The United States Dietary Guidelines for Americans (www.health.gov/ dietaryguidelines/2015/) defines the term processed food as “any raw agricultural commodity [product] that has been subject to processing, such as canning, cooking, freezing, dehydration, or milling. Processing certain foods can make them last longer by killing organisms in the food or slowing their growth.” Ultra-processed food is defined by the NOVA food classification system (www.world.openfoodfacts.org/nova) as industrial formulations of food “made mostly or entirely from substances derived from foods and additives, with little if any intact Group 1 food.” Ingredients usually include added sugars, oils, fats, and/or salt, “…but ultra-processed products also include other sources of energy and nutrients not normally used in culinary preparations.” On the one hand, modern food technology allows us to feed the growing global population by increasing food production and optimizing how long that food lasts. However, ongoing research is revealing the adverse health effects caused by the amount of processed, packaged food that typically comprises the Western diet. No matter what diet you ascribe to—low-carb, vegetarian, ketogenic, vegan, Mediterranean, or something in between—a portion of your food has likely undergone some level of food processing. Widespread awareness of the health implications of processed and ultra-processed foods, and what counts as a processed food, is important in order for all of us to attain and maintain healthy eating habits.

Health effects of ultra-processed food consumption

In a cohort study published in JAMA Internal Medicine in February 2019 that analyzed data from roughly 45,000 French adults 45 years of age or older, researchers found that a 10-percent increase in ultra-processed food (UPF) consumption was associated with a 14-percent higher risk of death from all causes.1 In an analysis of data from 105,000 participants, published in the BMJ (British Medical Journal) in 2018, researchers found that a 10-percent increase in UPF consumption was associated with a greater than 10-percent increase in risks of overall cancer and a 10-percent increase in risks for breast cancer in particular.2 Another study published in 2017 in the American Journal of Hypertension analyzed a Spanish cohort of about 15,000 adults who initially did not have hypertension; participants were followed for an average of nine years. The analysis found that people who consumed the most UPFs had a higher risk for hypertension than those who consumed the lowest amounts of UPFs.3 A separate analysis of these same study participants, published in the American Journal of Clinical Nutrition, found that the people who consumed the highest amounts of UPFs were at a higher risk for overweight and obesity.4

What counts as a processed food, exactly?

The idea of “processed food” can be vague. To a point, most of the food we eat undergoes some type of processing. Depending on the definition, raw nuts that have been roasted or fresh produce that’s been washed or bagged before shipment to a grocery store could fall into the processed food category. All processed foods lie on a spectrum of healthfulness, and their place on this spectrum relies on the level and type of processing they’ve undergone. Identifying where certain foods appear on this spectrum can be helpful in identifying those foods to avoid and which to enjoy.

A team from the Center for Epidemiological Studies in Health and Nutrition at the University of Sao Paulo in Brazil undertook the task of defining a food processing spectrum and produced the NOVA food classification system. This scale defines four categories of foods based on level of processing and provides recommendations for consumption or avoidance of these food groups.5 Check out a detailed description of the NOVA scale on the next page.

SOURCES

1. 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. Published online February 11, 2019.

2. Fiolet T, Srour B, Sellem L. Consumption of ultra-processed foods and cancer risk: results from NutriNet-Santé prospective cohort. BMJ. 2018;360.

3. Mendonça RD, Lopes AC, Pimenta AM, et al. Ultra-processed food consumption and the incidence of hypertension in a Mediterranean cohort: the seguimiento universidad de navarra project. Am J Hypertens. 2017 Apr 1;30(4):358–366.

4. Mendonça RD, Pimenta AM, Gea, A. Ultraprocessed food consumption and risk of overweight and obesity: the University of Navarra Follow-Up (SUN) cohort study. Am J Clin Nutr. 2016 Nov;104(5):1433–1440.

5. Monteiro CA, Cannon G, Levy RB, et al. NOVA. The star shines bright. [Food classification. Public health]. World

Nutrition. January–March 2016, 7, 1–3, 28–38.