Trends in Consumption of Ultra-Processed Foods Among US Children Aged 2–19 Years, 2003–2016

Abstract

Abstract Objectives Ultra-processed foods (UPF) are a major sources of calories in the US diet, but trends and disparities in intakes among children are not established. We characterized trends in UPF consumption among US children from 2003 to 2016, overall and in key demographic subgroups. Methods We analyzed 24-hour dietary recall data from 7 consecutive cycles of NHANES (2003–04 to 2015–16) among US children aged 2–19 years (total sample: 23,758). Food items were classified according to the NOVA classification system as unprocessed/minimally processed, processed culinary ingredients, processed, or UPF. Trends in consumption were assessed by treating the 2-year survey cycle as a continuous variable in survey-weighted linear regression models. Findings were evaluated overall and stratified by age, sex, race/ethnicity, and parental educational level. Results In 2015–2016, UPFs contributed to 63.5% of energy intake among US children, with much lower intakes of unprocessed/minimally processed foods (26.6%), processed foods (7.8%), and processed culinary ingredients (3.8%). From 2003 to 2016, intakes increased for UPFs (+1.7% energy) and processed culinary ingredients (+1.6%) and decreased for unprocessed/minimally processed foods (−3.4%) (all p-trend <0.001). Among subgroups of UPF, % E increased for ready-to-eat or frozen meals (i.e., pizza, sandwich, hamburger, and other packaged meals) from 3.8% to 11.1%; and cakes, cookies and pastries from 5.4% to 7.2%; and decreased for sugar-sweetened beverages (from 9.6% to 4.8%) and French fries (from 2.4% to 1.4%), (all p-trend < 0.0001). Increasing trends in UPF intake were similar across age, sex, race/ethnicity, and parental educational subgroups (p-interactions > 0.05), but were higher among children with lower family income (income-to-poverty ratio <1.3, +3.6% energy) than with higher family incomes (−0.1% and + 1.7%) (p-interactions <0.05). Conclusions Nearly two-thirds of calories among US children now come from UPF, with gradual overall increases between 2003 and 2016, replacing unprocessed/minimally processed foods, and additional disparities by family income. These findings inform policy priorities and strategies to improve diet quality and disparities among US children. Funding Sources NIH/NIMHD.