Bowl of Froot Loops cereal, an ultra-processed food
Aisle of ultra-processed foods in an American supermarket

Ultra-processed food (UPF) is an industrially formulated edible substance derived from natural food or synthesized from other organic compounds.[1][2] The resulting products are designed to be highly profitable, convenient, and hyperpalatable, often through food additives such as preservatives, colourings, and flavourings.[3]

The state of research into ultra-processed foods and their effects is evolving rapidly as of 2023.[4] Epidemiological data suggest that consumption of ultra-processed foods is associated with higher risks of certain diseases, including obesity, type 2 diabetes, cardiovascular diseases, and certain types of cancer.[5] Researchers also present ultra-processing as a facet of environmental degradation caused by the food industry.[6]

Definitions

Concerns around food processing have existed since at least the Industrial Revolution.[7] Many critics identified 'processed food' as problematic, and movements such as raw foodism attempted to eschew food processing entirely, but since even basic cookery results in processed food, this concept failed in itself to influence public policy surrounding the epidemiology of obesity.

Michael Pollan's influential book The Omnivore's Dilemma referred to highly processed industrial food as 'edible food-like substances'.[8] Carlos Augusto Monteiro cited Pollan as an influence in coining the term 'ultra-processed food' in a 2009 commentary.[9] Monteiro's team developed the Nova classification for grouping unprocessed and processed foods beginning in 2010, whose definition of ultra-processing has become most widely accepted and has gradually become more refined through successive publications.[10] The identification of ultra-processed foods, as well as the category itself, is a subject of debate among nutrition and public health scientists, and other definitions have been proposed.[11]

A survey of systems for classifying levels of food processing in 2021 identified four 'defining themes':

  1. Extent of change (from natural state);
  2. Nature of change (properties, adding ingredients);
  3. Place of processing (where/by whom);
  4. Purpose of processing (why, essential/cosmetic).[12]

Of the various systems they surveyed, the researchers found that only the Nova classification takes all four themes into account.

Monteiro's 2009 commentary

Carlos Monteiro, working with a team of researchers at the University of São Paulo, first published the concept of ultra-processed foods in a 2009 invited commentary for Public Health Nutrition:

Ultra-processed foods are basically confections of group 2 ingredients [substances extracted from whole foods], typically combined with sophisticated use of additives, to make them edible, palatable, and habit-forming. They have no real resemblance to group 1 foods [minimally processed foods], although they may be shaped, labelled and marketed so as to seem wholesome and 'fresh'. Unlike the ingredients included in group 2, ultra-processed foods are typically not consumed with or as part of minimally processed foods, dishes and meals. On the contrary, they are designed to be ready-to-eat (sometimes with addition of liquid such as milk) or ready-to-heat, and are often consumed alone or in combination (such as savoury snacks with soft drinks, bread with burgers).[9]

This definition is as much social as one based on specific ingredients, which makes the understanding of ultra-processed foods highly intuitive, even among untrained consumers.[13][14] A letter responding to Monteiro's 2009 commentary suggested that the definition 'lacks precision', since it lacks the measurable definitions of traditional food science.[15] Because of this, researchers disagree whether the definition can form a valid basis for scientific control.[16] Researchers have developed a quantitative definition for hyperpalatable food, but not for ultra-processed food.[17]

Nova classification

Label for Nova group 4, 'ultra-processed foods'

Monteiro's team subsequently presented ultra-processed foods as a group in the Nova food classification system.[18] The system focuses on food processing rather than foods types or nutrients. Nova categorizes foods into four groups:[3]

  1. Unprocessed or minimally processed foods
  2. Processed culinary ingredients
  3. Processed foods
  4. Ultra-processed foods

Nova is an open classification that refines its definitions gradually through new scientific publications rather than through a central advisory board.[10] The most recent overview of Nova published with Monteiro defines ultra-processed food as follows:

