Ultra-processed Products Research Articles

“Warning: ultra-processed”: an online experiment examining the impact of ultra-processed warning labels on consumers’ product perceptions and behavioral intentions

BackgroundNutrient content and degree of processing are complementary but distinct concepts, and a growing body of evidence shows that ultra-processed foods (UPFs) can have detrimental health effects independently from nutrient content. 10 + countries currently mandate front-of-package labels (FOPL) to inform consumers when products are high in added sugars, saturated fat, and/or sodium. Public health advocates have been calling for the addition of ultra-processed warning labels to these FOPLs, but the extent to which consumers would understand and be influenced by such labels remains unknown. We examined whether the addition of ultra-processed warning labels to existing nutrient warning labels could influence consumers’ product perceptions and purchase intentions.MethodsIn 2023, a sample of adults in Brazil (n = 1,004) answered an open-ended question about the meaning of the term “ultra-processed,” followed by an online experiment where they saw four ultra-processed products carrying warning labels. Participants were randomly assigned to view either only nutrient warning labels or nutrient plus ultra-processed warning labels. Participants then answered questions about their intentions to purchase the products, product perceptions, and perceived label effectiveness.ResultsMost participants (69%) exhibited a moderate understanding of the term “ultra-processed” prior to the experiment. The addition of an ultra-processed warning label led to a higher share of participants who correctly identified the products as UPFs compared to nutrient warning labels alone (Cohen’s d = 0.16, p = 0.02). However, the addition of the ultra-processed warning label did not significantly influence purchase intentions, product healthfulness perceptions, or perceived label effectiveness compared to nutrient warning labels alone (all p > 0.05). In exploratory analyses, demographic characteristics and prior understanding of the concept of UPF did not moderate the effect of ultra-processed warning labels.ConclusionsUltra-processed warning labels may help consumers better identify UPFs, although they do not seem to influence behavioral intentions and product perceptions beyond the influence already exerted by nutrient warning labels. Future research should examine how ultra-processed warning labels would work for products that do and do not require nutrient warnings, as well as examine the benefits of labeling approaches that signal the health effects of UPFs.Trial registrationClinicalTrials.gov, NCT05842460. Prospectively registered March 15th, 2023.

Food additives in ultra-processed products and some health effects

Food additives in ultra-processed products and some health effects

Reply-Letter to the Editor - "Ultra-Processed Products and Risk of Liver Cancer: A Prospective Cohort Study"

Reply-Letter to the Editor - "Ultra-Processed Products and Risk of Liver Cancer: A Prospective Cohort Study"

Commercial determinants of health and cancer prevention in South Africa

Aim Commercial determinants, encompassing marketing strategies, corporate social responsibility, and lobbying, significantly contribute to avoidable cancer deaths globally. In South Africa, 30-50% of cancers are preventable, but SA focuses mainly on tobacco control, ignoring major causes of cancer such as alcohol, obesity, and ultra-processed foods. This paper highlights the role of these commercial determinants in contributing to cancer in SA. It outlines strategies and barriers in addressing these determinants. Approach While conventional approaches focus on individual responsibility relating to risk factors like tobacco, alcohol, and unhealthy diets, the role of industries in promoting these risk factors remains inadequately addressed. The paper explores the marketing and non-marketing methods employed by industries, such as tobacco, alcohol, and ultra-processed products, to maximise profits while neglecting public health consequences. Findings The article sheds light on industry tactics, including strategic partnerships, sponsorship, and diversionary narratives during crises, aimed at safeguarding profits. It emphasises the less-explored realm of non-marketing strategies, such as political lobbying, industry-funded research, and the ‘revolving door’ phenomenon where industry insiders become policymakers. Conclusions The article advocates for a paradigm shift in cancer prevention policies, urging the government to implement a comprehensive suite of measures that include increased taxation on harmful products, strict restrictions on marketing, enhanced product labelling, and eliminating conflict of interest in health research and policies. Addressing the commercial determinants necessitates not only recognising their impact but also adopting a multi-level governance approach that prioritises public health over corporate profits. The paper concludes by emphasising the urgency of recognising the links between alcohol, food regulation, and cancer prevention. The overarching goal is to shift power relations, fostering governance for the collective good and ensuring equitable access to preventive measures, especially for vulnerable populations.

