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      Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study

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          Abstract

          Objectives

          To investigate the contribution of ultra-processed foods to the intake of added sugars in the USA. Ultra-processed foods were defined as industrial formulations which, besides salt, sugar, oils and fats, include substances not used in culinary preparations, in particular additives used to imitate sensorial qualities of minimally processed foods and their culinary preparations.

          Design

          Cross-sectional study.

          Setting

          National Health and Nutrition Examination Survey 2009–2010.

          Participants

          We evaluated 9317 participants aged 1+ years with at least one 24 h dietary recall.

          Main outcome measures

          Average dietary content of added sugars and proportion of individuals consuming more than 10% of total energy from added sugars.

          Data analysis

          Gaussian and Poisson regressions estimated the association between consumption of ultra-processed foods and intake of added sugars. All models incorporated survey sample weights and adjusted for age, sex, race/ethnicity, family income and educational attainment.

          Results

          Ultra-processed foods comprised 57.9% of energy intake, and contributed 89.7% of the energy intake from added sugars. The content of added sugars in ultra-processed foods (21.1% of calories) was eightfold higher than in processed foods (2.4%) and fivefold higher than in unprocessed or minimally processed foods and processed culinary ingredients grouped together (3.7%). Both in unadjusted and adjusted models, each increase of 5 percentage points in proportional energy intake from ultra-processed foods increased the proportional energy intake from added sugars by 1 percentage point. Consumption of added sugars increased linearly across quintiles of ultra-processed food consumption: from 7.5% of total energy in the lowest quintile to 19.5% in the highest. A total of 82.1% of Americans in the highest quintile exceeded the recommended limit of 10% energy from added sugars, compared with 26.4% in the lowest.

          Conclusions

          Decreasing the consumption of ultra-processed foods could be an effective way of reducing the excessive intake of added sugars in the USA.

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          Most cited references35

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          The US Department of Agriculture Automated Multiple-Pass Method reduces bias in the collection of energy intakes.

          William Rumpler, John L. Cleveland, Linda A Ingwersen … (2008)
          The US Department of Agriculture Automated Multiple-Pass Method (AMPM) is used for collecting 24-h dietary recalls in What We Eat In America, the dietary interview component of the National Health and Nutrition Examination Survey. Because the data have important program and policy applications, it is essential that the validity of the method be tested. The accuracy of the AMPM was evaluated by comparing reported energy intake (EI) with total energy expenditure (TEE) by using the doubly labeled water (DLW) technique. The 524 volunteers, aged 30-69 y, included an equal number of men and women recruited from the Washington, DC, area. Each subject was dosed with DLW on the first day of the 2-wk study period; three 24-h recalls were collected during the 2-wk period by using the AMPM. The first recall was conducted in person, and subsequent recalls were over the telephone. Overall, the subjects underreported EI by 11% compared with TEE. Normal-weight subjects [body mass index (in kg/m(2)) 30). Although the AMPM accurately reported EIs in normal-weight subjects, research is warranted to enhance its accuracy in overweight and obese persons.
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            Ultra-processed products are becoming dominant in the global food system.

            B Popkin, J-C Moubarac, Jonathan G. Cannon … (2013)
            The relationship between the global food system and the worldwide rapid increase of obesity and related diseases is not yet well understood. A reason is that the full impact of industrialized food processing on dietary patterns, including the environments of eating and drinking, remains overlooked and underestimated. Many forms of food processing are beneficial. But what is identified and defined here as ultra-processing, a type of process that has become increasingly dominant, at first in high-income countries, and now in middle-income countries, creates attractive, hyper-palatable, cheap, ready-to-consume food products that are characteristically energy-dense, fatty, sugary or salty and generally obesogenic. In this study, the scale of change in purchase and sales of ultra-processed products is examined and the context and implications are discussed. Data come from 79 high- and middle-income countries, with special attention to Canada and Brazil. Results show that ultra-processed products dominate the food supplies of high-income countries, and that their consumption is now rapidly increasing in middle-income countries. It is proposed here that the main driving force now shaping the global food system is transnational food manufacturing, retailing and fast food service corporations whose businesses are based on very profitable, heavily promoted ultra-processed products, many in snack form. © 2013 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of the International Association for the Study of Obesity.
            Article 0 comments Cited 313 times – based on 0 reviews     Review now
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              National health and nutrition examination survey: analytic guidelines, 1999-2010.

              Clifford Johnson, Ryne Paulose-Ram, Cynthia Ogden … (2013)
              Background-Analytic guide lines were first created in 1996 to assist data users in analyzing data from the Third National Health and Nutrition Examination Survey (NHANES III),conducted from 1988 to 1994 by the Centers for Disease Control and Prevention's National Center for Health Statistics. NHANES became a continuous annual survey in 1999, with data released to the public in 2-year intervals. In 2002, 2004, and 2006, guidelines were created and posted on the NHANES website to assist analysts in understanding the key issues related to analyzing data from 1999 onward. This report builds on these previous guidelines and provides the first comprehensive summary of analytic guidelines for the 1999-2010 NHANES data. Objectives-This report provides general guidelines for researchers in analyzing 1999-2010 NHANES publicly released data. Information is presented on key issues related to NHANES data, including sample design, demographic variables, and combining survey cycles. Guidance is also provided on data analysis, including the use of appropriate survey weights, calculating variance estimations, determining the reliability of estimates, age adjustment, and computing population counts.
              Article 0 comments Cited 296 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open
                Journal ID (iso-abbrev): BMJ Open
                Journal ID (hwp): bmjopen
                Journal ID (publisher-id): bmjopen
                Title: BMJ Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2044-6055
                Publication date Collection: 2016
                Publication date (Electronic): 4 January 2016
                Volume: 6
                Issue: 3
                Electronic Location Identifier: e009892
                Affiliations
                [1 ]Department of Nutrition, School of Public Health, University of São Paulo , São Paulo, Brazil
                [2 ]Center for Epidemiological Studies in Health and Nutrition, University of São Paulo , São Paulo, Brazil
                [3 ]Friedman School of Nutrition Science and Policy, Tufts University , Boston, Massachusetts, USA
                Author notes
                [Correspondence to ] Dr Carlos Augusto Monteiro; carlosam@ 123456usp.br
                Article
                Publisher ID: bmjopen-2015-009892
                DOI: 10.1136/bmjopen-2015-009892
                PMC ID: 4785287
                PubMed ID: 26962035
                SO-VID: 3296591d-cbc0-494e-b503-444a5c9015fc
                Copyright © Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
                License:

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                Date received : 3 September 2015
                Date revision received : 29 October 2015
                Date accepted : 11 November 2015
                Categories
                Subject: Nutrition and Metabolism
                Subject: Research
                Subject: 1506
                Subject: 1612
                Subject: 1714
                Subject: 1724
                Custom metadata
                special-feature press-release

                ScienceOpen disciplines: Medicine
                Keywords: ultra-processed,added sugars,dietary intake,nhanes,us
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: ultra-processed, added sugars, dietary intake, nhanes, us

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