Industrially manufactured food products made up of several ingredients (formulations) including sugar, oils, fats and salt (generally in combination and in higher amounts than in processed foods) and food substances of no or rare culinary use (such as high-fructose corn syrup, hydrogenated oils, modified starches and protein isolates). Group 1 foods are absent or represent a small proportion of the ingredients in the formulation. Processes enabling the manufacture of ultra-processed foods include industrial techniques such as extrusion, moulding and pre-frying; application of additives including those whose function is to make the final product palatable or hyperpalatable such as flavours, colourants, non-sugar sweeteners and emulsifiers; and sophisticated packaging, usually with synthetic materials. Processes and ingredients here are designed to create highly profitable (low-cost ingredients, long shelf-life, emphatic branding), convenient (ready-to-(h)eat or to drink), tasteful alternatives to all other Nova food groups and to freshly prepared dishes and meals. Ultra-processed foods are operationally distinguishable from processed foods by the presence of food substances of no culinary use (varieties of sugars such as fructose, high-fructose corn syrup, ‘fruit juice concentrates’, invert sugar, maltodextrin, dextrose and lactose; modified starches; modified oils such as hydrogenated or interesterified oils; and protein sources such as hydrolysed proteins, soya protein isolate, gluten, casein, whey protein and ‘mechanically separated meat’) or of additives with cosmetic functions (flavours, flavour enhancers, colours, emulsifiers, emulsifying salts, sweeteners, thickeners and anti-foaming, bulking, carbonating, foaming, gelling and glazing agents) in their list of ingredients.[19]

The Nova definition of ultra-processed food does not comment on the nutritional content of food and is not intended to be used for nutrient profiling.[20]

International Agency for Research on Cancer (IARC)

The International Agency for Research on Cancer, an intergovernmental agency that forms part of the World Health Organization, classifies foods by their degree of processing. This system breaks food into 'non-processed', 'moderately processed', and 'highly processed' food.[21] The system does not take into account the nature or purpose of changes.[22]

Siga Index

The Siga Index is a classification system for processed foods developed in France in 2018.[23] It is based on both the degree of processing and the nutritional quality of foods, using a holistic and reductionist approach.[24]

The Siga Index assigns a score from 1 to 100 to each food product, where higher scores indicate higher nutritional quality and lower processing. The Siga Index also defines ultra-processed foods (UPFs) as those with a score below 40, which are considered to have low nutritional value and high levels of additives, preservatives, and artificial ingredients.[25]

International Food Information Council (IFIC)

The International Food Information Council defines five levels of food processing:[26][27]

  1. Minimally processed
  2. Foods processed for preservation
  3. Mixtures of combined ingredients
  4. Ready-to-eat processed foods
  5. Prepared foods/meals

NUPENS

The Center for Epidemiological Research in Nutrition and Health at the University of São Paulo has proposed a variant on the Nova classification consisting of:[28]

  1. Unprocessed, minimally, or moderately processed foods
  2. Processed foods
  3. Ultra-processed foods

Economics

Ultra-processed food as a percentage of household purchases in some European countries, as of 2018

Ultra-processed foods are an important part of the portfolio of the food industry because they rely on low cost ingredients and often enjoy higher profit margins.[29] They often have an extended shelf life, an important consideration for lower income consumers without reliable access to refrigeration. Among other reasons for the popularity of ultra-processed foods are the inexpensive cost of their main ingredients and aggressive marketing, especially toward youth consumers and particularly in middle income countries.[30][31]

Health effects

Numerous research studies have linked the consumption of ultra-processed foods to an array of health issues. The high levels of sugar, fat, and salt in these foods, coupled with their low fibre content, have been associated with an increased risk of non-communicable diseases.[5] High consumption of ultra-processed foods has been linked with obesity, hypertension, high cholesterol, and type 2 diabetes.[32]

Moreover, studies have indicated a potential association between the consumption of ultra-processed foods and an increased risk of some cancers.[33] The exact mechanisms underlying these associations are not fully understood, but potential factors could include the presence of contaminants, certain food additives, and the high heat treatment of these foods, which can lead to the formation of potentially harmful compounds.[34]

Environmental impact

Beyond health implications, the production of ultra-processed foods also has significant environmental impacts.[6] These foods require extensive processing and packaging, resulting in higher energy consumption and waste production compared to minimally processed foods. Moreover, the globalized supply chains for the ingredients of ultra-processed foods contribute to greenhouse gas emissions.[35]

Regulation and policy

Given the health and environmental impacts of ultra-processed foods, there have been calls for better regulation and policy surrounding these products. These measures face significant challenges, including industry opposition and the global nature of food supply chains. Future policy efforts may require a combination of regulation, education, and incentives to promote healthier, more sustainable food choices.