Exploring barriers and facilitators to feeding children with minimal or no "Junk Food": Insights from Mexican women.

This study aims to investigate the factors that promote or hinder the feeding of children with minimal or no ultra-processed products to inform the design of an mHealth strategy in Mexico and prevent child malnutrition among the economically vulnerable. An exploratory qualitative study was conducted, involving 24 in-depth face-to-face interviews with caregivers of children aged 24-59 months from both urban and rural communities. To analyze the data, we used thematic analysis and incorporated a few elements of grounded theory. More barriers than facilitators were identified. Key barriers included: misconceptions and the widespread availability of junk food through an extensive network of grocery stores; neighbors and family gifting junk food; the association of soda with celebrations; the practice of indulging children with junk food; and the normalization of junk food consumption by both adults and children. Facilitators included: caregivers' awareness of the health risks associated with junk food; economic constraints limiting junk food purchases; support from husbands in regulating children's junk food consumption; the presence of a family member with diabetes; specific cultural beliefs about children's digestive health; as well as displacement of "healthy" foods that nourish children. Based on our findings, we formulated recommendations for interventions at intrapersonal, interpersonal, organizational, community, and public policy levels to support healthier feeding practices for children.

Allergens weaning: what is missing from commercial baby food?

Background. Current recommendations for infant weaning suggest introducing common food allergens by the age of 12 months. While homemade meals are advisable, there is a notable demand for commercially available complementary foods (CACF). Furthermore, emerging evidence suggests a potential link between the consumption of ultra-processed products and the incidence of allergic diseases. This study aimed to examine the presence of the fourteen main food allergens in CACF ingredients through label analysis and evaluate their extent of processing. Methods. Between January and February 2024, labels of all CACF found in infant feeding sections of 10 Portuguese grocery retailers were analyzed. CACF were categorized based on the NOVA food classification system's processing levels. Milk formulas, products for children over 15 months, and those for children with food allergies or intolerances were excluded Results. Of the 492 products analysed, 132 contained wheat and 112 contained milk. 16 products included fish and 6 contained egg. Soy was listed as an ingredient in 11 products, mainly as soy lecithin. Only 2 product contained nuts, and 1 product contained peanuts. None of the products contained the remaining six allergens. The majority of milk- and wheat-containing products were classified as ultra-processed and contained added sugars and/or sweeteners. Conclusions. Despite the current guidelines, commercial baby foods often lack major allergens, namely nuts and peanuts, eggs, and shellfish. Our results underscore the need for healthy, age-appropriate, minimally processed products that incorporate rather than exclude major food allergens.

Crime and Nourishment: A Narrative Review Examining Ultra-Processed Foods, Brain, and Behavior

Recently, there has been increased scientific and clinical interest in the potential harms associated with ultra-processed foods, including poor mental health, aggression, and antisocial behavior. Research spanning epidemiology, mechanistic pre-clinical work, addiction science, microbiome and exposome science, and human intervention trials has underscored that nutrition is of relevance along the criminal justice continuum. As such, the emerging dietetics research is salient to the thousands of international psychologists and allied mental health professionals that are engaged in justice work, including forensics, prevention, and intervention. In addition, relationships between nutrition and behavior relate to “food crime”, an emergent area unifying criminal justice researchers with psychology, public health, and other interdisciplinary sectors. Food crime scrutinizes the vast harms, including non-communicable diseases and adverse behavioral outcomes, as influenced by the distribution of addictive ultra-processed food products. Here, we examine the emergent research, including biophysiological mechanisms, and evidence indicating that dietary patterns/components intersect with psychosocial vulnerabilities linked with risks of antisocial behavior and justice involvement. Viewed through a prevention lens, the study of nutrition and aggressive behavior should be prioritized, especially if the outcomes emerge as externalities of the global consumption of ultra-processed food. In the context of criminal justice and behavior, there is a need for forensic examination of how industry influence and power structures can undermine matters of food justice.

