Global study links consumption of ultraprocessed foods to preventable premature deaths

A study analyzing data from nationally representative dietary surveys and mortality data from eight countries (Australia, Brazil, Canada, Chile, Colombia, Mexico, United Kingdom, and United States) shows that premature deaths attributable to consumption of ultraprocessed foods (UPFs) increase significantly according to their share in individuals' total energy intake. The new study, appearing in the American Journal of Preventive Medicine, published by Elsevier, reinforces the call for global action to reduce UPF consumption, supported by regulatory and fiscal policies that foster healthier environments.

UPFs are ready-to-eat-or-heat industrial formulations that are made with ingredients extracted from foods or synthesized in laboratories, with little or no whole foods in their composition. These have gradually been replacing traditional foods and meals made from fresh and minimally processed ingredients.

Frozen pizza, ready-to-eat meals, instant noodles, and many store-bought breads are just a few examples of what some consider UPFs, or products that contain a long list of ingredients, chemical additives, and little to no “whole” foods

UPFs affect health beyond the individual impact of high content of critical nutrients (sodium, trans fats, and sugar) because of the changes in the foods during industrial processing and the use of artificial ingredients, including colorants, artificial flavors and sweeteners, emulsifiers, and many other additives and processing aids, so assessing deaths from all-causes associated with UPF consumption allows an overall estimate of the effect of industrial food processing on health.

A review, published in the British Medical Journal (BMJ) in 2024, looked at 45 studies involving almost 10 million participants. The review authors suggest that eating more ultraprocessed foods is linked to a higher risk of dying from any cause and has ties to 32 health conditions, including heart disease, mental health disorders, type 2 diabetes, and other problems.

While previous studies focused on specific dietary risk factors instead of food patterns, the current study modeled data from nationally representative dietary surveys and mortality data from eight countries (Australia, Brazil, Canada, Chile, Colombia, Mexico, United Kingdom, and United States) to link dietary patterns, considering the extent and purpose of industrial food processing, to deaths from all causes.

The lead author of the research explains, "We first estimated a linear association between the dietary share of UPFs and all-cause mortality, so that each 10% increase in the participation of UPFs in the diet increases the risk of death from all causes by 3%. Then, using the relative risks and the food consumption data for all countries (ranging from 15% of the total energy intake in Colombia, to over 50% of the calories in the United States), we built a model that estimated that the percentage of all-cause premature preventable deaths due to the consumption of UPFs can vary from 4% in countries with lower UPF consumption to almost 14% in countries with the highest UPF consumption".

In 2018, 124,000 premature deaths were attributable to the consumption of UPFs in the United States.

High consumption of UPFs has been associated with 32 different diseases, including cardiovascular disease, obesity, diabetes, some types of cancer, and depression. For the first time, this study has estimated the burden of UPF intake on premature deaths from all-causes in different countries, showing that the attributable mortality is significant in all settings and that addressing UPF consumption should be a global public nutrition priority.

It is concerning that, while in high-income countries UPF consumption is already high but relatively stable for over a decade, in low- and middle-income countries the consumption has continuously increased, meaning that while the attributable burden in high-income countries is currently higher, it is growing in the other countries. This shows that policies that disincentivize the consumption of UPFs are urgently needed globally, promoting traditional dietary patterns based on local fresh and minimally processed foods.

In the U.S., approximately two-thirds, or 67%, of the daily calories consumed by adolescents come from ultra-processed foods. This represents a significant portion of their overall dietary intake, and has increased from around 61% in 1999 to 67% by 2018

UPFs have industrial formulations, chemicals, refined oils, fats, starches, and proteins, which make them last longer and are highly palatable, or pleasant tasting. This makes people eat more of them, and they are more calorie-dense, meaning people are consuming more calories even when they are eating smaller amounts of food.

To understand what ultraprocessed foods are, it helps to understand how NOVA classifies foods. Here is a link to their classification system: NOVA-Classification-Reference-Sheet.pdf

Group 1: Unprocessed or minimally processed foods.

Unprocessed, or “natural,” foods are obtained directly from plants or animals and do not undergo any alteration. Minimally processed foods are natural foods that have been cleaned, had inedible or unwanted parts removed, or have been ground, dried, fermented, pasteurized, frozen, or gone through other processes that subtract part of the food. No oil, fat, sugar, salt, or other substances have been added to foods in this category.

Examples include fresh or pasteurized fruit or vegetable juices with no added sugar or other substances; eggs; dried fruits; lentils, chickpeas, and beans; nuts; fresh and dried herbs and spices; fresh or pasteurized milk and yogurt without sugar; fresh or frozen meat, poultry, and seafood.

Group 2: Processed culinary ingredients

These are products extracted from natural foods using processes including pressing, grinding, crushing, pulverizing, and refining. They are used in homes and restaurants to season and cook food.

Examples include oils made from seeds, nuts, and fruits (olive oil, corn oil, sunflower oil); white, brown, and other types of sugar and molasses from cane or beets; honey; maple syrup; butter; lard; and refined or coarse salt.

(The use of processed culinary ingredients does not make meals nutritionally unbalanced as long as they are used in moderation in food preparation for natural or minimally processed foods.)

Group 3: Processed foods

These are foods from Group 1 that are made outside the home with salt, sugar, oil, or substances from Group 2 added to preserve them or make them more palatable. These items are derived directly from food and are recognized versions of the original food. Most processed foods have two or three ingredients.

Examples include freshly made cheeses; bacon and beef jerky; salted or sugared nuts or seeds; canned or bottled legumes or vegetables; unpackaged, freshly made breads; tomato extract, pastes, or concentrates (with salt and/or sugar); and fruits in sugar syrup.

Group 4: Ultraprocessed foods

These are industrial formulations made mostly or completely from substances (oil, fat, sugar, starch, and protein) extracted from food or derived from hydrogenated fats or modified starches. They can also be synthesized in laboratories with flavor enhancers, colors, and additives to make them highly palatable. These typically have five or more (usually many more) ingredients.

Examples include sweetened and flavored yogurts; breakfast cereals and bars; cola, energy, and sports drinks; pastries, cakes, cookies, and cake mixes; instant soups; ice cream and frozen desserts; packaged breads, hamburger, and hot dog buns; and pre-prepared pizzas, pasta, hamburgers, sausages, chicken nuggets, and fish sticks.

Remember... You are what you eat!