Four Latin American countries—Brazil,[36] Uruguay,[37] Peru,[38] and Ecuador[39]—have so far published national official dietary guidelines that recommend avoiding ultra-processed foods. Chile requires warning labels on some ultra-processed foods and taxes sugar-sweetened beverages.[40] A report on obesity published by the World Bank in 2020 mentions ultra-processed foods as a potential contributor.[41]

In 2022, the Scientific Advisory Committee on Nutrition (SACN) reviewed scientific literature to consider whether the British government should adopt a position on ultra-processed food and recommended further research, scheduling a review on its position for June 2024.[42]

Criticism

Following the publication of the Nova classification, some researchers questioned whether food processing should itself be considered a factor in nutrient intake, especially in a prominent 2017 criticism written by researchers, one of which was funded by Nestlé and the Kerry Group.[43] UPFs are imprecisely defined and it is unclear how any adverse effects on health may come about.[44]

In 2022, Carlos Monteiro and Arne Astrup argued for and against the Nova classification in a series of three articles written in the style of an Oxford debate. Montiero argued, for the 'yes' side:

The recommendation to prefer unprocessed/minimally processed foods and freshly made meals instead of ultra-processed foods (following the Nova food classification system) is being increasingly adopted in new official dietary guidelines issued by national governments and international health associations. This recommendation is supported by systematic reviews and meta-analyses of nationally representative dietary surveys and long-term cohort studies. These data show that increased intake of ultra-processed foods is associated with poor-quality diets and with increased morbidity and mortality from several chronic diseases. Various attributes of ultra-processed foods acting through known, plausible, or suggested physiologic and behavioral mechanisms relate them to ill health, and it is likely that different combinations of attributes and mechanisms affect different health outcomes. Although more research should be done to identify these mechanisms, existing evidence is sufficient to recommend the avoidance of ultra-processed foods to optimize health and policies to support and make feasible this recommendation.[45]

Astrup's 'no' argument centres on the Nova definition of ultra-processed foods as not yet sufficiently proven by scientific research for broad application in public health policy:

Clearly, many aspects of food processing can affect health outcomes, but conflating them into the notion of ultra-processing is unnecessary, because the main determinants of chronic disease risk are already captured by existing nutrient profiling systems. In conclusion, the Nova classification adds little to existing nutrient profiling systems; characterizes several healthy, nutrient-dense foods as unhealthy; and is counterproductive to solve the major global food production challenges.[46]

The two researchers nonetheless share consensus that further study is required to understand the effect of food processing on human health:

The participants in this debate agree that food processing vitally affects human health, and that the extent of food processing significantly affects diet quality and health outcomes. They disagree on the significance of ultra-processing, as defined within the Nova food classification system.[47]