Mechanism of tumbling-curing to improve beef quality: Insights from the structural and functional properties of myofibrillar protein

Beef is highly nutritious but lacks tenderness and emulsification properties. This study aimed to investigate the impact of static curing (SC), tumbling-curing (TC), pulsating vacuum tumbling-curing (PVTC), and vacuum tumbling-curing (VTC) on the structural and functional properties of myofibrillar proteins and the mechanisms involved in enhancing beef quality. VTC significantly enhanced beef tenderness, water-holding capacity (WHC) and cooking yield. Additionally, the shear force was reduced by 58% and the cooking yield and WHC were increased by 6% compared with SC. There was an increase in the myofibrillar protein (MP) α-helix content and sulfhydryl content, while there was a reduction in the surface hydrophobicity and dityrosine content. These changes led to the enhancement of the functional properties of beef, such as protein emulsification and solubility. VTC minimized the damage caused by the curing process to the secondary and tertiary structures of MP by reducing their aggregation and oxidation. When compared with other curing methods, VTC proved to be an effective technology for enhancing beef tenderness and emulsification properties, therefore, essential in promoting ultra-processed beef products.

To imitate or not to imitate? How consumers perceive animal origin products and plant-based alternatives imitating minimally processed vs ultra-processed food

Changing dietary habits towards a reduction of animal origin proteins, such as meat and fish, in favor of plant-based alternatives can positively contribute to sustainability, health and animal suffering related issues. Despite this awareness and the large variety of plant-based alternatives available on the market, willingness to reduce or substitute animal origin proteins is still very low. This research investigates the role of a so far overlooked factor in the study of consumer adoption of plant-based diets, namely the role of food processing, adding to the understanding of how consumers perceive animal origin products and their plant-based alternatives imitating a minimally processed vs ultra-processed food. Through a Swiss online study with 607 consumers, our results showed that the resemblance to a minimally processed (e.g., chicken filet, tuna) or ultra-processed product (e.g., meatball, fish stick) differently affect animal origin products and plant-based imitations. Specifically, while consumers perceived more positively the minimally processed meat/fish than the ultra-processed one in the animal origin category, in terms of perceived environmental friendliness, perceived health and purchase intention, the reverse was observed for the plant-based imitations. Thus, contributing to theory and practice, the results of this research suggest that the like-to-like imitation of an animal origin product is not only ineffective but can also be counterproductive for perceptions-of sustainability and health- and purchase intentions of plant-based alternatives.

Ultra-processed products and risk of liver cancer: A prospective cohort study

Background & AimsSeveral studies have shown positive associations between ultra-processed foods and drinks and cancer risk. However, evidence remains limited for liver cancer. We aimed to evaluate the associations between ultra-processed foods and drinks and liver cancer risk. MethodsWe included 73,119 participants (22,431 Whites, 47,837 Blacks, 2851 other race) from the Southern Community Cohort Study. Ultra-processed products were defined based on the Nova classification using data from a validated food frequency questionnaire and calculated as percentage of daily foods by weight. Incident liver cancer and vital status were ascertained via linkages to state cancer registries and the National Death Index as of December 31, 2019. ResultsWith a median of 13.9 year’s follow-up, we documented 453 incident liver cancer cases. Participants with higher intake of ultra-processed foods had an elevated risk of liver cancer (hazard ratios [HR] Tertile 3 vs. tertile 1 1.69, 95% confidence intervals [CI]: 1.28-2.22; Ptrend<0.001). The subclasses of ultra-processed foods, such as ultra-processed grains and fried potatoes (HR T3 vs. T1 1.29, 95% CI: 1.01-1.65; Ptrend=0.03), processed protein foods (HR T3 vs. T1 1.49, 95% CI: 1.14-1.94; Ptrend=0.007) and mixed dishes (HR T3 vs. T1 1.39, 95% CI: 1.09-1.77; Ptrend=0.01), were positively associated with liver cancer risk. No significant association was found for ultra-processed drinks (HR T3 vs. T1 0.85, 95% CI: 0.67-1.07; Ptrend=0.16). DiscussionIn a prospective cohort with predominantly low-income Southern US adults, we found certain ultra-processed foods were associated with a higher risk of liver cancer. Further studies are needed to confirm our findings.

Nutritional Quality of Breakfast Cereals on the French, Belgian and Luxembourg Markets: Which Cereals for Children?

