Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Nutrition research challenges for processed food and health

Subjects

Abstract

Existing highly processed food (HPF) classification systems show large differences in the impact of these foods on biochemical risk factors for disease. If public health nutrition is to consider the degree of food processing as an important element of the link between food and health, certain gaps in research must be acknowledged. Quantifying the food additive exposure derived from HPFs is a task made challenging by the lack of data available on the occurrence and concentration of additives in food and the degree to which the natural occurrence of additives in unprocessed foods confounds exposure estimates. The proposed role of HPFs in health outcomes could also be associated with altered nutrient profiles. Differences exist within and between HPF classification systems in this regard and there are conflicting data on the impact of controlling for nutrient intake. Furthermore, research is needed on how the sensory aspects of HPFs contribute to energy intake. Current data suggest that high energy intake rate may be the mechanism linking HPFs and increased energy intake. A high priority now is to clarify the basis of definitions used to categorize foods as highly processed and, in a constructive sense, to distinguish between the contributions of nutrients, additives and sensory properties to health.

This is a preview of subscription content

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

References

  1. Pagliai, G. Consumption of ultra-processed foods and health status: a systematic review and meta-analysis. Br. J. Nutr. 125, 308–318 (2021).

    CAS  PubMed  Google Scholar 

  2. Juul, F., Vaidean, G., Lin, Y., Deierlein, A. L. & Parekh, N. Ultra-processed foods and incident cardiovascular disease in the Framingham Offspring Study. J. Am. Coll. Cardiol. 77, 1520–1531 (2021).

    PubMed  Google Scholar 

  3. Du, S., Kim, H. & Rebholz, C. M. Higher ultra-processed food consumption is associated with increased risk of incident coronary artery disease in the Atherosclerosis Risk in Communities Study. J. Nutr. 151, 3746–3754 (2021).

    PubMed  Google Scholar 

  4. Fiolet, T. et al. Consumption of ultra-processed foods and cancer risk: results from NutriNet-Santé prospective cohort. Br. Med. J. 360, k322 (2018).

    Google Scholar 

  5. Rico-Campà, A. et al. Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study. Br. Med. J. 365, 1949 (2019).

    Google Scholar 

  6. Lichtenstein, A. H. et al. 2021 dietary guidance to improve cardiovascular health: a scientific statement from the American Heart Association. Circulation 144, e472–e487 (2021).

    PubMed  Google Scholar 

  7. Moubarac, J. C., Parra, D. C., Cannon, G. & Monteiro, C. A. Food classification systems based on food processing: significance and implications for policies and actions: a systematic literature review and assessment. Curr. Obes. Rep. 3, 256–272 (2014).

    PubMed  Google Scholar 

  8. Poti, J. M., Mendez, M. A., Ng, S. W. & Popkin, B. M. Is the degree of food processing and convenience linked with the nutritional quality of foods purchased by US households? Am. J. Clin. Nutr. 101, 1251–1262 (2015).

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Slimani, N. et al. Contribution of highly industrially processed foods to the nutrient intakes and patterns of middle-aged populations in the European Prospective Investigation into Cancer and Nutrition study. Eur. J. Clin. Nutr. 63, S206–S225 (2009).

    CAS  PubMed  Google Scholar 

  10. Eicher-Miller, H. A., Fulgoni, V. L. & Keast, D. R. Processed food contributions to energy and nutrient intake differ among US children by race/ethnicity. Nutrients 7, 10076–10088 (2015).

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Eicher-Miller, H. A., Fulgoni, V. L. & Keast, D. R. Contributions of processed foods to dietary intake in the US from 2003–2008: a report of the Food and Nutrition Science Solutions Joint Task Force of the academy of Nutrition and Dietetics, American Society for Nutrition, institute of Food Technologists, and International Food Information Council. J. Nutr. 142, 2065S–2072S (2012).

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Martinez-Perez, C. et al. Use of different food classification systems to assess the association between ultra-processed food consumption and cardiometabolic health in an elderly population with metabolic syndrome (PREDIMED-Plus Cohort). Nutrients 13, 2471–2489 (2021).

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Bleiweiss-Sande, R. et al. Robustness of food processing classification systems. Nutrients 11, 1344 (2019).

    CAS  PubMed Central  Google Scholar 

  14. Monteiro, C. A., Cannon, G., Lawrence, M., Costa Louzada, M. L. & Pereira Machado, P. Ultra-processed Foods, Diet Quality and Human Health (FAO, 2019).

    Google Scholar 

  15. Rauber, F. et al. Ultra-processed food consumption and chronic non-communicable diseases-related dietary nutrient profile in the UK (2008–2014). Nutrients 10, 587 (2018).

