Ultra-processed foods: background, concepts and

scientific evidence

Maria Laura da Costa Louzada

On Behalf the Center of Epidemiological Studies on Nutrition and Health (NUPENS) team

University of Sao Paulo

Rice

Beans

Flour

Eggs

Milk

Red meat and poultry

Vegetable Oil

Table sugar

Candies and other sweet snacksCrackers

Industrialized cookies, cakes and pies

Sausage and other reconstituted meat

Ready-to-eat dishes

Sugar-sweetened beverages

-3.5

-2.5

-1.5

-0.5

0.5

1.5

2.5

Sources: Brazilian Household Budget Surveys

Changes in food purchases by the Brazilian population (1987-2009)

Rice

Beans

Flour

Eggs

Milk

Red meat and poultry

Vegetable Oil

Table sugar

Candies and other sweet snacksCrackers

Industrialized cookies, cakes and pies

Sausage and other reconstituted meat

Ready-to-eat dishes

Sugar-sweetened beverages

-3.5

-2.5

-1.5

-0.5

0.5

1.5

2.5

Sources: Brazilian Household Budget Surveys

Changes in food purchases by the Brazilian population (1987-2009)

Unprocessed

foods

Industrial processing to increase

the durability, optimize or shorten

preparation time and modify

sensory characteristics.

Processed foods

Minimally processed

foods

Processed culinary

ingredients→ →

Freshly prepared

culinary preparations

Removing non-edible parts, drying,

freezing, pasteurization, fermentation,

pressing, packaging, adding salt or sugar...

NOVA classification system and types of food processing:

harmless, beneficial or essential processing

NOVA classification system and types of food processing:

harmful processing

Unprocessed

foods

→Several step of

industrial processing:

ultra-processing

→

Whole foods broken down into components (oils / proteins / starch / sugar)

Hydrogenation, hydrolysis and other chemical modifications

“Recombination” (extrusion, immersion frying, etc.)

Addition of flavorings, dyes, emulsifiers...

Sophisticated packaging often with synthetic materials

Ready-to-eat industrial formulations

of food-derived substances (oils, fats,

sugars, starch, protein isolates) that

contain little or no whole food and are

often added with flavorings,

colorings, emulsifiers and other

cosmetic additives.

Why avoid ultra-processed foods?

Canhada et al., 2019Mendonça et al, 2016Rauber et al., 2020Vandevijvere et al., 2019PAHO, 2015Rohatgi et al., 2017 (pregnant woman)Mendonça et al, 2017Srour et al., 2019Srour et al., 2020Levy et al., 2020Fiolet et al, 2018Blanco-Rojo et al., 2019Rico-Campà et al., 2019Schnabel et al., 2019Kim et al., 2019Gómez-Donoso et al, 2019Adjibade et al., 2019Sandoval-Insausti et al., 2019Vasseur et al., 2020

Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Hypertension*CVC disease*T2 Diabetes*T2 Diabetes*Cancer*All-cause mortality*All-cause mortality*All-cause mortality*All-cause mortality*Depression*Depression*Frailty*Inflammatory Bowel Diseases

Cohort studies(n=25)

Louzada et al., 2015Juul et al, 2018Rauber et al., 2020Machado et al., 2020Nardocci et al., 2018Adams and White, 2015Seale et al., 2020Julia et al., 2018Silva et al., 2018Djupegot, 2017 Monteiro et al., 2018Canella et al., 2014Crivellenti et al., 2019 (pregnant woman)Sartorelli et al., 2019 (pregnant woman)Steele et al., 2019Lavigne-Robichaud, et al., 2018Nasreddine et al., 2018Lopes et al., 2019Queiroz, 2018Badanai et al., 2019 (pregnant woman)Schnabel et al., 2018

RCT (n=1)

Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicatorsObesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators* and gestational diabetesMetabolic syndrome*Metabolic syndrome*Metabolic syndrome*C-reactive ProteinCancer*Depression*Functional Gastrointestinal Disorders*

Case-control and cross-sectional studies (n=27)

Hall et al., 2019 Obesity indicators*

Impact of ultra-processed food consumption on children’s, adolescent’s and adult’s

health: a systematic literature review. Louzada et al. Reports in Public Health. Under review.