Objective: Analyse the breakfast cereal market to help to help healthcare professionals to guide parents in choosing healthy products for their children. Study design: Observational study of the breakfast cereals available in the biggest supermarkets, discount stores and organic chains in France, Belgium and Luxembourg. Methods: An analysis of nutritional qualities using three indicators: Nutri-Score (initial and modified version), WHO Europe nutrient profile model, and Nova. Results: 645 products were listed; 559 excluding duplicates. A total of 28.8% are marketed to children and make up the group of "children's" cereals, 62.1% of cereals are Muesli, Oats and other cereal flakes (MOCF), and 54.9% are "organic". The study shows that "children's" cereals have a poorer nutritional profile: a higher proportion of Nutri-Score D, higher sugar content, lower fibre content, less conformity with the WHO Europe nutrient profile model and a higher proportion ofultra-processed. On the other hand, MOCF and "organic" products generally have a better nutritional profile: less sugar, more fibre, more Nutri-Score A, less Nutri-Score D and fewer ultra-processed products. Conclusions: Parents should therefore opt for cereals that do not bear any reference to children on the packaging.

Allura Red AC is a xenobiotic. Is it also a carcinogen?

Merriam-Webster and Oxford define a xenobiotic as any substance foreign to living systems. Allura Red AC (a.k.a., E129; FD&C Red No. 40), a synthetic food dye extensively used in manufacturing ultra-processed foods and therefore highly prevalent in our food supply, falls under this category. The surge in synthetic food dye consumption during the 70s and 80s was followed by an epidemic of metabolic diseases and the emergence of early-onset colorectal cancer in the 1990s. This temporal association raises significant concerns, particularly given the widespread inclusion of synthetic food dyes in ultra-processed products, notably those marketed toward children. Given its interactions with key contributors to colorectal carcinogenesis such as inflammatory mediators, the microbiome, and DNA damage, there is growing interest in understanding Allura Red AC's potential impact on colon health as a putative carcinogen. This review discusses the history of Allura Red AC, current research on its effects on the colon and rectum, potential mechanisms underlying its impact on colon health, and provides future considerations. Indeed, although no governing agencies classify Allura Red AC as a carcinogen, its interaction with key guardians of carcinogenesis makes it suspect and worthy of further molecular investigation. The goal of this review is to inspire research into the impact of synthetic food dyes on colon health.

Factors underlying mothers’ decision to offer ultra-processed meals during early childhood

The growing evidence on the negative health effects of ultra-processed products indicates the need to develop strategies to discourage their consumption among infants and children. The development of such strategies requires a deeper understanding of the factors underlying children’s consumption of ultra-processed products. In this context, the present work aimed to analyze factors underlying mothers’ decision to offer meals composed of ultra-processed products during early childhood (6 months to 5 years old). An online survey with 888 mothers was conducted. Participants were shown a series of pictures of ultra-processed meals and were asked to indicate whether they would offer them to their children or not. A follow-up open-ended question was used to explore reasons underlying negative responses. A relevant proportion of mothers indicated that they would offer the ultra-processed meals to their children (48.5 % to 64.5 %). On the other hand, motives for not offering ultra-processed meals to children were mainly related to food processing and nutritional composition. Several variables of the child (age, food fussiness), the mother (education level and socio-economic status), and the household (presence of children older than 5 years) had a significant effect on the likelihood of mothers offering ultra-processed meals and mentioning different reasons for not doing so. Results stress the need to implement strategies to increase perceived risk of ultra-processed products, particularly among parents with low educational level and from low socio-economic status.

Modifying the Health Star Rating nutrient profiling algorithm to account for ultra-processing.

To modifythe Australian and New Zealand Health Star Rating to account for ultra-processing and compare the alignment of the modified ratings with NOVA classifications and the current Australian Dietary Guidelines classifications of core (recommended foods) and discretionary (foods to limit). Data was cross-sectionally analysed for 25 486 products. Four approaches were compared to the original Health Star Rating: (1) five 'negative' points added to ultra-processed products (modification 1; inclusion approach); (2) ultra-processed products restricted to a maximum of 3.0 Health Stars (modification 2; capping approach); (3 and 4) same approach used for modifications 1 and 2 but only applied to products that already exceeded 10 'negative' points from existing Health Star Rating attributes (modifications 3 and 4, respectively; hybrid approaches). Alignment occurred when products (i) received <3.5 Health Stars and were NOVA group 4 (for NOVA comparison) or discretionary (for Dietary Guidelines comparison), or (ii) received ≥3.5 Health Stars and were NOVA groups 1-3 or core. All Health Star Rating modifications resulted in greater alignment with NOVA (ranging from 69% to 88%) compared to the original Health Star Rating (66%). None of the modifications resulted in greater alignment to the Dietary Guidelines classifications overall (69% to 76%, compared with 77% for the original Health Star Rating), but alignment varied considerably by food category. If ultra-processing were incorporated into the Australian and New Zealand Health Star Rating, consideration of ultra-processing within the broader dietary guidance framework would be essential to ensure coherent dietary messaging to Australians.

