October 2019 Issue
Ask the Expert: Ultraprocessed Foods
By Toby Amidor, MS, RD, CDN, FAND
Vol. 21, No. 10, P. 8
Q: My clients have been asking whether they need to avoid “ultraprocessed” foods. What exactly does this mean, and what are ultraprocessed foods’ health effects?
A: Ultraprocessed foods, which may include soft drinks and sweet or savory packaged snacks, typically are defined as those consisting mostly or entirely of additives and substances derived from foods that have undergone several sequences of processing. Recent evidence links ultraprocessed foods to poor diet quality, increased risk of a variety of diseases, and adverse health outcomes.
The term “ultraprocessed” was coined 10 years ago by Carlos Monteiro, MD, PhD, who asserted that a food’s degree of processing—not only its nutrient profile—should be examined when determining its healthfulness.1 Monteiro and colleagues at Brazil’s University of São Paulo developed what today is the most prominent food classification system, NOVA, which has been validated by the United Nations.
NOVA groups foods into four categories based on the extent of industrial food processing involved in their manufacture. The four classifications are 1) unprocessed or minimally processed foods such as grains, pulses, fruits, vegetables, and fresh meat and milk; 2) processed culinary ingredients such as oils, pastas, flours, sugar, and salt; 3) processed foods such as canned fruits and vegetables, seasoned nuts, cured or smoked meats, cheese, and bread; and 4) ultraprocessed food and drink products such as soft drinks, ice cream, candy, burgers and hot dogs, and instant, powdered, and preprepared foods.2
What the Research Says
Data from 2000–2012 found that 61% of calories consumed in the United States were from ultraprocessed food, 23% were from minimally processed food, and 16% were from processed ingredients.3 Numerous studies have found that increased ultraprocessed food consumption is associated with decreased diet quality. A 2017 study examined the dietary intake of 33,694 individuals aged 2 and older from the 2004 Canadian Community Health Survey. A significant positive relationship was found between ultraprocessed food intake and the amount of carbohydrate, sugar, total fat, saturated fat, and energy density in the foods consumed, while researchers saw an inverse relationship between ultraprocessed food consumption and intake of protein, fiber, and many common micronutrients.4
In terms of health consequences, a 2017 review looked at the association between ultraprocessed food consumption and obesity. Four of the five studies examined found that higher purchase or consumption of ultraprocessed foods was associated with overweight or obesity. Additional studies found relationships between ultraprocessed food intake and higher fasting glucose, metabolic syndrome, CVD risk factors, and risk of hypertension.5 There also may be a relationship between ultraprocessed food and cancer: A 2018 study found that a 10% increase in ultraprocessed food intake was associated with a greater than 10% heightened risk of breast cancer and cancer overall.6 However, these studies can’t establish causality, and it’s difficult to determine whether the results are linked with the processing itself or the nutrient content of ultraprocessed foods; more research is needed.
Recommendations for Clients
It’s rather unrealistic for most clients to eliminate ultraprocessed foods completely from their diets, but RDs can help them reduce their consumption and opt for unprocessed and minimally processed foods to the extent possible based on availability, affordability, and accessibility. RDs can do this by educating clients on which foods in their diets are ultraprocessed vs minimally processed, helping them plan meals and snacks to gradually reduce the amount of ultraprocessed food consumed, and creating an honest dialogue with them about what dietary changes will be sustainable long term.
“Better-for-you” ultraprocessed foods formulated to be more nutrient dense and include fewer ingredients may be a viable alternative to conventional ultraprocessed foods, but their health effects haven’t been studied. Ultimately, it’s best for clients to include as many unprocessed and minimally processed foods over ultraprocessed foods as possible.
— Toby Amidor, MS, RD, CDN, FAND, is the founder of Toby Amidor Nutrition (http://tobyamidornutrition.com) and a Wall Street Journal best-selling author. Her cookbooks include Smart Meal Prep for Beginners, The Easy 5-Ingredient Healthy Cookbook, The Healthy Meal Prep Cookbook, The Greek Yogurt Kitchen, and the forthcoming The Create-Your-Plate Diabetes Cookbook and The Best Rotisserie Chicken Cookbook Ever. She’s a nutrition expert for FoodNetwork.com and a contributor to U.S. News Eat + Run and Muscle&Fitness.com.
1. Monteiro CA. Nutrition and health. The issue is not food, nor nutrients, so much as processing. Public Health Nutr. 2009;12(5):729-731.
2. Monteiro CA, Cannon G, Levy R, et al. NOVA. The star shines bright. World Nutr. 2016;7(1-3):28-38.
3. Poti JM, Mendez MA, Ng SW, Popkin BM. Is the degree of food processing and convenience linked with the nutritional quality of foods purchased by US households? Am J Clin Nutr. 2015;10(6):1251-1262.
4. Moubarac JC, Batal M, Louzada ML, Martinez Steele E, Monteiro CA. Consumption of ultra-processed foods predicts diet quality in Canada. Appetite. 2017;108:512-520.
5. Poti JM, Braga B, Qin B. Ultra-processed food intake and obesity: what really matters for health — processing or nutrient content? Curr Obes Rep. 2017;6(4):420-431.
6. Fiolet T, Srour B, Sellem L, et al. Consumption of ultra-processed foods and cancer risk: results from NutriNet-Santé prospective cohort. BMJ. 2018;360:k322.