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Ultra-Processed Foods, Dietary Quality and Human Health

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A Special Issue of Nutrients (ISSN 2072-6643) belonging to the section "Nutrition and Public Health".

Deadline for manuscript submissions: closed (20 January 2026) | Viewed by 50583

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Prof. Dr. Martin Smollich

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Institute of Nutritional Medicine, University Medical Center Schleswig-Holstein, 23538 Luebeck, Germany
Interests: pharmaconutrition; dietary supplements; functional food; food fortification; plant-based dairy and meat alternatives

Special Issue Information

Dear Colleagues,

A plethora of epidemiological studies demonstrate associations between the high consumption of ultra-processed food (UPF) and the risk of almost any non-communicable disease (NCD), disease-specific mortality, and all-cause mortality. Observational studies have notable limitations, as have the different food classification systems, and proof of causality and its distinct mechanisms is still lacking. Although intuitive and apparently plausible, the concept of UPF is intricate and has been challenged by mechanistic studies. Moreover, calls for a regulatory restriction of UPF marketing and consumption would have an impact not only on food safety, nutrient supply, and dietary habits, but also on sustainability, food fortification, resource efficiency, food waste, planetary health goals, and socio-economic perspectives. Therefore, different dimensions have to be taken into account when assessing the consequences of dietary recommendations that are not based on nutrients, but on the degree of food processing.

Prof. Dr. Martin Smollich
Guest Editor

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Keywords

ultra-processed food
NOVA classification
non-communicable diseases
food systems

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Published Papers (6 papers)

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Research

14 pages, 594 KB

Open AccessArticle

Beyond Nutrients: NOVA-Defined Dietary Patterns in Crohn’s Disease and Healthy Adults

by Ayva Lewis, Thea Ulsamer, Laura Franco, Stephanie Gold, Natasha Haskey and Maitreyi Raman

Nutrients 2026, 18(7), 1068; https://doi.org/10.3390/nu18071068 - 27 Mar 2026

Viewed by 1378

Abstract

Background: Diet quality and food processing patterns are increasingly recognized as important determinants of Crohn’s disease (CD) risk and disease outcomes; however, direct comparisons with healthy populations using integrated nutrient- and processing-based frameworks remain limited. Therefore, we aim to quantify ultra-processed food (UPF) consumption using the NOVA classification, compare UPF intake between CD patients and healthy controls, and assess its association with diet quality indices. Methods: Baseline dietary intake data were analyzed from two randomized controlled trial cohorts: adults with mild to moderately active CD enrolled in the Crohn’s Disease Therapeutic Dietary Intervention (CD-TDI) trial (n = 64; NCT04596566), and healthy adults participating in the MAPMed study (n = 33, NCT06765369). Dietary intake was assessed using two non-consecutive 24 h recalls collected with the Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24^®). Energy-normalized macronutrient and micronutrient intakes were compared with Dietary Reference Intakes (DRIs). Overall diet quality was evaluated using the Healthy Eating Index-2020 (HEI-2015), Alternate Mediterranean Diet score (aMED), and Dietary Inflammatory Index (DII). Foods were classified according to the NOVA food processing system to estimate total and proportional energy intake from UPFs (NOVA group 4). Results: Both the CD cohort and healthy cohort exhibited suboptimal dietary patterns, with HEI scores indicating a need for improvement, low adherence to the Mediterranean diet (aMED), and neutral-to-pro-inflammatory DII scores, with no significant between-group differences (all p > 0.05). Although total energy intake differed between groups (p = 0.04), the proportion of energy derived from UPFs (NOVA group 4) accounted for half of the total intake in both cohorts (51.3–51.8%; p = 0.55). Higher UPF intake was associated with lower HEI and aMED scores and higher DII scores. Conclusions: In this study, there were no significant differences in the dietary patterns in those with CD compared to healthy controls. The high contribution of UPFs observed in both cohorts underscores widespread suboptimal dietary quality and highlights the utility of NOVA-based food processing measures as complementary to nutrient-based assessments for understanding diet-related inflammatory burden in CD. Full article