Food additives associated with gut dysbiosis in processed and ultra-processed products commercialized in the Uruguayan market

Recent empirical evidence suggests that gut dysbiosis is one of the negative health outcomes potentially associated with chronic consumption of some food additives. In this context, the present study aimed at analyzing the disclosure of food additives associated with gut dysbiosis in the labels of products commercialized in the Uruguayan market. A cross-sectional survey of packaged products commercialized in nine supermarkets was conducted between August and September 2021. All packaged processed and ultra-processed products available in each data collection site were surveyed using a cellphone app. The information available on the labels was manually extracted and the disclosure of food additives was analyzed using a computer assisted approach. Results showed that 38.1% of the products disclosed at least one food additive associated with gut dysbiosis. Disclosure was most frequent in ice-cream and popsicles, beverages, meat products and analogues, desserts, and fats, oils and fat and oil emulsions. Potassium sorbate was the individual additive associated with gut dysbiosis most frequently disclosed on the labels, followed by mono- and di-glycerides of fatty acid, sucralose, carboxymethylcellulose, acesulphame potassium, carrageenan, and sodium benzoate. These food additives frequently co-occurred and network analysis enabled the identification of patterns of co-occurrence. Taken together, results from the present work suggest the need to conduct additional research to assess the intake of food additives associated with gut dysbiosis at the population level, as well as to evaluate potential synergistic effects of food additives.

Prevalence of consumption of mechanically separated meat, consumer profile, nutrient intake and food choices among manufacturing workers in Northeastern Brazil

Mechanically separated meat (MSM) is widely used in the food industry, however, there is a lack of studies on its consumption in populations. The objective of this study was to identify the frequency and amount of MSM consumption, factors associated with MSM consumption, nutrient intake and preferential choice of food groups among MSM consumers. This was an observational, cross-sectional prospective study based on a probability sample of manufacturing workers, conducted in Brazil. Logistic and linear multiple regression with robust standard errors were used. 921 workers from 33 manufacturing companies were studied, with an average age of 38.2 ± 10.7 years, 55.9% males. MSM products are consumed by 28.8% and represent in average 10% of total daily caloric intake, and 47.3% of the daily kcal from ultra-processed products. Younger age and greater waist circumference are associated with MSM consumption. Younger age and lesser educational level are associated with increased contribution of MSM to total daily kcal intake. MSM consumers have greater consumption of energy, fats, carbohydrates and sodium. Their dietary patterns are characterized by lower consumption of in natura and minimally processed foods, such as tubers and roots, fruits, white and red meat, and eggs and greater consumption of ultra-processed foods and beverages.

Effects of glyphosate herbicide ingestion on kidney function in rats on a balanced diet.

Glyphosate is the most widely used herbicide worldwide and in Brazil. There is currently increasing concern about the effects of glyphosate on human health. The Brazilian Institute for Consumer Protection showed data on the presence of glyphosate in some of Brazil's most consumed ultra-processed products. Currently, regulations on the upper limit for these residues in ultra-processed foods have yet to be established by the National Health Surveillance, and ultra-processed food consumption is independently associated with an increased risk of incident chronic kidney disease. Since an unbalanced diet can interfere with kidney function, this study aims to investigate the effect of daily intake of 5 mg/kg bw glyphosate in conjunction with a balanced diet and the possible impact on renal function in rats. Kidney function, kidney weight, markers of renal injury, and oxidative stress were evaluated. There was a decrease in kidney weight. The main histopathological alterations in renal tissues were vacuolation in the initial stage and upregulation of the kidney injury marker KIM-1. Renal injury is associated with increased production of reactive oxygen species in mitochondria. This study showed changes in the kidney of rats exposed to a balanced diet with glyphosate, suggesting a potential risk to human kidney. Presumably, ultra-processed food that contain glyphosate can potentiate this risk. The relevance of these results lies in drawing attention to the need to regulate glyphosate concentration in ultra-processed foods in the future.

