Ultra-processed food Dr Viola Zulian

Ultra-processed food

friend or enemy?

Obesity is a chronic disease that is spreading like wildfire. From an epidemiological point of view, it is estimated that over 600 million people are affected and that in 2030 about 70% of the world’s population will be interested.

There are many reasons involved, including the availability of food, the sedentary lifestyle and the consumption of food which is too energetically rich.

In this last group, ultra-processed foods are pointed out.

But do we really eat?

Well apparently yes, thank goodness still in a contained way. According to European, New Zealand and US national surveys, we purchase 25% to 60% of ultra-processed foods. (1)

As consumption trends are definitely on the rise, many researchers have been interested in the relationship they have with our health: are they good or bad?

First of all, let’s understand: what are ultra-processed foods?

  • They are foods made up of multiple ingredients for industrial use only.
  • are assembled from substances derived from food or synthesized from other organic sources.
  • Contain minimal quantities, or even no presence, of intact food in its natural state.
  • They are ready for immediate consumption or need minimal heating.
  • They are fat, sugars and salty compounds, free of fiber and trace elements. (2)
  • They are packaged and often have an attractive packaging.
  • They are highly palatable
  • They have preservatives, additives, dyes

Divided into groups:

  1. SUGARS: packaged pastries, snacks, ice creams, candies, dairy products, chocolate, energy bars.
  2. Fruits and vegetables: powders for dehydrated broth, brick broths, vegetable patties, canned fruit, vegetables already cooked with sauces, fruit desserts and sweetened yoghurt.
  3. Drinks: carbonated and non-carbonated, sweet or artificially sweetened
  4. Carbohydrates and cereals for breakfast: packaged bread, ready-made first courses (frozen and non-frozen), slimming meal substitutes, savory pies and ready-made pizzas
  5. Meat and fish: nuggets, sticks, salami, canned tuna, canned meat, sausages, hot dogs, sausages
  6. Thickeners, emulsifiers, artificial flavors, margarines and spreadable creams

NOVA classification of ultra-processed foods

On April 1, 2016, the United Nations (UN) general assembly proclaimed a decade (2016-2025) dedicated to nutrition as part of a development program supported by FAO and WHO.

Considering the role that food has on the environmental impact, FAO Director-General Josè Graziano da Silva said “This revolution places nutrition at the heart of sustainable development”.

The concept of ultra-processed food was developed by a team of researchers from the University of Sãn Paulo in Brazil.

«The most important factor now, considering food, nutrition and public health, is not nutrients and it is not food, but rather what was done to the food and nutrients originally contained in them, before being purchased and consumed.

The point is therefore the processing of food, or to be more precise the nature, the degree and the purpose of the processing, and what happens to the food and to us as a result of this processing ».

But the food industry claims that food processing allows you to eat bread without mold, to make jam a spreadable gel, to avoid the separation of peanut butter etc.

The reality is that almost all food undergoes some form of transformation, from industrial hydrogenation to cooking in our home oven.

It is therefore following this purpose that the NOVA classification was born:


Group 2: TREATED CULINARY INGREDIENTS (oils, butter, sugar, salt)

 Group 3: PROCESSED FOODS consisting of Group 1 to which Group 2 is added

Group 4: ULTRA-PROCESSED FOOD (UPF): it is not modified food but formulations made almost or completely from substances derived from food and additives, with little if any intact group 1 foods. (3)

It therefore follows that seasoning the salad with olive oil (group 2) has a completely different weight than eating chips (group 4). To avoid therefore, misunderstandings and understand the weight that the different stages of processing have on health, this world classification has been created.

What is the problem with ultraprocessed food?

As conceived, the UPF is not modified food but of particularly unhealthy industrial food formulations: fats, starches, sweeteners, salt, additives. The UPF is therefore rich in saturated, hydrogenated fats, deprived of any nutritional component. Thus they are related to chronic diseases of the «non-communicable diseases-NCDs» class.

NCDs are those set of diseases that cannot be transmitted from one person to another but that develop due to lifestyle (nutrition, sedentary lifestyle, types of work, tobacco, exposure to pollutants, etc.).

Most UPFs are formulated to be almost addictive and make it difficult to choose something healthier to prevent overconsumption. (4)

Since they are basically synthetic foods, they have very low production costs.

The profits are used almost entirely to subsidize advertising, attractive packaging and make them accessible especially for children and young people (surprises, prize competitions, collection of points, etc.). (5)

The UPF is also ready to use, or ready to be consumed: sometimes it is sufficient to heat it, other times it is sufficient to discard it. This way you can eat on the street, at work, in front of a screen, in the car or on the phone. And this, definitely clashes with marketing that proposes a social model for which some foods unite the family … (I refrain from listing them but we all have at least two or three in mind!).

This market has an oligopolistic structure (6) (that is, of a few companies that produce a homogeneous good, defining a distorted offer between seller and buyer). In this way they support each other and build eating habits in a ubiquitous way: that is, they teach how to snack.

In addition to being a problem for health and the social system, processed food has an economic impact.

The UPF multinationals earn a lot of profits thanks to the very low cost of the raw material. They therefore reinvest by purchasing local markets for minimally-processed food. To compete with these, regional markets themselves produce UPF food. Thus companies become monoculture broodmares of raw materials to confirm UPF, preventing the development of a food market that serves to feed people with real food. (7)

This reality is more present in developing countries allowing the spread of an unhealthy habit among poor people. (7)

Let’s not forget also that obesity and its metabolic complications have a very important economic weight and that therefore, we will probably pay less for the shopping receipt but public health rests on the pockets of all citizens.

Finally, the UPF has a significant environmental impact: its packaging alone accounts for one third of the volume of waste in the USA.  (8) Cans, plastic boxes, disposable packs, plastic bottles make up a mountain of non-biodegradable waste.

The multinationals, maintaining their oligarchy, distribute all over the world by consuming non-renewable energy for transportation. Especially as regards animal breeding, both water consumption and monoculture feed production (soybean, corn,

etc) induce environmental pollution associated with an impoverishment of non-renewable resources.

How does this food affect health?

Since about 10 years ago, Brazilian researchers coined this term(9) there has been an increase in research related to it. The object of the study is to demonstrate how the intake of poor foods from a nutritional point of view can promote cardiovascular diseases (such as dyslipidemia, hypertension), obesity and metabolic syndrome and cancer. (2)

In a large French prospective study (NutriNet-Santé), the dietary habits of 105,159 citizens were analyzed and recorded over a period of 2 years, followed by an average follw-up of 5.2 years.

Patients who had significant UPF consumption had a 10% greater risk of developing cardiovascular disease than the low-consumption group.

Also in the same prospective cohort, the link between UPF consumption and breast cancer was seen. A 10% increase in UPF consumption increases the appearance of breast cancer by 11% and all other cancers by 12%.

Among the possible causes of this report, the authors include:

  1. Food low in micronutrients and fiber;
  2. High glycemic response and less sense of satiety;
  3. By increasing obesity, they favor all hormone dependent tumors and especially breast cancer in post-menopausal women
  4. The effect of additives is poorly understood. Although most of the additives are added respecting the maximum permitted doses, little is known about the “cocktail” effect of the set of multiple additives mixed together. (10)

For some additives, studies on animal or cellular models have shown their carcinogenicity which must be confirmed in humans.

For example titanium dioxide is a food additive that contains nanoparticles. We use these to whiten foods or to leave them in the packaging so that food is preserved better and longer. Studies in rats show that it can have a pre-neoplastic effect on the intestinal mucosa. So WHO and the International Agency for Research on Cancer define it as “possible carcinogenetics for the human (group 2B)”. (11)

Same thing could be said about aspartame: long-term results are not known.

  1. The heating process of the UPF could produce molecules such as acrylamide.

The European Food Safety Agency defines it “genotoxic”, that is, capable of changing DNA. (12)

A recent meta-analysis shows a modest association between acrylamide and endometrial and renal tumors in non-smokers. (13)

  1. Finally, bisphenol A, contained in packaging in contact with food, scientific evidence increasingly shows its role in the pathogenesis of NCDs, of tumors, reserving its role as endocrine disruptor. (14)

A Brazilian cross-section study of nearly 56,000 people showed that the consumption of UPF food is linked to an increase in overweight and obesity in all age groups. (15)

It is therefore more than evident that the increase in the percentage of UPF food is related to NCD diseases, obesity to cancer, increasing mortality. (16)

So how to behave regarding the UPF?

