Negative Health Impacts of Ultra-Processed Foods Go Beyond Their Nutritional Profiles, Researchers Say

Two major studies in the United States and Italy link premature death and colorectal cancer to highly processed food consumption.
By Paolo DeAndreis
Sep. 9, 2022 11:27 UTC

The impact of ultra-processed food con­sump­tion on human health may be more sig­nif­i­cant than the food’s nutri­tional qual­i­ties.

According to new research in Italy, food rat­ings cur­rently used for pack­aged food labels may miss the point by mainly focus­ing on the nutri­tional pro­file of processed foods.

People should stop focus­ing only on the nutri­tional pro­file of food. They need to start explor­ing the degree of pro­cess­ing in the food they buy.- Marialaura Bonaccio, senior epi­demi­ol­o­gist, Italian Mediterranean Neurologic Institute

The research paper pub­lished by the Journal of the British Medical Association (BMJ) found that sig­nif­i­cant ultra-processed food con­sump­tion leads to higher mor­tal­ity risks by sev­eral causes. However, the nutri­tional pro­file of such food does not impact these risks.

The same edi­tion of the BMJ also fea­tured American research demon­strat­ing a link between high con­sump­tion of ultra-processed food and col­orec­tal can­cer, with sig­nif­i­cant dif­fer­ences in the impact between men and women.

See Also:Health News

Investigating the results of their 15-year study on more than 20,000 indi­vid­u­als, the Italian researchers tested the effects of con­sum­ing ultra-processed food, clas­si­fied as such by NOVA rat­ings, while also con­sid­er­ing their nutri­tional clas­si­fi­ca­tion from the Food Standards Agency Nutrient Profiling System (FSAm-NPS).

NOVA was devel­oped by researchers at the University of São Paulo in Brazil. According to a 2019 United Nations Food and Agricultural Organization paper, NOVA def­i­n­i­tions of ultra-processed foods are the most applied in sci­en­tific lit­er­a­ture.

FSAm-NPS, on the other hand, is cur­rently used to rate foods by rel­e­vant front-of-pack-label­ing sys­tems, such as the French-born Nutri-Score.

We felt the need to see if Nutri-Score could really help improve pub­lic health, as the European Commission is cur­rently con­sid­er­ing its intro­duc­tion as an E.U.-wide manda­tory food rat­ing sys­tem,” Marialaura Bonaccio, senior epi­demi­ol­o­gist at the Italian Mediterranean Neurologic Institute and co-author of the study, told Olive Oil Times.

In the last 10 years, research has gone beyond focus­ing on the sole nutri­tional com­po­si­tion of foods,” she added. Thanks to the work of Carlos Monteiro and oth­ers, the research has begun focus­ing on how food is trans­formed and manip­u­lated.”

According to the researchers, both FSAm-NPS and NOVA reach their food rat­ing goals when indi­vid­u­ally applied to foods. Results change, though, when the two indexes are jointly con­sid­ered.

Both sys­tems cor­rectly pre­dict health risks,” Bonaccio said. If you con­stantly choose foods rated as inad­e­quate by Nutri-Score, you expose your­self to greater risks of incur­ring rel­e­vant dis­eases. The same goes for NOVA, which is also asso­ci­ated with coro­nary heart dis­ease risk.”

When they are jointly con­sid­ered, though, the risks asso­ci­ated with Nutri-Score are reduced by the NOVA sys­tem, and that tells us we are not see­ing the impact of a nutri­ent-poor diet but the impact of ultra-processed foods,” she added. More than 80 per­cent of foods Nutri-Score rates as poor qual­ity foods are ultra-processed.”

In the study, the authors wrote that a sig­nif­i­cant pro­por­tion of the higher mor­tal­ity risk asso­ci­ated with an ele­vated intake of nutri­ent-poor foods was explained by a high degree of food pro­cess­ing. In con­trast, the rela­tion between a high ultra-processed food intake and mor­tal­ity was not explained by the poor qual­ity of these foods.”

The NOVA sys­tem typ­i­cally defines ultra-processed food as food hav­ing five or more ingre­di­ents not usu­ally found in a house­hold. Those sub­stances, such as addi­tives and enhancers, are part of ultra-pro­cess­ing meth­ods as they derive from the fur­ther pro­cess­ing of food com­po­nents.

The ultra-process def­i­n­i­tion is cru­cial because it is not uni­vo­cal. It is mostly com­mon sense,” Bonaccio said. If I bake a pie at home, I might use many sim­ple ingre­di­ents such as flour, eggs or milk. And the out­come might depend on the cor­rect bal­ance among those ingre­di­ents.”

But when, on top of that, I use food addi­tives, then the pie starts to become an ultra-processed food,” she added. That is why the def­i­n­i­tion is not totally unam­bigu­ous. For exam­ple, if in a super­mar­ket you see a fruit-based yogurt whose pack­age dis­plays five lines of ingre­di­ents, it might be enough to spot an ultra-processed food.”


