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. 2017 Feb 14;15(1):6.
doi: 10.1186/s12963-017-0119-3.

The Share of Ultra-Processed Foods and the Overall Nutritional Quality of Diets in the US: Evidence From a Nationally Representative Cross-Sectional Study

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Free PMC article

The Share of Ultra-Processed Foods and the Overall Nutritional Quality of Diets in the US: Evidence From a Nationally Representative Cross-Sectional Study

Euridice Martínez Steele et al. Popul Health Metr. .
Free PMC article

Abstract

Background: Recent population dietary studies indicate that diets rich in ultra-processed foods, increasingly frequent worldwide, are grossly nutritionally unbalanced, suggesting that the dietary contribution of these foods largely determines the overall nutritional quality of contemporaneous diets. Yet, these studies have focused on individual nutrients (one at a time) rather than the overall nutritional quality of the diets. Here we investigate the relationship between the energy contribution of ultra-processed foods in the US diet and its content of critical nutrients, individually and overall.

Methods: We evaluated dietary intakes of 9,317 participants from 2009 to 2010 NHANES aged 1+ years. Food items were classified into unprocessed or minimally processed foods, processed culinary ingredients, processed foods, and ultra-processed foods. First, we examined the average dietary content of macronutrients, micronutrients, and fiber across quintiles of the energy contribution of ultra-processed foods. Then, we used Principal Component Analysis (PCA) to identify a nutrient-balanced dietary pattern to enable the assessment of the overall nutritional quality of the diet. Linear regression was used to explore the association between the dietary share of ultra-processed foods and the balanced-pattern PCA factor score. The scores were thereafter categorized into tertiles, and their distribution was examined across ultra-processed food quintiles. All models incorporated survey sample weights and were adjusted for age, sex, race/ethnicity, family income, and educational attainment.

Results: The average content of protein, fiber, vitamins A, C, D, and E, zinc, potassium, phosphorus, magnesium, and calcium in the US diet decreased significantly across quintiles of the energy contribution of ultra-processed foods, while carbohydrate, added sugar, and saturated fat contents increased. An inverse dose-response association was found between ultra-processed food quintiles and overall dietary quality measured through a nutrient-balanced-pattern PCA-derived factor score characterized by being richer in fiber, potassium, magnesium and vitamin C, and having less saturated fat and added sugars.

Conclusions: This study suggests that decreasing the dietary share of ultra-processed foods is a rational and effective way to improve the nutritional quality of US diets.

Keywords: Diet quality; Dietary nutrient profile; Dietary patterns; Macronutrients; Micronutrients; NHANES; PCA; Ultra-processed.

Figures

Fig. 1
Fig. 1
“Nutrient balanced pattern” factor score regressed on the dietary share of ultra-processed foods evaluated by restricted cubic splines, US population aged 1+ years (NHANES 2009–2010) (N = 9,317). Legend: The values shown on the x-axis correspond to the 5th, 27.5th, 50th, 72.5th, and 95th percentiles for percentage of total energy from ultra-processed foods (knots). Coefficient for linear term = -0.03, 95% CI: -0.04 to -0.02 (beta = -0.35). There was little evidence of nonlinearity in the restricted cubic spline model (Wald test for linear term p < 0.001; Wald test for all non-linear terms p = 0.16)

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