See also

References

  1. ↑ Monteiro, Carlos (2010). "The big issue is ultra-processing". World Nutrition. 1 (6): 237–269. ISSN 2041-9775.
  2. ↑ Monteiro, Carlos (2011). "The big issue is ultra-processing. Why bread, hot dogs – and margarine – are ultra-processed". World Nutrition. 2 (10): 534–549. ISSN 2041-9775.
  3. 1 2 Monteiro, Carlos A.; Cannon, Geoffrey; Levy, Renata B; Moubarac, Jean-Claude; Louzada, Maria L. C.; Rauber, Fernanda; Khandpur, Neha; Cediel, Gustavo; Neri, Daniela; Martinez-Steele, Euridice; Baraldi, Larissa G.; Jaime, Patricia C. (2019). "Ultra-processed foods: what they are and how to identify them". Public Health Nutrition. 22 (5): 936–941. doi:10.1017/S1368980018003762. ISSN 1368-9800. PMC 10260459. PMID 30744710.
  4. ↑ Touvier, Mathilde; Louzada, Maria Laura da Costa; Mozaffarian, Dariush; Baker, Phillip; Juul, Filippa; Srour, Bernard (2023-10-09). "Ultra-processed foods and cardiometabolic health: public health policies to reduce consumption cannot wait". BMJ. 383: e075294. doi:10.1136/bmj-2023-075294. ISSN 1756-1833. PMC 10561017. PMID 37813465.
  5. 1 2 Pagliai, G.; Dinu, M.; Madarena, M. P.; Bonaccio, M.; Iacoviello, L.; Sofi, F. (2021-02-14). "Consumption of ultra-processed foods and health status: a systematic review and meta-analysis". British Journal of Nutrition. 125 (3): 308–318. doi:10.1017/S0007114520002688. ISSN 0007-1145. PMC 7844609. PMID 32792031.
  6. 1 2 Leite, Fernanda Helena Marrocos; Khandpur, Neha; Andrade, Giovanna Calixto; Anastasiou, Kim; Baker, Phillip; Lawrence, Mark; Monteiro, Carlos Augusto (2022-03-01). "Ultra-processed foods should be central to global food systems dialogue and action on biodiversity". BMJ Global Health. 7 (3): e008269. doi:10.1136/bmjgh-2021-008269. ISSN 2059-7908. PMC 8895941. PMID 35346976.
  7. ↑ Moubarac, Jean-Claude; Parra, Diana C.; Cannon, Geoffrey; Monteiro, Carlos A. (2014-06-01). "Food classification systems based on food processing: significance and implications for policies and actions. A systematic literature review and assessment". Current Obesity Reports. 3 (2): 256–272. doi:10.1007/s13679-014-0092-0. ISSN 2162-4968. PMID 26626606. S2CID 23606942.
  8. ↑ Pollan, Michael (2006). The omnivore's dilemma: A natural history of four meals. New York: Penguin Press. ISBN 978-1-59420-082-3.
  9. 1 2 Monteiro, Carlos A. (2009-05-01). "Nutrition and health. The issue is not food, nor nutrients, so much as processing". Public Health Nutrition. 12 (5): 729–731. doi:10.1017/S1368980009005291. ISSN 1475-2727. PMID 19366466. S2CID 42136316.
  10. 1 2 Gibney, Michael J (2019-02-01). "Ultra-processed foods: Definitions and policy issues". Current Developments in Nutrition. 3 (2): nzy077. doi:10.1093/cdn/nzy077. PMC 6389637. PMID 30820487.
  11. ↑ Fardet, Anthony; Rock, Edmond (2019-11-01). "Ultra-processed foods: A new holistic paradigm?". Trends in Food Science & Technology. 93: 174–184. doi:10.1016/j.tifs.2019.09.016. ISSN 0924-2244. S2CID 203896042.
  12. ↑ Sadler, Christina R.; Grassby, Terri; Hart, Kathryn; Raats, Monique; Sokolović, Milka; Timotijevic, Lada (2021-06-01). "Processed food classification: Conceptualisation and challenges". Trends in Food Science & Technology. 112: 149–162. doi:10.1016/j.tifs.2021.02.059. ISSN 0924-2244. S2CID 233647428.
  13. ↑ Hässig, Alenica; Hartmann, Christina; Sanchez-Siles, Luisma; Siegrist, Michael (2023-08-01). "Perceived degree of food processing as a cue for perceived healthiness: The NOVA system mirrors consumers' perceptions". Food Quality and Preference. 110: 104944. doi:10.1016/j.foodqual.2023.104944. hdl:20.500.11850/625580. ISSN 0950-3293. S2CID 259941132.
  14. ↑ Ares, Gastón; Vidal, Leticia; Allegue, Gimena; Giménez, Ana; Bandeira, Elisa; Moratorio, Ximena; Molina, Verónika; Curutchet, María Rosa (2016-10-01). "Consumers' conceptualization of ultra-processed foods". Appetite. 105: 611–617. doi:10.1016/j.appet.2016.06.028. ISSN 0195-6663. PMID 27349706. S2CID 3554621.
