Ultra-processed food consumption in UK adolescents: distribution, trends, and sociodemographic correlates using the National Diet and Nutrition Survey 2008/09 to 2018/19

Background The consumption of ultra-processed foods (UPF) has been proposed as a key driver of the global rise in non-communicable diseases. Evidence from several countries suggests that adolescents are the highest consumers. This study examined UPF consumption in a representative sample of UK adolescents. Methods We used data from 4-day food diaries from adolescents (11-18y) in the UK National Diet and Nutrition Survey (2008/09-2018/19) (n=3,270). UPF were identified using the NOVA classification. We estimated the percentage of Total Energy Intake (%TEI) and the absolute weight (grams). Linear regression models quantified differences in UPF consumption across survey years and its association with participants individual characteristics. Results Mean UPF consumption was 861 (SD 442) g/d and this accounted for 65.9% (SD 13.4%) of TEI. Between 2008 and 2019, mean UPF consumption decreased from 996 to 776 g/d [-211 (95%CI: -302;-120)] and from 67.7% to 62.8% of TEI [-4.8% (95%CI:-8.1;-1.5)]. Higher %TEI was consumed by adolescents with lower socioeconomic status; white ethnicity and living in England North. A higher weight of UPF consumption was associated with being male, white, age 18y, having parents with routine or manual occupation, living in England North, and living with obesity. Discussion and conclusion Average energy intake from UPF has decreased over a decade in UK adolescents. We observed a social and regional patterning of UPF consumption, with higher consumption among adolescents from lower socioeconomic backgrounds, from a white ethnicity and living in England North. Our findings suggest a relationship between individual characteristics and UPF consumption by UK adolescents. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Funding: This study was part of YCU PhD studentship funded by the NIHR School for Public Health Research (Grant Reference Number PD/SPH/2015), supervised by Frank de Vocht, Russell Jago, Zoi Toumpakari and Martin White. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.  The NIHR School for Public Health Research is a partnership between the Universities of Sheffield; Bristol; Cambridge; Imperial; and University College London; The London School for Hygiene and Tropical Medicine (LSHTM); LiLaC a collaboration between the Universities of Liverpool and Lancaster; and Fuse The Centre for Translational Research in Public Health a collaboration between Newcastle, Durham, Northumbria, Sunderland and Teesside Universities. YCU is now a postdoctoral research associate at the Medical Research Council (MRC) to the MRC Epidemiology Unit, University of Cambridge [grant number MC/UU/00006/5] and this study received funding for publication by the MRC Epidemiology Unit. EVS acknowledge support from the MRC Epidemiology Unit (MC/UU/00006/5). NGF acknowledges support from the MRC Epidemiology Unit (MC/UU/00006/3), the National Institute of Health and Care Research (NIHR) Cambridge Biomedical Research Centre (NIHR203312), and she is an NIHR Senior Investigator. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. JA is supported by the MRC Epidemiology Unit, University of Cambridge [Medical Research Council grant number MC/UU/00006/7] mrc.ukri.org. KO is supported by the Medical Research Council (MC/UU/00006/2). FDV and RJ are partially funded by the National Institute for Health Research Applied Research Collaboration West (NIHR ARC West). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced are available online at https://beta.ukdataservice.ac.uk/datacatalogue/studies/study?id=6533 NOVA food classification are available upon reasonable request to the authors