Abstract
As evidence grows about negative health impacts of ultra-processed foods (UPFs), nutrient-centred advice is contested, and food-based dietary guidelines are increasingly utilised. Previous analyses of dietary guidelines evaluated their potential impact on health and sustainability, but little research has been conducted to examine how the concept of UPFs is reflected in dietary advice for consumers. This paper systematically analyses whether and how UPFs are represented in dietary guidelines internationally. Based on a systematic online search, the consumer-targeted key messages of 106 dietary guidelines were identified and a qualitative content analysis was conducted. A coding framework was developed to classify messages as 'eat more' or 'eat less' according to the language used (eg, 'choose' vs 'avoid') and to differentiate between a focus on nutrients or food processing. Specific foods mentioned in 'eat less' guidelines were classified according to their level of processing using the NOVA framework. 99% of guidelines utilised some type of nutrient-based message, either promoting 'positive' nutrients (eg, vitamins) or discouraging the consumption of 'negative' nutrients (mainly salt, sugar and fat). Explicit references to food processing were present in 45% of 'eat less' guidelines and 5% of 'eat more' guidelines. Implicit references (eg, promoting 'raw' or discouraging 'packaged' foods) were found in 43% of 'eat less' and 75% of 'eat more' guidelines. 53% of the specific foods referred to in 'eat less' advice were UPFs. Overall, nutrient-based messages were more common than messages about processing levels. The majority of discouraged foods were UPFs, however some minimally processed foods were discouraged, which points to tensions and contradictions between nutrient- and processing-based dietary advice. As dietary guidelines begin to include advice about food processing, it is important to consider both consumer understanding of the terms used and their capacity to act on the advice.
Highlights
Over the past decade, nutrition research and dietary advice have increasingly focused on levels of food processing, the health harms associated with the consumption of ultra-processed foods (UPFs).[1,2]
This study provides the first systematic assessment of how the concept of UPFs is incorporated in dietary advice around the world
This paper documents the diversity of terms and foods associated with this concept, which may provide important insights to the public health nutrition community as to how dietary guidelines for consumers discuss UPFs and the concept of food processing, and the issues and ambiguities with current approaches
Summary
Nutrition research and dietary advice have increasingly focused on levels of food processing, the health harms associated with the consumption of ultra-processed foods (UPFs).[1,2] In 2010, the NOVA framework was published as a food classification system to distinguish foods based on their industrial processing levels, ranging from ‘unprocessed’ to ‘ultra-processed.’[3]. UPFs are distinguished by the industrial nature and purpose of their processing – often to create foods with novel physical and chemical compositions (eg, by using modified substances such as protein isolates, food colouring or emulsifiers to imitate sensory properties of fresh foods). Few national nutrition policies are based on levels of food processing. A small number of dietary guidelines use the NOVA framework as a basis to evaluate quality and harms of foods and diets based on processing levels.[7,8]
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