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.
Highlights
Food processing includes all the processes needed to transform raw or harvested foodstuffs into new products, ensuring their safety, palatability, and shelf-life [1]
Most of the data on ultra-processed foods (UPF) consumption have been derived from FFQs and 24 h dietary recall, which are not validated for estimating UPF; such data should be considered with caution
Despite the NOVA system classifying foods based on the food processing technology without providing any information about the nutritional content of the food, the UPF group has been suggested to be an indicator of poor food quality due to the generally high amounts of free or added sugars, fats, low levels of fiber, and high energy density
Summary
Food processing includes all the processes needed to transform raw or harvested foodstuffs into new products, ensuring their safety, palatability, and shelf-life [1]. A Brazilian group of researchers coordinated by Monteiro instead proposed the NOVA classification, which classifies foods into four main categories based on their degree of processing, without providing any indication of their nutritional content: (i) unprocessed and minimally processed foods such as fruit and vegetables, milk, eggs, and meats; (ii) processed culinary ingredients, including oils, butter, lard, sugar, and salt; (iii) processed foods such as canned fish or legumes, typically produced by adding salt, oil, sugar, or other substances from group 2 to group 1 foods, and using preservation methods such as canning and bottling; and (iv) ultra-processed foods (UPF) [4]. UPF include, amongst others, carbonated soft drinks; sweet, fatty, or salty packaged snacks; candies; ice creams; pastries; margarines; and many others
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