  15. ↑ Darmon, Nicole (2009-10-01). "The good, the bad, and the ultra-processed". Public Health Nutrition. 12 (10): 1967–1968. doi:10.1017/S1368980009991212. ISSN 1475-2727. PMID 19732488. S2CID 233340283.
  16. ↑ Visioli, Francesco; Marangoni, Franca; Fogliano, Vincenzo; Rio, Daniele Del; Martinez, J. Alfredo; Kuhnle, Gunter; Buttriss, Judith; Ribeiro, Hugo Da Costa; Bier, Dennis; Poli, Andrea (2022-06-22). "The ultra-processed foods hypothesis: a product processed well beyond the basic ingredients in the package". Nutrition Research Reviews. 36 (2): 340–350. doi:10.1017/S0954422422000117. hdl:11577/3451280. ISSN 0954-4224. PMID 35730561. S2CID 249923737.
  17. ↑ Fazzino, Tera L.; Rohde, Kaitlyn; Sullivan, Debra K. (2019-11-01). "Hyper-palatable foods: Development of a quantitative definition and application to the US Food System Database". Obesity. 27 (11): 1761–1768. doi:10.1002/oby.22639. hdl:1808/29721. ISSN 1930-7381. PMID 31689013. S2CID 207899275.
  18. ↑ Monteiro, Carlos Augusto; Levy, Renata Bertazzi; Claro, Rafael Moreira; de Castro, Inês Rugani Ribeiro; Cannon, Geoffrey (2010). "A new classification of foods based on the extent and purpose of their processing". Cadernos de Saúde Pública. 26 (11): 2039–2049. doi:10.1590/S0102-311X2010001100005. ISSN 0102-311X. PMID 21180977.
  19. ↑ Martinez-Steele, Euridice; Khandpur, Neha; Batis, Carolina; Bes-Rastrollo, Maira; Bonaccio, Marialaura; Cediel, Gustavo; Huybrechts, Inge; Juul, Filippa; Levy, Renata B.; da Costa Louzada, Maria Laura; Machado, Priscila P.; Moubarac, Jean-Claude; Nansel, Tonja; Rauber, Fernanda; Srour, Bernard (2023-06-01). "Best practices for applying the Nova food classification system". Nature Food. 4 (6): 445–448. doi:10.1038/s43016-023-00779-w. ISSN 2662-1355. PMID 37264165. S2CID 259024679.
  20. ↑ Lockyer, Stacey; Spiro, Ayela; Berry, Sarah; He, Jibin; Loth, Shefalee; Martinez-Inchausti, Andrea; Mellor, Duane; Raats, Monique; Sokolović, Milka; Vijaykumar, Santosh; Stanner, Sara (2023). "How do we differentiate not demonise – Is there a role for healthier processed foods in an age of food insecurity? Proceedings of a roundtable event". Nutrition Bulletin. 48 (2): 278–295. doi:10.1111/nbu.12617. ISSN 1471-9827. PMID 37164357. S2CID 258618401.
  21. ↑ Chajès, Véronique; Biessy, Carine; Byrnes, Graham; Deharveng, Geneviève; Saadatian-Elahi, Mitra; Jenab, Mazda; Peeters, Petra H. M.; Ocké, Marga; Bueno-de-Mesquita, H. Bas; Johansson, Ingegerd; Hallmans, Göran; Manjer, Jonas; Wirfält, Elisabet; Jakszyn, Paula; González, Carlos A. (2011-11-01). "Ecological-level associations between highly processed food intakes and plasma phospholipid elaidic acid concentrations: Results from a cross-sectional study within the European Prospective Investigation Into Cancer and Nutrition (EPIC)". Nutrition and Cancer. 63 (8): 1235–1250. doi:10.1080/01635581.2011.617530. ISSN 0163-5581. PMID 22043987. S2CID 23413731.
  22. ↑ Slimani, N; Deharveng, G; Southgate, D A T; Biessy, C; Chajès, V; van Bakel, M M E; Boutron-Ruault, M C; McTaggart, A; Grioni, S; Verkaik-Kloosterman, J; Huybrechts, I; Amiano, P; Jenab, M; Vignat, J; Bouckaert, K (2009-11-01). "Contribution of highly industrially processed foods to the nutrient intakes and patterns of middle-aged populations in the European Prospective Investigation into Cancer and Nutrition study". European Journal of Clinical Nutrition. 63 (S4): S206–S225. doi:10.1038/ejcn.2009.82. ISSN 0954-3007. PMID 19888275.
  23. ↑ Fardet, Anthony (2018). "Characterization of the degree of food processing in relation with its health potential and effects". Advances in Food and Nutrition Research. Vol. 85. Elsevier. pp. 79–129. doi:10.1016/bs.afnr.2018.02.002. ISBN 978-0-12-815089-4. ISSN 1043-4526. PMID 29860978.
  24. ↑ Davidou, Sylvie; Christodoulou, Aris; Fardet, Anthony; Frank, Kelly (2020-03-26). "The holistico-reductionist Siga classification according to the degree of food processing: an evaluation of ultra-processed foods in French supermarkets". Food & Function. 11 (3): 2026–2039. doi:10.1039/C9FO02271F. ISSN 2042-650X. PMID 32083627. S2CID 211231016.
