Mayo Clinic Proceedings Home

Ultraprocessed Foods and Public Health: A Need for Education

  • Miguel Ángel Martínez-González
    Correspondence
    Correspondence: Address to Miguel Ángel Martínez-González, Department of Preventive Medicine and Public Health, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain.
    Affiliations
    Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
    CIBERObn, Carlos III Health Institute, Madrid, Spain
    Department of Nutrition, Harvard University T H Chan School of Public Health, Boston, MA
    IdiSNA, Pamplona, Spain
    Search for articles by this author
  • Nerea Martín-Calvo
    Affiliations
    Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
    CIBERObn, Carlos III Health Institute, Madrid, Spain
    IdiSNA, Pamplona, Spain
    Search for articles by this author
      Ultraprocessed foods, which are made from food constituents but without any identifiable intact food in them, contain coloring chemicals, stabilizing substances, flavoring agents, and other additives that imitate or intensify the sensory qualities of foods or culinary preparations. They are also heavily loaded with free sugars, fats, salt, synthetic antioxidants, preservatives, and a variety of other chemical additives. Examples of ultraprocessed foods include sugar-sweetened beverages, sugared milk, fruit drinks, fast foods (eg, sausages, burgers), cookies, candy sweets, and savory packaged snacks.
      The reason for their expanded consumption is that ultraprocessed foods are tasty, as well as convenient and considerably inexpensive for the industry. They tend to have a long shelf life and allow for huge profit margins. Unfortunately, they are very rich in energy and in potentially unhealthy elements. Moreover, they replace healthy, nutritious, fresh foods, thus depriving consumers of the benefits derived from a high-quality food pattern mainly based in nonprocessed or minimally processed foods, such as the traditional Mediterranean diet.
      From a geographic perspective, at the country level, higher consumption of ultraprocessed foods is strongly associated with higher rates of obesity.
      • Monteiro C.A.
      • Moubarac J.C.
      • Levy R.B.
      • Canella D.S.
      • Louzada M.L.D.C.
      • Cannon G.
      Household availability of ultra-processed foods and obesity in nineteen European countries.
      From a temporal perspective, the current pandemic of obesity
      • González-Muniesa P.
      • Martínez-González M.A.
      • Hu F.B.
      • et al.
      Obesity.
      has been preceded by global increases in the production and consumption of ultraprocessed foods, with estimates of a 3-fold increase in their consumption in some Western countries between 1990 and 2010.
      • Rico-Campà A.
      • Martínez-González M.A.
      • Alvarez-Alvarez I.
      • et al.
      Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study.
      Many voices are arguing for the need to address structural (social, economic, cultural, and psychological) determinants of the current undeterred expansion of the obesity pandemic, which is compromising life expectancy and can, eventually, compromise the sustainability of most health systems worldwide. In this regard, ultraprocessed foods merit consideration. Beyond geographic or temporal analyses (ecological comparisons) and mechanistic arguments, long-term, prospective, and well-controlled epidemiologic studies at the individual level have shown a strong obesogenic effect of ultraprocessed foods.
      • Mendonça R.D.
      • Pimenta A.M.
      • Gea A.
      • et al.
      Ultraprocessed food consumption and risk of overweight and obesity: the University of Navarra Follow-Up (SUN) cohort study.
      In addition to obesity and weight gain, ultraprocessed foods have also been linked to cancer
      • Fiolet T.
      • Srour B.
      • Sellem L.
      • et al.
      Consumption of ultra-processed foods and cancer risk: results from NutriNet-Santé prospective cohort.
      and cardiovascular disease
      • Srour B.
      • Fezeu L.K.
      • Kesse-Guyot E.
      • et al.
      Ultra-processed food intake and risk of cardiovascular disease: prospective cohort study (NutriNet-Santé).
      in recent large epidemiologic studies conducted in France. In the present issue of Mayo Clinic Proceedings, Blanco-Rojo et al
      • Blanco-Rojo R.
      • Sandoval-Insausti H.
      • López-García E.
      • et al.
      Consumption of ultra-processed foods and mortality: a national prospective cohort in Spain.
      show in an elegant prospective cohort conducted in a representative sample of Spain that higher consumption of ultraprocessed foods was independently associated with higher all-cause mortality after nearly 8 years of follow-up. When ultraprocessed foods provided more than 1 of every 3 calories, the relative increase in total mortality was 44% compared with the group in which ultraprocessed foods provided only 1 of every 7 calories.
      The results of 3 very recent and well-conducted prospective cohort studies concur with these findings. These 3 large studies were conducted in the United States
      • Kim H.
      • Hu E.A.
      • Rebholz C.M.
      Ultra-processed food intake and mortality in the USA: results from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994).
      (Third National Health and Nutrition Examination Survey), France,
      • Schnabel L.
      • Kesse-Guyot E.
      • Allès B.
      • et al.
      Association between ultraprocessed food consumption and risk of mortality among middle-aged adults in France.
      and Spain.
      • Rico-Campà A.
      • Martínez-González M.A.
      • Alvarez-Alvarez I.
      • et al.
      Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study.
      All 4 cohorts applied strict adjustment for potential confounding and conducted robust statistical analyses. Their results are consistent and are summarized in the Figure and in the Supplemental Table, available online at http://www.mayoclinicproceedings.org.
      Figure thumbnail gr1
      FigureHazard ratios (95% CIs) for the comparison of extreme quartiles in 4 study cohorts.
      These consistent findings preserve the temporal sequence and show dose-response patterns and strength in the association with such an important outcome as all-cause mortality. Together, they raise issues pertaining to individual health, public health, and public health care policy. For example, the latter may involve education regarding the rise in the consumption of ultraprocessed foods and these observed associations. Blanco-Rojo et al
      • Blanco-Rojo R.
      • Sandoval-Insausti H.
      • López-García E.
      • et al.
      Consumption of ultra-processed foods and mortality: a national prospective cohort in Spain.
      are to be commended for their important and timely contribution to this salient field in individual and population health.

