Nutrients or processing? An analysis of food and drink items from the UK National Diet and Nutrition Survey based on nutrient content, the NOVA classification, and front of package traffic light labelling

Abstract Objective To compare food and drink in the UK National Diet and Nutrition Survey (NDNS) database based on their front of package label multiple traffic light (FOPL MTL) score, nutrient content and NOVA classification. Design National cross-sectional nutrient profiling analysis. Setting The UK food and drink supply. Food and drink items were obtained from Intake24, the electronic dietary assessment method used in NDNS Year 12 (2019–20). Main outcome measures Nutrient content, FOPL MTL and the NOVA classification of each item. Items were coded into minimally processed food (MPF), processed culinary ingredients (PCI), processed food (PF) and ultra-processed food (UPF) according to the NOVA classification, and coded into green, amber and red FOPL traffic lights according to Food Standards Agency guidance on fat, saturated fat, total sugar and salt content per 100g. Results Out of 2,980 items, 55.4% were UPF, 33.1% were MPF, 9.5% were PF, and 2.0% were PCI. UPFs contained greater fat, saturated fat, total sugar, and salt per 100g than MPFs, and had a higher energy density and greater proportion of hyper-palatable items (p<0.001). PFs contained more fat, saturated fat, salt and energy per 100g than MPFs (all p<0.001), but a similar amount of total sugar. UPFs had higher odds of containing red FOPL (odds ratio (OR): 4.59 [95%CI: 3.79 to 5.57]), lower odds of containing green FOPL (OR: 0.05 [95%CI: 0.03, 0.10]), and higher odds of an unhealthier overall FOPL MTL score (OR: 7.0 [95%CI: 6.1 to 8.2], compared with MPFs. When considering items without any red traffic lights, UPF still contained more fat, saturated fat, total sugar and salt than MPFs, and had a higher energy density and greater proportion of hyper-palatable items (p < 0.001). However, a number of UPFs have healthier FOPL MTL scores. Conclusions Most items in the UK are UPF. UPFs have an unhealthier nutritional profile than MPFs, are more likely to have an unhealthier FOPL MTL score and be more energy-dense and hyper-palatable. When considering items without any red FOPL, UPFs still have a poorer nutritional profile than MPFs, with a higher energy density and hyper-palatability. But, not all UPFs were unhealthy according to FOPL. The results have important implications for understanding how consumers may interpret the healthiness of UPFs or FOPL MTLs, and updating UK food and drink labelling. What is known: Nutrient content is an important determinant of diet-related health. Nutrient content is reflected in UK national dietary guidelines, and at point of purchase through front of package label multiple traffic light (FOPL MTL) scores for nutrients of concern. Higher intakes of ultra-processed food (UPF), as defined by the NOVA classification, are associated with higher risks of adverse health outcomes including obesity and cardiometabolic disease. The overlap between the nutrient content and FOPL MTLs of the UK food and drink supply with food processing is unknown. How FOPL MTLs might be used to guide consumer purchasing behaviour of UPFs is unclear. What this study adds: This is the first study to compare the nutritional characteristics of food and drink items representative of the UK supply with the NOVA classification. There is partial overlap between FOPL MTL and NOVA; UPFs tend to have an unhealthier nutrient profile, but a considerable number of UPFs are considered healthy, based on their FOPL MTL score. UPFs also tend to be more energy dense and hyper-palatable than MPFs, even when considering only ‘healthy’ items (without any red FOPL traffic lights).