    PubMed Central  Google Scholar 

  16. Steele, E. M., Popkin, B. M., Swinburn, B. & Monteiro, C. A. The share of ultra-processed foods and the overall nutritional quality of diets in the US: evidence from a nationally representative cross-sectional study. Popul. Health Metrics 15, 6 (2017).

    Google Scholar 

  17. Costa Louzada, M. L. et al. Ultra-processed foods and the nutritional dietary profile in Brazil. Rev. Saude Publica 49, 38 (2015).

    PubMed  Google Scholar 

  18. Moubarac, J. C., Batal, M., Louzada, M. L., Martinez Steele, E. & Monteiro, C. A. Consumption of ultra-processed foods predicts diet quality in Canada. Appetite 108, 512–520 (2017).

    PubMed  Google Scholar 

  19. Julia, C. et al. Contribution of ultra-processed foods in the diet of adults from the French NutriNet-Santé study. Public Health Nutr. 21, 27–37 (2018).

    PubMed  Google Scholar 

  20. Solans, M. et al. Consumption of ultra-processed food and drinks and chronic lymphocytic leukemia in the MCC-Spain study. Int. J. Environ. Res. Public Health 18, 1–12 (2021).

    Google Scholar 

  21. Rico-Campa, A. et al. Association between consumption of ultra-processed foods and all-cause mortality: SUN prospective cohort study. Br. Med. J. 365, 1949 (2019).

    Google Scholar 

  22. Griffin, J., Albaloul, A., Kopytek, A., Elliott, P. & Frost, G. Effect of ultra-processed food intake on cardiometabolic risk is mediated by diet quality: a cross-sectional study. BMJ Nutr. Prev. Health. 4, 174–180 (2021).

    PubMed  PubMed Central  Google Scholar 

  23. Gupta, S., Hawk, T., Aggarwal, A. & Drewnowski, A. Characterizing ultra-processed foods by energy density, nutrient density, and cost. Front. Nutr. 6, 70 (2019).

    PubMed  PubMed Central  Google Scholar 

  24. Rolls, B. J. The relationship between dietary energy density and energy intake. Physiol. Behav. 97, 609–615 (2009).

    CAS  PubMed  PubMed Central  Google Scholar 

  25. Lustig, R. H. Processed food—an experiment that failed. JAMA. Pediatr. 171, 212–214 (2017).

    PubMed  Google Scholar 

  26. Buckley, J. P. et al. Ultra-processed food consumption and exposure to phthalates and bisphenols in the US national health and nutrition examination survey, 2013–2014. Environ. Int. 131, 105057 (2019).

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Drewnowski, A. Perspective: identifying ultra-processed plant-based milk alternatives in the USDA branded food products database. Adv .Nutr. 12, 2068–2075 (2021).

    PubMed  Google Scholar 

  28. Gilsenan, M. B., Lambe, J. & Gibney, M. J. Irish National Food Ingredient Database: application for assessing patterns of additive usage in foods. Food Addit. Contam. 19, 1105–1115 (2002).

    CAS  PubMed  Google Scholar 

  29. Chazelas, E. et al. Exposure to food additive mixtures in 106,000 French adults from the NutriNet-Santé cohort. Sci. Rep. 11, 1–21 (2021).

    Google Scholar 

  30. Choline: Fact Sheet for Health Professionals (NIH, accessed December 2021); https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/

  31. Penniston, K. L., Nakada, S. Y., Holmes, R. P. & Assimos, D. G. Quantitative assessment of citric acid in lemon juice, lime juice, and commercially-available fruit juice products. J. Endourol. 22, 567–570 (2008).

    PubMed  Google Scholar 

  32. McCance, R. A., Widdowson, E. M., Paul, A. A. & Southgate, D. A. T. McCance and Widdowson’s The Composition of Foods (HM Stationery Office, 1978).

    Google Scholar 

  33. Opinion of the Scientific Panel on Contaminants in the Food Chain on a Request from the European Commission to Perform a Scientific Risk Assessment on Nitrate in Vegetables. EFSA J. 689, 1–79 (2008).

  34. Baker, R. A. Reassessment of some fruit and vegetable pectin levels. J Food Sci. 62, 2225–2299 (2006).

    Google Scholar 

  35. Porter, T., Wharton, M. A. & Bennett, B. B. Evaluation of carotene content of fresh and cooked spinach. Food Res. 12, 133–141 (1947).

    CAS  PubMed  Google Scholar 

  36. Yun, S. S. et al. Naturally occurring benzoic, sorbic, and propionic acid in vegetables. Food Addit. Contam. B 12, 167–174 (2019).

