Consumption of Ultra-Processed Foods and Diet Quality Among U.S. Adults and Children

Abstract Objectives Consumption of ultra-processed foods (UPF) has been linked to higher added sugar, sodium, and unhealthful fats, but the association of UPF with overall diet quality is unclear. We investigated how UPF consumption relates to overall diet quality in the U.S. Methods Dietary data were derived from the two most recent cycles of NHANES (2013–2016) including 10,064 adults and 5920 children with one or more 24-hr dietary recalls. UPFs were identified by the degree of processing using the NOVA classification, with total UPF intake (% energy) assessed in quartiles. Diet quality was assessed using the validated American Heart Association (AHA) 2020 continuous primary diet score (range 0–50; based on total fruits/vegetables, whole grains, fish/shellfish, sugar-sweetened beverages, and sodium), AHA secondary diet score (range 0–80; adding nuts/seeds/legumes, processed meat, and saturated fat), and Healthy Eating Index (HEI)-2015 score (range 0–100). Poor diet was defined as < 40% adherence to the AHA primary score. Linear and logistic regressions estimated the relationships between UPF intake and diet quality, accounting for NHANES complex survey design and adjusting for age, sex, race/ethnicity, income, and education. Results Compared to the lowest quartile of UPF consumption (<42.3%E), the multivariable-adjusted AHA primary score was −7.60% (−1.82 points, P < 0.001) lower in the second quartile, −17.9% (−4.31 points, P < 0.001) lower in the third quartile, and −29.3% (−7.04 points, P < 0.001) lower in the highest quartile (>67.8%E). Corresponding values in children were −8.01% (−1.73, P < 0.001), −15.2% (−3.28, P < 0.001), and −29.8% (−6.43, P < 0.001). Compared to the lowest quartile of UPF, adults in the second quartile had 63% higher risk of poor diet quality (multivariable-adjusted OR 1.63; 95% CI 1.35–1.98); in the third quartile, 2.5-fold higher risk (OR, 2.64; 2.13–3.26); and in the highest quartile, nearly 5-fold higher risk (OR 4.85; 3.93–5.97). Corresponding ORs for poor diet quality in children were 1.52 (1.22–1.89), 2.44 (1.94–3.06), and 5.37 (4.16–6.94) across quartiles of UPF, respectively. Findings were similar using the AHA secondary score and HEI-2015 score. Conclusions Higher consumption of UPF associates with substantially lower diet quality in the United States among both adults and children. Funding Sources NIH.