Ultra-processed food intake in association with BMI change and risk of overweight and obesity: A prospective analysis of the French NutriNet-Santé cohort

PLoS Med. 2020 Aug 27;17(8):e1003256. doi: 10.1371/journal.pmed.1003256. eCollection 2020 Aug.


Background: Ultra-processed food (UPF) consumption has increased drastically worldwide and already represents 50%-60% of total daily energy intake in several high-income countries. In the meantime, the prevalence of overweight and obesity has risen continuously during the last century. The objective of this study was to investigate the associations between UPF consumption and the risk of overweight and obesity, as well as change in body mass index (BMI), in a large French cohort.

Methods and findings: A total of 110,260 adult participants (≥18 years old, mean baseline age = 43.1 [SD 14.6] years; 78.2% women) from the French prospective population-based NutriNet-Santé cohort (2009-2019) were included. Dietary intakes were collected at baseline using repeated and validated 24-hour dietary records linked to a food composition database that included >3,500 different food items, each categorized according to their degree of processing by the NOVA classification. Associations between the proportion of UPF in the diet and BMI change during follow-up were assessed using linear mixed models. Associations with risk of overweight and obesity were assessed using Cox proportional hazard models. After adjusting for age, sex, educational level, marital status, physical activity, smoking status, alcohol intake, number of 24-hour dietary records, and energy intake, we observed a positive association between UPF intake and gain in BMI (β Time × UPF = 0.02 for an absolute increment of 10 in the percentage of UPF in the diet, P < 0.001). UPF intake was associated with a higher risk of overweight (n = 7,063 overweight participants; hazard ratio (HR) for an absolute increase of 10% of UPFs in the diet = 1.11, 95% CI: 1.08-1.14; P < 0.001) and obesity (n = 3,066 incident obese participants; HR10% = 1.09 (1.05-1.13); P < 0.001). These results remained statistically significant after adjustment for the nutritional quality of the diet and energy intake. Study limitations include possible selection bias, potential residual confounding due to the observational design, and a possible item misclassification according to the level of processing. Nonetheless, robustness was tested and verified using a large panel of sensitivity analyses.

Conclusions: In this large observational prospective study, higher consumption of UPF was associated with gain in BMI and higher risks of overweight and obesity. Public health authorities in several countries recently started to recommend privileging unprocessed/minimally processed foods and limiting UPF consumption.

Trial registration: ClinicalTrials.gov NCT03335644 (https://clinicaltrials.gov/ct2/show/NCT03335644).

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Body Mass Index*
  • Cohort Studies
  • Energy Intake / physiology*
  • Fast Foods / adverse effects*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Nutrition Surveys / trends*
  • Nutritive Value / physiology*
  • Obesity / diagnosis
  • Obesity / epidemiology
  • Overweight / diagnosis
  • Overweight / epidemiology*
  • Prospective Studies
  • Risk Factors

Associated data

  • ClinicalTrials.gov/NCT03335644

Grants and funding

NutriNet-Santé was supported by the following public institutions: Ministère de la Santé (solidarites-sante.gouv.fr), Santé Publique France (santepubliquefrance.fr), Institut National de la Santé et de la Recherche Médicale (INSERM) (inserm.fr), Institut National de la Recherche Agronomique (INRAE) (inrae.fr), Conservatoire National des Arts et Métiers (CNAM) (cnam.fr), and Université Sorbonne Paris Nord (univ-paris13.fr). EC was supported by a Doctoral Funding from Université Sorbonne Paris Nord - Galilée Doctoral School (univ-paris13.fr). MD was supported by a grant from the Fondation pour la Recherche Médicale (frm.org). CD was supported by a grant from the French National Cancer Institute (INCa) (e-cancer.fr). Researchers were independent from funders. Funders had no role in the study design, collection, analysis, and interpretation of data, the writing of the report, and the decision to submit the article for publication.