    CAS  Google Scholar 

  37. Park, S. Y. et al. Evaluation of natural food preservatives in domestic and imported cheese. Korean J. Food Sci. Anim. Resour. 36, 531–537 (2016).

    PubMed  PubMed Central  Google Scholar 

  38. Aguilar, F. et al. EFSA Panel on Food Additives and Nutrient Sources Added to Food.Scientific opinion on the re‐evaluation of iron oxides and hydroxides (E 172) as food additives. EFSA J. 13, 4317 (2015).

    Google Scholar 

  39. Aguilar, F. et al. EFSA Panel on Food Additives and Nutrient Sources Added to Food.Scientific opinion on the re‐evaluation of erythorbic acid (E 315) and sodium erythorbate (E 316) as food additives. EFSA J. 14, 4360 (2016).

    Google Scholar 

  40. Aguilar, F. et al. EFSA Panel on Food Additives and Nutrient Sources Added to Food. Re‐evaluation of sodium nitrate (E 251) and potassium nitrate (E 252) as food additives. EFSA J. 15, e04787 (2017).

    Google Scholar 

  41. Tralau, T. et al. A prospective whole-mixture approach to assess risk of the food and chemical exposome. Nat. Food 2, 463–468 (2021).

    CAS  Google Scholar 

  42. Srour, B. et al. Ultra-processed food intake and risk of cardiovascular disease: prospective cohort study (NutriNet Santé). BMJ 365, 1451 (2019).

    Google Scholar 

  43. Narula, N. et al. Association of ultra-processed food intake with risk of inflammatory bowel disease: prospective cohort study. BMJ 374, 1554 (2021).

    Google Scholar 

  44. Sandoval-Insausti, H. Ultra-processed food consumption and incident frailty: a prospective cohort study of older adults. J. Gerontol. A 75, 1126–1133 (2020).

    Google Scholar 

  45. Gómez-Donoso, C. et al. Ultra-processed food consumption and the incidence of depression in a Mediterranean cohort: the SUN Project. Eur. J. Nutr. 59, 1093–1103 (2020).

    PubMed  Google Scholar 

  46. Zaretsky, J. et al. Ultra-processed food targets bone quality via endochondral ossification. Bone Res. 9, 14 (2021).

    CAS  PubMed  PubMed Central  Google Scholar 

  47. de Souza, M. S., Vaz, J. D. S., Martins-Silva, T., Bomfim, R. A. & Cascaes, A. M. Ultra-processed foods and early childhood caries in 0–3-year-olds enrolled at primary healthcare centers in Southern Brazil. Public Health Nutr. 24, 3322–3330 (2021).

    PubMed  Google Scholar 

  48. Scaranni, P. O. D. S. et al. Ultra-processed foods, changes in blood pressure and incidence of hypertension: the Brazilian longitudinal study of adult health (ELSA-Brasil). Public Health Nutr. 24, 3352–3360 (2021).

    PubMed  Google Scholar 

  49. Melo, B., Rezende, L., Machado, P., Gouveia, N. & Levy, R. Associations of ultra-processed food and drink products with asthma and wheezing among Brazilian adolescents. Pediatr. Allergy Immunol. 29, 504–511 (2018).

    CAS  PubMed  Google Scholar 

  50. Nestares, T. et al. Influence of ultra-processed foods consumption on redox status and inflammatory signaling in young celiac patients. Nutrients 13, 156 (2021).

    CAS  PubMed Central  Google Scholar 

  51. Silva, C. A. et al. The role of food processing in the inflammatory potential of diet during pregnancy. Rev Saude Publica 53, 113 (2019).

    PubMed  PubMed Central  Google Scholar 

  52. Machado, P. P. et al. Ultra-processed food consumption and obesity in the Australian adult population. Nutr. Diabetes 10, 39 (2020).

    CAS  PubMed  PubMed Central  Google Scholar 

  53. Chapman, N. A., Jacobs, R. J. & Braakhuis, A. J. Role of diet and food intake in age-related macular degeneration: a systematic review. Clin. Exp. Ophthalmol. 47, 106–127 (2019).

    PubMed  Google Scholar 

  54. Dhillon, J., Running, C. A., Tucker, R. M. & Mattes, R. D. Effects of food form on appetite and energy balance. Food Qual. Prefer. 48, 368–375 (2016).

    Google Scholar 

  55. Hall, K. D. et al. Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake. Cell Metab. 32, 67–77 (2020).

    Google Scholar 

  56. Yeomans, M. R. Taste, palatability and the control of appetite. Proc. Nutr. Soc. 57, 609–615 (1998).

    CAS  PubMed  Google Scholar 

  57. Rolls, B. J., Rolls, E. T., Rowe, E. A. & Sweeney, K. Sensory specific satiety in man. Physiol. Behav. 27, 137–142 (1981).