      Supplemental Online Material

      References

        • Monteiro C.A.
        • Moubarac J.C.
        • Levy R.B.
        • Canella D.S.
        • Louzada M.L.D.C.
        • Cannon G.
        Household availability of ultra-processed foods and obesity in nineteen European countries.
        Public Health Nutr. 2018; 21: 18-26
        • González-Muniesa P.
        • Martínez-González M.A.
        • Hu F.B.
        • et al.
        Obesity.
        Nat Rev Dis Primers. 2017; 3: 17034
        • Rico-Campà A.
        • Martínez-González M.A.
        • Alvarez-Alvarez I.
        • et al.
        Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study.
        BMJ. 2019; 365: l1949
        • Mendonça R.D.
        • Pimenta A.M.
        • Gea A.
        • et al.
        Ultraprocessed food consumption and risk of overweight and obesity: the University of Navarra Follow-Up (SUN) cohort study.
        Am J Clin Nutr. 2016; 104: 1433-1440
        • Fiolet T.
        • Srour B.
        • Sellem L.
        • et al.
        Consumption of ultra-processed foods and cancer risk: results from NutriNet-Santé prospective cohort.
        BMJ. 2018; 360: k322
        • Srour B.
        • Fezeu L.K.
        • Kesse-Guyot E.
        • et al.
        Ultra-processed food intake and risk of cardiovascular disease: prospective cohort study (NutriNet-Santé).
        BMJ. 2019; 365: l1451
        • Blanco-Rojo R.
        • Sandoval-Insausti H.
        • López-García E.
        • et al.
        Consumption of ultra-processed foods and mortality: a national prospective cohort in Spain.
        Mayo Clin Proc. 2019; 94: 2178-2188
        • Kim H.
        • Hu E.A.
        • Rebholz C.M.
        Ultra-processed food intake and mortality in the USA: results from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994).
        Public Health Nutr. 2019; 22: 1777-1785
        • Schnabel L.
        • Kesse-Guyot E.
        • Allès B.
        • et al.
        Association between ultraprocessed food consumption and risk of mortality among middle-aged adults in France.
        JAMA Intern Med. 2019; 179: 490-498

      Linked Article