*Statistically significant dose-response associations

Bawaked et al., 2020Costa et al., 2020Cunha et al., 2018Costa et al., 2015Rauber et al., 2015Azeredo et al., 2020

Obesity indicators, blood pressure* and dyslipidemiaObesity indicators* Obesity indicatorsObesity indicators* and glycemiaDyslipidemia*Asthma

Gadelha et al., 2019De Melo et al, 2017Enes et al., 2019D'Avilla et al., 2017Tavares et al., 2012Melo et al., 2018Elias et al., 2019

Obesity indicatorsObesity indicators and blood pressureObesity indicatorsindicators and blood pressure*Metabolic syndrome*Asthma*Asthma*

Children/adolescent

Adult

Canhada et al., 2019Mendonça et al, 2016Rauber et al., 2020Vandevijvere et al., 2019PAHO, 2015Rohatgi et al., 2017 (pregnant woman)Mendonça et al, 2017Srour et al., 2019Srour et al., 2020Levy et al., 2020Fiolet et al, 2018Blanco-Rojo et al., 2019Rico-Campà et al., 2019Schnabel et al., 2019Kim et al., 2019Gómez-Donoso et al, 2019Adjibade et al., 2019Sandoval-Insausti et al., 2019Vasseur et al., 2020

Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Hypertension*CVC disease*T2 Diabetes*T2 Diabetes*Cancer*All-cause mortality*All-cause mortality*All-cause mortality*All-cause mortality*Depression*Depression*Frailty*Inflammatory Bowel Diseases

Cohort studies(n=25)

Louzada et al., 2015Juul et al, 2018Rauber et al., 2020Machado et al., 2020Nardocci et al., 2018Adams and White, 2015Seale et al., 2020Julia et al., 2018Silva et al., 2018Djupegot, 2017 Monteiro et al., 2018Canella et al., 2014Crivellenti et al., 2019 (pregnant woman)Sartorelli et al., 2019 (pregnant woman)Steele et al., 2019Lavigne-Robichaud, et al., 2018Nasreddine et al., 2018Lopes et al., 2019Queiroz, 2018Badanai et al., 2019 (pregnant woman)Schnabel et al., 2018

RCT (n=1)

Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicatorsObesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators* and gestational diabetesMetabolic syndrome*Metabolic syndrome*Metabolic syndrome*C-reactive ProteinCancer*Depression*Functional Gastrointestinal Disorders*

Case-control and cross-sectional studies (n=27)

Hall et al., 2019 Obesity indicators*

*Statistically significant dose-response associations

Bawaked et al., 2020Costa et al., 2020Cunha et al., 2018Costa et al., 2015Rauber et al., 2015Azeredo et al., 2020

Obesity indicators, blood pressure* and dyslipidemiaObesity indicators* Obesity indicatorsObesity indicators* and glycemiaDyslipidemia*Asthma

Gadelha et al., 2019De Melo et al, 2017Enes et al., 2019D'Avilla et al., 2017Tavares et al., 2012Melo et al., 2018Elias et al., 2019

Obesity indicatorsObesity indicators and blood pressureObesity indicatorsindicators and blood pressure*Metabolic syndrome*Asthma*Asthma*

Children/adolescent

Adult

Source: Impact of ultra-processed food consumption on children’s, adolescent’s and adult’s health: systematic literature review. Louzada et al. Reports in Public Health. Under review.