WHO Recommendations (17):

• Banish hydrogenated fats (contained in industrial chips, pizza, pastry, biscuits, sweets, ice cream, spreads).
• Limit saturated fat to 10% of the total energy intake. Fats must not exceed 30% of the daily calorie intake. Some ruminant animals produce trans hydrogenated fats (cow, sheep, goat and camel), their intake must not exceed 1% of total fat.
• The sugars must be less than 10% of the energy intake, considering that there are additional benefits if this intake falls below 5%. By sugars we mean refined sugar, honey, maple syrup, coconut sugar, molasses, fruit juices.
• Salt: maximum 5 g of salt per day (one coffee spoon). It must be iodized salt.

Michael Pollan, author of the book In defense of food, suggests eating real foods and not industrial transformations of the latter “do not eat foods prepared by people dressed as surgeons” and continues “eat foods produced by plants and not by plants”.

The cultural revolution on food education is difficult and requires immense efforts.

Even though I am solicited by the subject, I am sometimes wrong.

But I believe that starting from the youngest, a culture linked to food can be spread as nourishment and not as consumption.

In Italy, for example, the “Fruit in schools” campaign was launched, which allows the distribution of seasonal fruit by raising awareness among young minds. (18)

My niece Aurora, together with my sister-in-law Diletta, created for the classmates together with a particularly attentive and sensitive teacher “the organized snack”: once a week the snack is distributed by local producers. Their goal is to decrease the economic and environmental impact of food, but it goes without saying that it also means avoiding UPF food. (Elementary School of Bolzano Vicentino -VI)

Here in France since 2013, there is a ban on providing the 10.00 am snack as it would favor overweight and the habit of snack (19).  Of course, rather than eating chips it is better to fast, but let’s remember that the brain works only with glucose.

It would therefore be appropriate to educate rather than deprive, as the educated child often becomes a spokesperson and champion in the family.

Advertising plays an equally important role, according to an analysis made by Roma Tre University, a child who watches TV from 16.00 to 19.00, watches a food advertisement every 5 minutes (and they are not complaints of carrots and chickpeas! Alas!). For the moment I have not found laws that limit this exhibition.

Personally, I do not let my children watch television during the week, and on the weekend there are paid platforms that now have really ridiculously low prices.

I know, the work to be done is titanic but I am convinced that the voices are beginning to be heard.

Without proselytism but with such benevolence, we should follow an attitude aimed at setting an example. I hope that you too, hero / heroine who have reached the end of this article, will be more aware of the topic and will try to improve your daily diet knowing that we vote with our money and that our choices will inevitably have a economic impact…. Yes, even with that euro and fifty of that can.

With Gratitude,

[1] C. Luiten et al. Ultra-processed foods have the worts nutrient profile, yet they are the most available packaged products in a sample of New Zeland supermarket. Public Health Nutr 2016

[2] CA. Monteiro The UN decade of nutrition, the NOVA food classification and the trouble with ultra-processing Publ Health Nutrition 2017

[3] CA Monteiro, The UN decade of Nutrition, the NOVA food classication and the trouble with ultra-processing , Public Health Nutrition 2017

[4] K Brownell Food and addiction. A comprehensive Handbook. Oxfor press

[5] P Chandon, Does food marketing need to make us fat? A review and solutions Nutr Rev 2012

[6] CA Monteiro, The snack attack, AM J of Public health 2010

[7] Rockfeller foundation , Unhealthy Developing World food market, 2013 Developing-World-Food-Markets.pdf

[8] Institute of food technologist, Fodd technology and its environmental impact, Food Technol 2012

[9] CA. Monteiro The issue is not food, nor nutrients, so much as processing. Public Health Nutr2009

[10] Fiolet T, Consumption of ultra-processed foods and cancer risk: results from NutriNet-Santé prospective cohort, BMJ 2018

[11] IARC Working Group on the Evaluation of Carcinogenic Risks to Humans Carbon black, titanium dioxide, and talc. IARC Monogr Eval Carcinog Risks Hum 2010

[12] Acrylamide in food. EFSA Journal 2015

[13] Virk-Baker MK, Dietary acrylamide and human cancer: a systematic review of literature. Nutr Cancer 2014

[14] Muncke J. Endocrine disrupting chemicals and other substances of concern in food contact materials: an updated review of exposure, effect and risk assessment. J Steroid Biochem Mol Biol 2011

[15] D Silva Canella Ultra-Processed Food Products and Obesity in Brazilian Households (2008–2009), Plos One 2014

[16] R Blanco-Rojo Consumption of Ultra-Processed Foods and Mortality: A National Prospective Cohort in Spain , mayo Clinic proceedings, 2019

[17] healthy-diet