Abstract
BackgroundRecent population dietary studies indicate that diets rich in ultra-processed foods, increasingly frequent worldwide, are grossly nutritionally unbalanced, suggesting that the dietary contribution of these foods largely determines the overall nutritional quality of contemporaneous diets. Yet, these studies have focused on individual nutrients (one at a time) rather than the overall nutritional quality of the diets. Here we investigate the relationship between the energy contribution of ultra-processed foods in the US diet and its content of critical nutrients, individually and overall.MethodsWe evaluated dietary intakes of 9,317 participants from 2009 to 2010 NHANES aged 1+ years. Food items were classified into unprocessed or minimally processed foods, processed culinary ingredients, processed foods, and ultra-processed foods. First, we examined the average dietary content of macronutrients, micronutrients, and fiber across quintiles of the energy contribution of ultra-processed foods. Then, we used Principal Component Analysis (PCA) to identify a nutrient-balanced dietary pattern to enable the assessment of the overall nutritional quality of the diet. Linear regression was used to explore the association between the dietary share of ultra-processed foods and the balanced-pattern PCA factor score. The scores were thereafter categorized into tertiles, and their distribution was examined across ultra-processed food quintiles. All models incorporated survey sample weights and were adjusted for age, sex, race/ethnicity, family income, and educational attainment.ResultsThe average content of protein, fiber, vitamins A, C, D, and E, zinc, potassium, phosphorus, magnesium, and calcium in the US diet decreased significantly across quintiles of the energy contribution of ultra-processed foods, while carbohydrate, added sugar, and saturated fat contents increased. An inverse dose–response association was found between ultra-processed food quintiles and overall dietary quality measured through a nutrient-balanced-pattern PCA-derived factor score characterized by being richer in fiber, potassium, magnesium and vitamin C, and having less saturated fat and added sugars.ConclusionsThis study suggests that decreasing the dietary share of ultra-processed foods is a rational and effective way to improve the nutritional quality of US diets.
Highlights
Recent population dietary studies indicate that diets rich in ultra-processed foods, increasingly frequent worldwide, are grossly nutritionally unbalanced, suggesting that the dietary contribution of these foods largely determines the overall nutritional quality of contemporaneous diets
The mean factor scores of these three remaining components decreased across the dietary share of ultra-processed foods (Additional file 1: Table S3). In this analysis of US nationally representative data, we show that a significant linear inverse relationship exists between the dietary contribution of ultra-processed foods and the dietary content of protein, fiber, vitamins A, C, D, and E, zinc, potassium, phosphorus, magnesium, and calcium
We found an inverse dose–response association between ultra-processed food dietary contribution and the overall dietary quality measured through a nutrient balanced pattern Principal Component Analysis (PCA)-derived factor score characterized by being richer in fiber, potassium, magnesium, and vitamin C, and having less saturated fat and added sugars
Summary
Recent population dietary studies indicate that diets rich in ultra-processed foods, increasingly frequent worldwide, are grossly nutritionally unbalanced, suggesting that the dietary contribution of these foods largely determines the overall nutritional quality of contemporaneous diets. Ultra-processed foods are formulations manufactured using several ingredients and a series of processes ( “ultra-processed”) Most of their ingredients are lowercost industrial sources of dietary energy and nutrients, and additives used for the purpose of imitating sensorial qualities of minimally processed foods or of culinary preparations of these foods, or to disguise undesirable sensory qualities of the final product. In the US, using 2009–2010 National Health and Nutrition Examination Survey (NHANES) day 1 data, a positive association was found between the dietary contribution of ultra-processed foods and the dietary content of added sugars [11] Another US study found that highly processed barcoded consumer packaged foods and beverages, mostly ultra-processed products, are higher in saturated fat, sugar, and sodium contents compared to less-processed foods [12]
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