(This article belongs to the Special Issue Ultra-Processed Foods, Dietary Quality and Human Health)

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15 pages, 1233 KB

Open AccessArticle

Ultra-Processed Food Consumption Among Caregivers and Children in the “Happy Smile” Project: Associations with Family Dietary Patterns and Periodontal Health-Related Quality of Life

by Vitor Hugo Gonçalves Sampaio, Guilherme Assumpção Silva, Amanda Rodrigues Araújo, Ana Laura Gavaldão Santana Moreira, Letícia Helena Theodoro, Alessandra Marcondes Aranega, Cristina Antoniali Silva and Daniela Atili Brandini

Nutrients 2026, 18(4), 678; https://doi.org/10.3390/nu18040678 - 19 Feb 2026

Cited by 1 | Viewed by 1024

Abstract

Background/Objectives: The consumption of ultra-processed foods (UPFs) has increased markedly in recent decades and has been associated with adverse health outcomes. In childhood, the family environment plays a central role in shaping dietary habits and oral health behaviors. This study investigated the association between UPF consumption by caregivers and children, its relationship with caregivers’ periodontal health-related quality of life, and described children’s dietary practices and oral hygiene habits. Methods: This cross-sectional study was conducted with caregivers of children participating in the Happy Smile Project in Birigui, São Paulo, Brazil. UPF consumption was assessed using a questionnaire based on the NOVA classification, and periodontal health-related quality of life was evaluated using the OHIP-14-PD. Results: A high frequency of UPF consumption was observed among both caregivers and children. Children whose caregivers had high UPF consumption were more likely to also present high consumption (OR = 9.96; 95% CI: 5.38–18.44; p < 0.001). Higher caregiver education was associated with lower odds of high UPF consumption among children. Children in the high-consumption group were older and showed higher consumption of sweetened milk beverages (p < 0.001). Risk behaviors for oral health, such as nighttime use of sweetened bottles and absence of toothbrushing afterward, were frequently reported. Regarding periodontal health-related quality of life, only the physical disability domain showed significantly higher scores among caregivers with high UPF consumption (p = 0.014). Conclusions: This study demonstrated that high consumption of ultra-processed foods by caregivers significantly increased the odds of children’s consumption and was associated with a greater negative impact on caregivers’ periodontal health-related quality of life, specifically in the physical disability domain. In addition, children exhibited a high frequency of oral health-damaging behaviors. These findings highlight the importance of family-centered strategies aimed at reducing the intake of ultra-processed foods and promoting healthier dietary and oral health behaviors. Full article

(This article belongs to the Special Issue Ultra-Processed Foods, Dietary Quality and Human Health)

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22 pages, 1500 KB

Open AccessArticle

Ultra-Processed Food and Frailty: Evidence from a Prospective Cohort Study and Implications for Future Research

by Elsa M. Konieczynski, Shivani Sahni, Paul F. Jacques and Elena N. Naumova

Nutrients 2025, 17(16), 2631; https://doi.org/10.3390/nu17162631 - 14 Aug 2025

Cited by 4 | Viewed by 4058

Abstract

Background: Ultra-Processed Foods (UPFs) make up a growing share of older adults’ diets and may contribute to frailty through pro-inflammatory pathways. The objective of this study was to examine the association of UPF intake with frailty development and with annual changes in select frailty components. Methods: This prospective cohort study used data from 2547 participants in the Framingham Offspring Cohort. UPF intake was assessed using a food frequency questionnaire and classified according to the NOVA framework, and frailty was defined by the Fried frailty phenotype. We used cumulative and mixed logistic regression models to examine the association between daily servings of UPF and odds of developing frailty, adjusting for baseline age, education, energy intake, multivitamin use, smoking, self-rated health, history of diabetes, cancer, cardiovascular disease, and diet quality. For the frailty component analysis, we used cumulative linear regression models to assess the association between UPF intake and annual changes in grip strength, gait speed, and weight, further adjusting for BMI and physical activity. We also evaluated potential effect modification by sex and baseline age (<60 vs. ≥60 years). Results: The study population was 55.1% female, with a mean age of 60.3 ± 8.9 years. Over an average follow-up of 10.8 years, 233 participants (9.2%) developed frailty. UPF intake was not associated with frailty development in either the cumulative or mixed regression models. UPF intake was not associated with annual weight change but was inversely associated with annual change in gait speed and with annual change in grip strength in men only. Conclusions: Our findings contribute preliminary evidence that, in middle-aged and older adults, increased UPF intake is not associated with frailty but may be related to worsening muscle strength and function. Further research with a more granular approach to UPF classification is required to translate these findings to practical recommendations and to clarify their clinical significance. Full article