    CAS  PubMed  Google Scholar 

  58. Forde, C. G., Mars, M. & de Graaf, K. Ultra-processing or oral processing? A role for energy density and eating rate in moderating energy intake from processed foods. Curr. Dev. Nutr. 4, 19 (2020).

    Google Scholar 

  59. Forde, C. G. From perception to ingestion; the role of sensory properties in energy selection, eating behavior and food intake. Food Qual. Prefer. 66, 171–77. (2018).

    Google Scholar 

  60. Bolhuis, D. P. & Forde, C. G. Application of food texture to moderate oral processing behaviours and energy intake. Trends Food Sci. Technol. 106, 445–456 (2020).

    CAS  Google Scholar 

  61. Teo, P. S., van Dam, R. M., Whitton, C., Tan, L. W. L. & Forde, C. G. Consumption of foods with higher energy intake rates is associated with greater energy intake, adiposity, and cardiovascular risk factors in adults. J. Nutr. 151, 370–378 (2021).

    PubMed  Google Scholar 

  62. Breslin, P. A. & Spector, A. C. Mammalian taste perception. Curr. Biol. 18, R148–R155 (2008).

    CAS  PubMed  Google Scholar 

  63. Small, D. M. & Di Feliceantonio, A. G. Processed foods and food reward. Science 363, 346–347 (2019).

    ADS  CAS  PubMed  Google Scholar 

  64. Martin, C. & Issanchou, S. Nutrient sensing: what can we learn from different tastes about the nutrient contents in today’s foods? Food Qual. Prefer. 71, 185–196 (2019).

    Google Scholar 

  65. Teo, P. S., Tso, R., van Dam, R. M. & Forde, C. G. Taste of modern diets: the impact of food processing on nutrient sensing and dietary energy intake. J. Nutr. 152, 200–210 (2021).

    PubMed Central  Google Scholar 

  66. Breen, C., Ryan, M., Gibney, M. J., Corrigan, M. & O’Shea, D. Glycemic, insulinemic, and appetite responses of patients with type 2 diabetes to commonly consumed breads. Diabetes Educ. 39, 376–386 (2013).

    PubMed  Google Scholar 

  67. Aston, L. M., Gambell, J. M., Lee, D. M., Bryant, S. P. & Jebb, S. A. Determination of the glycaemic index of various staple carbohydrate-rich foods in the UK diet. Eur. J. Clin. Nutr. 62, 79–85 (2008).

    Google Scholar 

  68. Reidy, K. C. et al. Food consumption patterns and micronutrient density of complementary foods consumed by infants fed commercially prepared baby foods. Nutr. Today 53, 68–78 (2018).

    PubMed  PubMed Central  Google Scholar 

  69. Gibney, M. J. et al. Towards an evidence-based recommendation for a balanced breakfast—a proposal from the International Breakfast Research Initiative. Nutrients 10, 1540 (2018).

    PubMed Central  Google Scholar 

  70. Li, K. et al. Dietary fat intakes in Irish adults in 2011: how much has changed in 10 years? Br. J. Nutr. 115, 1798–1809 (2016).

    CAS  PubMed  Google Scholar 

  71. Azaïs-Braesco, V. et al. A review of total & added sugar intakes and dietary sources in Europe. Nutr. J. 16, 6 (2017).

    PubMed  PubMed Central  Google Scholar 

  72. Get the Facts: Added Sugars (CDC, accessed December 2021); https://www.cdc.gov/nutrition/data-statistics/added-sugars.html

  73. Mozaffarian, D. et al. Food Compass is a nutrient profiling system using expanded characteristics for assessing healthfulness of foods. Nat. Food 2, 809–818 (2021).

    Google Scholar 

  74. Monteiro, C. A. & Cannon, G. Product reformulation will not improve public health. World Nutr. 3, 406–434 (2012).

    Google Scholar 

  75. Scrinis, G. & Monteiro, C. A. Ultra-processed foods and the limits of product reformulation. Public Health Nutr. 21, 247–252 (2018).

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Michael J. Gibney.

Ethics declarations

Competing interests

M.J.G. has engaged in paid and non-paid consultancy for a wide range of food companies that manufacture processed foods. He has provided online presentations on ultraprocessed foods to the staff of Unilever and Mondelez. C.G.F. is currently a paid member of the Kerry Health and Nutrition Institute.

Peer review

Peer review information

Nature Food thanks Eileen Kennedy and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Gibney, M.J., Forde, C.G. Nutrition research challenges for processed food and health. Nat Food 3, 104–109 (2022). https://doi.org/10.1038/s43016-021-00457-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s43016-021-00457-9

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing