micronutrient deficiencies, often exacerbated by diets high in UPFs, which can impair neurodevelopment and cognitive performance. As UPFs continue to dominate modern diets, accounting for over 50% of total energy intake in some developed nations, understanding their long-term impact on brain development is crucial. Early-life exposure to UPFs may contribute to lasting cognitive deficits and increased susceptibility to mental health disorders, emphasizing the urgent need for targeted dietary interventions and public health strategies aimed at pregnant women, children, and adolescents.

Keywords: brain development; cognition; eating behaviors; maternal; motivation; nutrition; offspring; ultra processed food.

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Abstract

Background: Crossover studies can induce order effects, especially when they lack a washout period.

Objectives: We performed secondary analyses comparing groups of subjects randomly assigned to different diet orders in 2 inpatient crossover studies originally designed to compare within-subject differences in ad libitum energy intake. One study compared minimally processed low-carbohydrate (LC) compared with low-fat (LF) diets, and the other matched macronutrients and compared minimally processed food (MPF) with ultraprocessed food (UPF) diets.

Methods: Diet order group comparisons of changes in body weight and body composition, and differences in energy expenditure and food intake were assessed over 4 wk in 20 adults randomly assigned to either the LC followed immediately by the LF diet (LC → LF) or the opposite order (LF → LC), and 20 adults randomly assigned to either the MPF followed by the UPF (MPF → UPF) diets or the opposite order (UPF → MPF).

Results: Subjects randomly assigned to LC → LF lost 2.9 ± 1.1 kg more body weight (P <0.001) and 1.5 ± 0.6 kg more body fat (P = 0.03) than the LF → LC group, likely because the LC → LF group consumed 921 ± 304 kcal/d less than the LF → LC group (P = 0.003). These energy intake differences were driven by the last 2 wk (-1610 ± 312 kcal/d; P < 0.0001), perhaps because of carryover effects of gut adaptations during the first 2 wk arising from large differences in the mass of food (1296 ± 215 g/d; P <0.00001) and fiber consumed (58 ± 6 g/d; P <0.00001). There were no significant diet order effects on energy intake, body weight, or body composition changes between UPF → MPF and MPF → UPF groups.

Conclusions: Diet order significantly affected energy intake, body weight, and body fat in a 4-wk crossover inpatient diet study varying in macronutrients, but not in a similarly structured study varying in ultraprocessed foods. This trial was registered at clinicaltrials.gov as NCT03407053 and NCT03878108.

Keywords: NOVA 4; energy intake; energy metabolism; ketogenic; methodology; weight loss.

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Abstract

Context: Relationships between ultraprocessed food (UPF) intakes and health have been well described in adults, but evidence of these relationships in older adults is rather limited. Demographic shifts in aging emphasize the importance of understanding the role of diet in maintaining health during later life.

Objective: The aim of this systematic review was to identify health outcomes associated with UPF consumption in those aged ≥60 years.

Data sources: The Medline, Web of Science, Scopus, and Embase databases were searched from inception until June 2023, using search terms representing UPF and any health outcome. Observational studies restricted to individuals aged ≥60 years using the Nova food classification were included. Articles were screened independently by 2 researchers using PECOS inclusion criteria.

Data extraction: Two-thirds of the studies in the present review were prospective cohort studies (n = 4) and the rest were cross-sectional (n = 2). The number of participants ranged from 652 to 2713 across the 6 studies. The mean age of participants ranged between 67 and 73 years.

Data analysis: In the prospective cohort studies, the highest consumption of UPF was associated with incident frailty, incident dyslipidemia, renal function decline, and abdominal obesity. For cross-sectional studies, the highest intake of UPF was associated with negative outcomes similar to young and middle-aged cohorts, with the addition of nutritional frailty and worse cognitive performance.

Conclusions: Currently, the limited understanding of how high UPF intakes could be associated with negative health outcomes for older adults influences the ability to inform policy and practice recommendations. More research is required owing to the very limited number of studies, specifically in older adults.

Systematic review registration: PROSPERO registration no. CRD42023442783.

Keywords: Nova food classification; food processing; observational study; older adults; ultra-processed food.

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