(This article belongs to the Special Issue Ultra-Processed Foods, Dietary Quality and Human Health)

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19 pages, 3189 KB

Open AccessArticle

Ultra-Processed Foods in the Food Supply: Prevalence, Nutritional Composition and Use of Voluntary Labelling Schemes

by Edvina Hafner, Maša Hribar and Igor Pravst

Nutrients 2025, 17(10), 1731; https://doi.org/10.3390/nu17101731 - 20 May 2025

Cited by 6 | Viewed by 4209

Abstract

Background: Ultra-processed foods (UPFs) represent a substantial part of modern diets, with a growing prevalence in food environments worldwide. Their unfavourable nutritional composition and adverse health effects present growing public health concerns. Methods: This study examines the prevalence of UPFs in the Slovenian food supply, their nutritional quality and the use of different food symbols and labelling schemes on food packaging. A cross-sectional analysis was conducted using the representative Slovenian branded foods database. A total of 23,173 prepacked foods and beverages were categorised into levels of processing according to the NOVA classification system. The nutritional composition of UPFs was compared to less processed products within 16 narrow subcategories. Additionally, the prevalence in the use of front-of-package nutrition labelling (FOPNL) and subjectively nutrition-related elements (SNREs) (such as EU Organic, Vegan labels etc.) were assessed across different food categories and processing levels. Results: Results show that UPFs represent 54.5% of the available products in the Slovenian food supply, with the highest prevalence in Confectionery (93%), Bread and bakery products (83%), Meat, meat products and alternatives (77%) and Convenience foods (74%). Comparison of nutritional composition indicated that UPFs had significantly poorer nutritional composition compared to less processed counterparts, including higher levels of sugar, salt and saturated fats, and a lower protein content. Breakfast cereals, Snack foods, Meat alternatives and Pre-prepared salads and sandwiches showed the most significant differences between UPFs and less processed counterparts. Analysis of the prevalence of symbols and labelling schemes revealed that 33.8% of products carried at least one FOPNL (15.0%) or SNRE (19.1%), with SNREs being more prevalent on less processed products and FOPNL predominantly used on UPFs (p < 0.05). The most prevalent SNRE was the EU Organic logo (12.7%), followed by the Vegan (4.7%) and Non-GMO (3.1%) logos, whereas the most frequent FOPNL was Reference Intakes (RI), presenting only energy value RI-Energy (12.5%), followed by nutrient-specific RI (1.6%), while other FOPNL were scarce and limited to certain categories. An additional comparison of visual presentation highlighted the potentially selective use of voluntary FOPNL to improve product framing. This raises concerns about their role in guiding consumer choices versus serving as marketing tools, especially when it comes to UPFs. Conclusions: Our findings highlight the need for monitoring UPFs in the food supply together with harmonised, mandatory labelling regulations to ensure transparency and empower consumers to make healthier choices. Full article

(This article belongs to the Special Issue Ultra-Processed Foods, Dietary Quality and Human Health)

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17 pages, 3577 KB

Open AccessArticle

Associations of Ultra-Processed Food Intake and Its Circulating Metabolomic Signature with Mental Disorders in Middle-Aged and Older Adults

by Shenghao Yuan, Tengfei Zhu, Jiawei Gu, Li Hua, Jinli Sun, Xiaobei Deng and Jinjun Ran