The food indus­try com­monly uses addi­tives to give spe­cific col­ors to food and sweeten or pre­serve it. Other addi­tives cover many func­tions, such as enhanc­ing fla­vors, sup­press­ing fungi, inhibit­ing par­tic­u­lar char­ac­ter­is­tics of the food or san­i­tiz­ing the food itself.

The pro­cess­ing of foods might play a role in health beyond their nutri­tional com­po­si­tion, through a vari­ety of mech­a­nisms trig­gered by non-nutri­tional com­po­nents, such as cos­metic addi­tives, food con­tact mate­ri­als, neo­formed com­pounds, and degra­da­tion of the food matrix,” wrote the researchers.

The health risks that we have found in our study are related to sig­nif­i­cant con­sump­tion of ultra-processed food,” Bonaccio added. Therefore, the sug­ges­tion here is not to abol­ish that kind of food but to limit its intake. People should stop focus­ing only on the nutri­tional pro­file of food. They need to start explor­ing the degree of pro­cess­ing in the food they buy.”

See Also:Updated Nutri-Score Label Indicates Whether Food Is Processed, Organic

She rec­om­mends that a suit­able method to limit ultra-processed food is to spend more time in the kitchen and fol­low the advice of food jour­nal­ist and author Michael Pollan not to eat any food your grand­mother would not rec­og­nize as food.

Your grand­mother would not know what sub­stances like mal­todex­trin are. That means that cook­ing must stay close to the ori­gin of food and away from food manip­u­la­tion as much as pos­si­ble,” Bonaccio said, cit­ing a widely-used ultra-processed car­bo­hy­drate.

In a joint edi­to­r­ial about the two stud­ies pub­lished by the BMJ, Carlos A. Monteiro, a pro­fes­sor of pub­lic health nutri­tion at the University of São Paulo and Geoffrey Cannon, a senior research fel­low, warned that to refor­mu­late ultra-processed foods by meth­ods such as replac­ing sugar with arti­fi­cial sweet­en­ers or fat with mod­i­fied starches and adding extrin­sic fiber, vit­a­mins, and min­er­als, is not a solu­tion.”

Reformulated ultra-processed foods would be espe­cially trou­ble­some if pro­moted as pre­mier’ or healthy’ prod­ucts,” they added. They would remain partly, mainly, or solely for­mu­la­tions of chem­i­cals.”

Following their study, the Italian researchers warned against adopt­ing any food label­ing sys­tem mainly based on the nutri­tional aspects of food.

Within Nutri-Score, for instance, you could find highly refined and processed foods which achieve a good and appar­ently healthy score,” Bonaccio said. That hap­pens because they might be low in salt, sugar or fats. But that does not mean they are to be con­sid­ered a healthy food.”

An exam­ple of this is arti­fi­cially-sweet­ened sugar-free sodas, which achieve healthy scores, even when they are not food at all, but just a chem­i­cal for­mu­la­tion,” Bonaccio added.

She noted that ultra-processed food intake is grow­ing glob­ally. In the United States and the United Kingdom, the most recent data show that 60 per­cent of the daily calo­ries, on aver­age, come from this kind of food. We are still at 20 per­cent in Italy, but that is the ten­dency here as well.”

While the lat­est American and Italian stud­ies join the grow­ing lit­er­a­ture on the health effects of ultra-processed food con­sump­tion, it remains unclear what the rea­sons are for such neg­a­tive health con­se­quences.

We must inves­ti­gate the inner mech­a­nism,” Bonaccio said. Being now able to set aside the nutri­tional aspects of poor qual­ity food, we still have to under­stand what trig­gers such harm­ful reac­tions.”

Researchers in many coun­tries are work­ing on sev­eral hypothe­ses, inves­ti­gat­ing the impact of alter­ations to the food matrix or the destruc­tion of phy­to­chem­i­cals and other sub­stances.

Other research is focused on the impact of food sep­a­ra­tion and re-aggre­ga­tion on the micro­biome and insulin response or the expo­sure to plas­tic due to the pack­ag­ing of most prod­ucts.

Each of those con­di­tions might be a trig­ger for phys­iopatho­log­i­cal processes,” Bonaccio said. We are cur­rently work­ing on the inflam­ma­tory path­way, as these aspects might exert a role in ris­ing inflam­ma­tion lev­els.”

The Mediterranean diet lights the path,” she con­cluded. The MedDiet is not only fruits, veg­eta­bles, a light intake of wine and olive oil; it is mostly an un-processed food diet. We should always remem­ber that it comes from farm­ers’ tra­di­tion made with raw foods or slightly processed foods and the use of min­i­mal tech­niques.”


Related Articles