Ultra-processed foods and obesity in adults

Louzada et al., 2015Juul et al, 2018Rauber et al., 2020Machado et al., 2020Nardocci et al., 2018

Natioanallyrepresentative samples

from Brazil, US, UK, Australia and Canada

Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*

Canhada et al., 2019Mendonça et al, 2016Rauber et al., 2020Vandevijvere et al., 2019PAHO, 2015Rohatgi et al., 2017 (pregnant woman)Mendonça et al, 2017Srour et al., 2019Srour et al., 2020Levy et al., 2020Fiolet et al, 2018Blanco-Rojo et al., 2019Rico-Campà et al., 2019Schnabel et al., 2019Kim et al., 2019Gómez-Donoso et al, 2019Adjibade et al., 2019Sandoval-Insausti et al., 2019Vasseur et al., 2020

Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Hypertension*CVC disease*T2 Diabetes*T2 Diabetes*Cancer*All-cause mortality*All-cause mortality*All-cause mortality*All-cause mortality*Depression*Depression*Frailty*Inflammatory Bowel Diseases

Cohort studies(n=25)

Louzada et al., 2015Juul et al, 2018Rauber et al., 2020Machado et al., 2020Nardocci et al., 2018Adams and White, 2015Seale et al., 2020Julia et al., 2018Silva et al., 2018Djupegot, 2017 Monteiro et al., 2018Canella et al., 2014Crivellenti et al., 2019 (pregnant woman)Sartorelli et al., 2019 (pregnant woman)Steele et al., 2019Lavigne-Robichaud, et al., 2018Nasreddine et al., 2018Lopes et al., 2019Queiroz, 2018Badanai et al., 2019 (pregnant woman)Schnabel et al., 2018

RCT (n=1)

Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicatorsObesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators* and gestational diabetesMetabolic syndrome*Metabolic syndrome*Metabolic syndrome*C-reactive ProteinCancer*Depression*Functional Gastrointestinal Disorders*

Case-control and cross-sectional studies (n=27)

Hall et al., 2019 Obesity indicators*

*Statistically significant dose-response associations

Bawaked et al., 2020Costa et al., 2020Cunha et al., 2018Costa et al., 2015Rauber et al., 2015Azeredo et al., 2020

Obesity indicators, blood pressure* and dyslipidemiaObesity indicators* Obesity indicatorsObesity indicators* and glycemiaDyslipidemia*Asthma

Gadelha et al., 2019De Melo et al, 2017Enes et al., 2019D'Avilla et al., 2017Tavares et al., 2012Melo et al., 2018Elias et al., 2019

Obesity indicatorsObesity indicators and blood pressureObesity indicatorsindicators and blood pressure*Metabolic syndrome*Asthma*Asthma*

Children/adolescent

Adult

Source: Impact of ultra-processed food consumption on children’s, adolescent’s and adult’s health: systematic literature review. Louzada et al. Reports in Public Health. Under review.

Ultra-processed foods and obesity in adults

Canhada et al., 2019Mendonça et al, 2016Rauber et al., 2020

Obesity indicators*Obesity indicators*Obesity indicators*

Elsa Study (Brazil)The Sun Project (Spain)

UK Biobank

Canhada et al., 2019Mendonça et al, 2016Rauber et al., 2020Vandevijvere et al., 2019PAHO, 2015Rohatgi et al., 2017 (pregnant woman)Mendonça et al, 2017Srour et al., 2019Srour et al., 2020Levy et al., 2020Fiolet et al, 2018Blanco-Rojo et al., 2019Rico-Campà et al., 2019Schnabel et al., 2019Kim et al., 2019Gómez-Donoso et al, 2019Adjibade et al., 2019Sandoval-Insausti et al., 2019Vasseur et al., 2020

Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Hypertension*CVC disease*T2 Diabetes*T2 Diabetes*Cancer*All-cause mortality*All-cause mortality*All-cause mortality*All-cause mortality*Depression*Depression*Frailty*Inflammatory Bowel Diseases

Cohort studies(n=25)

Louzada et al., 2015Juul et al, 2018Rauber et al., 2020Machado et al., 2020Nardocci et al., 2018Adams and White, 2015Seale et al., 2020Julia et al., 2018Silva et al., 2018Djupegot, 2017 Monteiro et al., 2018Canella et al., 2014Crivellenti et al., 2019 (pregnant woman)Sartorelli et al., 2019 (pregnant woman)Steele et al., 2019Lavigne-Robichaud, et al., 2018Nasreddine et al., 2018Lopes et al., 2019Queiroz, 2018Badanai et al., 2019 (pregnant woman)Schnabel et al., 2018