Nutrients 2025, 17(9), 1582; https://doi.org/10.3390/nu17091582 - 4 May 2025

Cited by 17 | Viewed by 7310

Abstract

Background: The global rise in ultra-processed food (UPF) consumption and the persistent burden of mental disorders have raised growing public health concerns. Emerging evidence suggests that unfavorable dietary patterns, particularly with high UPF intake, contribute to the development of mental disorders. Objective: To assess the associations of UPF-related metabolic signatures and mental disorders. Methods: In this population-based cohort study of 30,059 participants from the UK Biobank, we first identified a plasma metabolic signature associated with UPF intake leveraging nuclear magnetic resonance metabolomics. We then applied Cox and logistic regression models to investigate the associations of both UPF consumption and its metabolic signature with incident mental disorders and specific psychological symptoms, respectively. Results: Higher UPF intake was significantly associated with increased risks of overall mental disorder (hazard ratio per 10% increment [95% confidence interval]: 1.04 [1.02, 1.06]), depressive disorder (1.14 [1.08, 1.20]), anxiety disorder (1.12 [1.06, 1.18]), and substance use disorder (1.06 [1.01, 1.11]), as well as several psychological symptoms including suicidal ideation (odds ratios [95% confidence interval]: 1.12 [1.03, 1.16]) and anxiety feeling (1.05 [1.01, 1.09]). Similarly, the UPF-related metabolic signature was independently associated with elevated risks of these mental health outcomes and partially mediated the associations between UPF intake and mental disorders. Conclusions: These findings highlighted the potential metabolic pathways underlying the neuropsychiatric risks of UPF consumption and underscored the importance of dietary quality in mental health. Full article

(This article belongs to the Special Issue Ultra-Processed Foods, Dietary Quality and Human Health)

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12 pages, 391 KB

Open AccessArticle

Investigating the Relationship Between Ultra-Processed Food Consumption and Academic Performance in the Adolescent Population: The EHDLA Study

by José Francisco López-Gil, Emily Cisneros-Vásquez, Jorge Olivares-Arancibia, Rodrigo Yañéz-Sepúlveda and Héctor Gutiérrez-Espinoza

Nutrients 2025, 17(3), 524; https://doi.org/10.3390/nu17030524 - 31 Jan 2025

Cited by 12 | Viewed by 31134

Abstract

Background: Previous studies have tested the link between diet quality and academic performance in the young population. However, no study has analyzed the specific relationship between ultra-processed food (UPF) consumption and academic performance in adolescents. The aim of the present study was to test the link of UPF consumption with academic performance in a sample of adolescents from Spain. Methods: This secondary cross-sectional analysis utilized information from 788 youths aged 12–17 participating in the Eating Healthy and Daily Life Activities study. The sample comprised 44.7% boys and 55.3% girls, with a median age of 14.0 years (interquartile range [IQR]: 13.0 to 15.0). The UPF consumption was measured through a self-completed food frequency survey. Academic performance was determined using end-of-year academic records provided by each educational institution. To examine the relationships between these variables, generalized linear models were employed. The models were adjusted for factors including sex, age, socioeconomic status, conduct, physical activity, sleep duration, body mass index, and sedentary behavior. Results: Significant dose–response associations between UPF consumption and all the different academic performance indicators, showing that higher UPF consumption is consistently associated with poorer academic performance (p < 0.001 for all). Higher daily UPF servings were associated with lower adjusted marginal means for grade point average, language, maths, and English. Furthermore, adolescents in the highest UPF tertile had a grade point average of 5.6 compared to 6.6 in the lowest tertile, with similar patterns being observed for language (6.0 vs. 7.0), maths (5.2 vs. 6.2), and English (5.7 vs. 6.6). Conclusions: Our study identifies a negative association between UPF consumption and academic performance in adolescents, highlighting it as a modifiable factor that could impact academic outcomes. Adolescents with higher UPF consumption exhibited consistently lower grades across various academic indicators, emphasizing the importance of dietary quality during this critical developmental period. Full article

(This article belongs to the Special Issue Ultra-Processed Foods, Dietary Quality and Human Health)

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