Effects of marketing claims on toddler food products on parents' product preferences, perceptions and purchasing intentions: an online experiment.

The retail market for toddler-specific packaged foods is growing. Many of these products are ultra-processed and high in nutrients of concern for health, yet marketed in ways that may make them appear wholesome. This study aims to assess parents' responses to claims on unhealthy, ultra-processed toddler food products and test whether removing such claims promotes more accurate product perceptions and healthier product preferences. Parents of toddlers aged 12 to < 36months (N = 838) were recruited for an online experiment testing four on-pack claim conditions: control (no claim); 'contains "good" ingredient'; 'free from "bad" ingredient'; and unregulated'child-related' claim. Participants were randomly assigned to one condition, then viewed images of toddler food products that varied in nutrition content and the claims displayed. Participants completed tasks assessing product preferences (unhealthy product displaying claim vs. a healthier option with no claim, across four food categories (banana bars, strawberry snacks, blueberry yogurt snacks and veggie snacks)), purchase intentions and product perceptions. Poisson regression (count variable) and linear regression (continuous outcomes) analyses were employed to test for mean differences by marketing claim conditions. For the overall sample, brief exposure to 'free from "bad" ingredient' claims increased participant's intentions to purchase unhealthy food products for their toddlers, but there was no clear evidence that 'contains "good" ingredient' claims and 'child-related' claims significantly impacted parent's preferences, purchase intentions and perceptions of toddler foods. However, certain claims influenced particular parent subgroups. Notably, parents with three or more children chose more unhealthy products when these products displayed 'contains "good" ingredient' or 'free from "bad" ingredient' claims; the latter claims also promoted stronger purchase intentions and enhanced product perceptions among this subgroup. Findings indicate that 'free from "bad" ingredient' claims on unhealthy toddler foods are of most concern, as they boost the appeal of these products to parents. 'Contains "good" ingredient' claims and 'child-related' claims showed limited effects in this study. Considering available evidence, we recommend claims should not be permitted on child-oriented foods, as they may promote inaccurate product perceptions and unhealthy product choices by parents, that can detract from their children's diets and health.

Proposal and Validation of a Measurement Scale of the Acceptance of Ultra-Processed Food Products.

Today, there is an increasing consumption of ultra-processed food products (UPFs), while more healthy options are available; however, there is no scale available that can adequately measure this phenomenon. In this context, the present study aims to develop and validate a measurement scale of the consumers' acceptance of ultra-processed food products. Research data (n = 478) were analyzed using Exploratory Factor Analysis (EFA), followed by a Confirmatory Factor Analysis (CFA). The results confirm the validity of the proposed measurement scale comprising nine factors: the quality of ultra-processed food products, ability to save time, low affordable price, effortless preparation, convenience, hedonic nature, marketing strategies, satisfaction and purchase intention. The present study makes a noticeable contribution to food marketing, and food companies could consider these factors to design and commercialize ultra-processed foods.

'Uma das coisas que mais agrega valor é o orgânico’ – Novas trajetórias e singularidades no mercado dos produtos orgânicos

As they were regulated and institutionalized, organic products took on new trajectories and meanings with the emergence of a more varied market focusing on specific audiences and new qualification references. In this paper we investigate some of the new meanings and different qualifications organic products have assumed by analyzing their new trajectories and singularities within an increasingly flexible and dynamic market containing wider and more heterogeneous range of actors and distinct products that circulate around the organic concept but are neither rigidly defined by or dependent upon this meaning. Using data from primary and secondary sources on how these products were singularized, we attempt to demonstrate that throughout the process of regulating and institutionalizing organic products, “organic” has not only become commodified but also assumed other overlapping meanings, with this characteristic potentially becoming less central or products even ceasing altogether to be organic. In our analysis we highlight trade fairs that focus on these products, their entry into large food companies and retailers, ultra-processed organic products, and how they approximate other qualification references (such as the concepts of vegan, diet, and light).