RCT (n=1)

Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicatorsObesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators*Obesity indicators* and gestational diabetesMetabolic syndrome*Metabolic syndrome*Metabolic syndrome*C-reactive ProteinCancer*Depression*Functional Gastrointestinal Disorders*

Case-control and cross-sectional studies (n=27)

Hall et al., 2019 Obesity indicators*

*Statistically significant dose-response associations

Bawaked et al., 2020Costa et al., 2020Cunha et al., 2018Costa et al., 2015Rauber et al., 2015Azeredo et al., 2020

Obesity indicators, blood pressure* and dyslipidemiaObesity indicators* Obesity indicatorsObesity indicators* and glycemiaDyslipidemia*Asthma

Gadelha et al., 2019De Melo et al, 2017Enes et al., 2019D'Avilla et al., 2017Tavares et al., 2012Melo et al., 2018Elias et al., 2019

Obesity indicatorsObesity indicators and blood pressureObesity indicatorsindicators and blood pressure*Metabolic syndrome*Asthma*Asthma*

Children/adolescent

Adult

Source: Impact of ultra-processed food consumption on children’s, adolescent’s and adult’s health: systematic literature review. Louzada et al. Reports in Public Health. Under review.

Ultra-processed foods and obesity in adults

Hall et al., 2019 Obesity indicators* National Institutes of Health (NIH) clinical trial

Ultra-processed diets cause excess calorie intake and weight gain

Hall et al., 2019

Ultra-processed diets cause excess calorie intake and weight gain

Hall et al., 2019

Ultra-processed foods and cardiovascular disease, diabetes and cancer

Ultra-processed foods and depression

Ultra-processed foods and all-cause mortality

Ultra-processed food and NCDs: mechanisms

Replacement of freshly made meals

based on unprocessed or minimally

processed foods.

Convenient, assessible, ready-to-eat, and “appealing”.

Higher energy intake rates (kcal/min)

Large portion sizes

Excessive and “mindless” calorie

consumption

Forde et al (2020)

• Higher energy density, more free sugar and saturated and trans fats

• Less dietary fiber, protein, vitamins and minerals and bioactive compounds.

• Overall deterioration of the nutritional dietary quality demonstrated in nationally representative studies of 10 middle- and high-income countries.

Ultra-processed food and NCDs: mechanisms

Moubarac et al., 2017; Louzada et al., 2018; Cediel et al., 2018; Steele et al., Rauber et al., 2018, Marron-Ponce et

al., 2019; Koiwai et al., 2019; Parra et al., 2019, Machado et al., 2019; Andrade et al unpublished

Sugars and oils/fats (often simultaneously and acellular)

Destruction of food matrix

Cosmetic additives

Removal of water content

Ultra-processed food and NCDs: mechanisms

Higher glycemic

response

Alteration of satiety

control systems

Sugars and oils/fats (often simultaneously and acellular)

Destruction of food matrix

Cosmetic additives

Removal of water content

Ultra-processed food and NCDs: mechanisms

Metabolic altarations and

neoplasic lesions

Higher glycemic

response

Alteration of satiety

control systems

Sugars and oils/fats (often simultaneously and acellular)

Destruction of food matrix

Cosmetic additives

Removal of water content

Ultra-processed food and NCDs: mechanisms

Metabolic altarations and

neoplastic lesions

Higher glycemic

response

Alteration of satiety

control systems

Ultra-processed food and NCDs: mechanisms

Sugars and oils/fats (often simultaneously and acellular)Neoformed contaminants

Plastic packaging

Sugars and oils/fats (often simultaneously and acellular)Neoformed contaminants

Plastic packaging

Increased risk of some chronic

diseases such as cardiovascular

diseases and cancer

Retail sales per capita of ultra-processed food anddrink products in global regions, 2000 and 2013

PAHO, 215. Ultra-processed food and drink products in Latin America: Trends,

impact on obesity, policy implications