The share of ultra-processed foods and the overall nutritional quality of diets in the US: evidence from a nationally representative cross-sectional study

Feb 15, 2017Population health metrics

How the amount of ultra-processed foods relates to overall diet quality in the US

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Abstract

In the US diet, the average content of critical nutrients decreases significantly as the energy contribution of ultra-processed foods increases.

Protein, fiber, vitamins A, C, D, and E, zinc, potassium, phosphorus, magnesium, and calcium content declines across higher quintiles of ultra-processed food energy contribution.
Carbohydrate, added sugar, and saturated fat contents increase with higher energy contributions from ultra-processed foods.
An inverse dose-response relationship exists between the share of ultra-processed foods and overall dietary quality, as indicated by a nutrient-balanced dietary pattern.
Overall dietary quality is characterized by increased fiber, potassium, magnesium, and vitamin C, along with reduced saturated fat and added sugars in lower quintiles of ultra-processed food consumption.
Decreasing the share of ultra-processed foods may improve the nutritional quality of US diets.

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BACKGROUND: 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. 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.

METHODS: We 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.

RESULTS: The 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.

CONCLUSIONS: This 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.

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The share of ultra-processed foods and the overall nutritional quality of diets in the US: evidence from a nationally representative cross-sectional study

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