  25. ↑ Fardet, Anthony (2018-10-01). "Vers une classification des aliments selon leur degré de transformation: Approches holistique et/ou réductionniste". Pratiques en Nutrition (in French). 14 (56): 32–36. doi:10.1016/j.pranut.2018.09.008. S2CID 187435561.
  26. ↑ Eicher-Miller, Heather A.; Fulgoni, Victor L.; Keast, Debra R. (2015-06-01). "Energy and nutrient intakes from processed foods differ by sex, income status, and race/ethnicity of US adults". Journal of the Academy of Nutrition and Dietetics. 115 (6): 907–918.e6. doi:10.1016/j.jand.2014.11.004. ISSN 2212-2672. PMID 25578928.
  27. ↑ Eicher-Miller, Heather A.; Fulgoni, Victor L.; Keast, Debra R. (2012-11-01). "Contributions of processed foods to dietary intake in the US from 2003–2008: A report of the Food and Nutrition Science Solutions Joint Task Force of the Academy of Nutrition and Dietetics, American Society for Nutrition, Institute of Food Technologists, and International Food Information Council". The Journal of Nutrition. 142 (11): 2065S–2072S. doi:10.3945/jn.112.164442. ISSN 0022-3166. PMC 3593301. PMID 22990468.
  28. ↑ Louzada, Maria Laura da Costa; Baraldi, Larissa Galastri; Steele, Euridice Martinez; Martins, Ana Paula Bortoletto; Canella, Daniela Silva; Moubarac, Jean-Claude; Levy, Renata Bertazzi; Cannon, Geoffrey; Afshin, Ashkan; Imamura, Fumiaki; Mozaffarian, Dariush; Monteiro, Carlos Augusto (2015-12-01). "Consumption of ultra-processed foods and obesity in Brazilian adolescents and adults". Preventive Medicine. 81: 9–15. doi:10.1016/j.ypmed.2015.07.018. ISSN 0091-7435. PMID 26231112.
  29. ↑ Scott, Caitlin (2018). "Sustainably sourced junk food? Big food and the challenge of sustainable diets". Global Environmental Politics. 18 (2): 93–113. doi:10.1162/glep_a_00458. ISSN 1526-3800. S2CID 57559050.
  30. ↑ Monteiro, C. A.; Moubarac, J.-C.; Cannon, G.; Ng, S. W.; Popkin, B. (2013). "Ultra-processed products are becoming dominant in the global food system". Obesity Reviews. 14 (S2): 21–28. doi:10.1111/obr.12107. ISSN 1467-7881. PMID 24102801. S2CID 13735684.
  31. ↑ Monteiro, Carlos Augusto; Cannon, Geoffrey; Moubarac, Jean-Claude; Levy, Renata Bertazzi; Louzada, Maria Laura C; Jaime, Patrícia Constante (2018). "The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing". Public Health Nutrition. 21 (1): 5–17. doi:10.1017/S1368980017000234. ISSN 1368-9800. PMC 10261019. PMID 28322183.
  32. ↑ Delpino, Felipe Mendes; Figueiredo, Lílian Munhoz; Bielemann, Renata Moraes; da Silva, Bruna Gonçalves Cordeiro; dos Santos, Francine Silva; Mintem, Gicele Costa; Flores, Thaynã Ramos; Arcêncio, Ricardo Alexandre; Nunes, Bruno Pereira (2022-08-10). "Ultra-processed food and risk of type 2 diabetes: a systematic review and meta-analysis of longitudinal studies". International Journal of Epidemiology. 51 (4): 1120–1141. doi:10.1093/ije/dyab247. ISSN 0300-5771. PMID 34904160.
  33. ↑ Isaksen, Irja Minde; Dankel, Simon Nitter (2023-06-01). "Ultra-processed food consumption and cancer risk: A systematic review and meta-analysis". Clinical Nutrition. 42 (6): 919–928. doi:10.1016/j.clnu.2023.03.018. ISSN 0261-5614. PMID 37087831. S2CID 257872002.
  34. ↑ Kliemann, Nathalie; Al Nahas, Aline; Vamos, Eszter P.; Touvier, Mathilde; Kesse-Guyot, Emmanuelle; Gunter, Marc J.; Millett, Christopher; Huybrechts, Inge (2022-07-01). "Ultra-processed foods and cancer risk: from global food systems to individual exposures and mechanisms". British Journal of Cancer. 127 (1): 14–20. doi:10.1038/s41416-022-01749-y. hdl:10362/153976. ISSN 0007-0920. PMC 9276654. PMID 35236935.
  35. ↑ Seferidi, Paraskevi; Scrinis, Gyorgy; Huybrechts, Inge; Woods, Jeremy; Vineis, Paolo; Millett, Christopher (2020-10-01). "The neglected environmental impacts of ultra-processed foods". The Lancet Planetary Health. 4 (10): e437–e438. doi:10.1016/S2542-5196(20)30177-7. hdl:11343/252595. ISSN 2542-5196. PMID 33038314. S2CID 222280757.
  36. ↑ Dietary Guidelines for the Brazilian Population (Report). Brasília: Brazilian Ministry of Health. 2014.
  37. ↑ "Guías Alimentarias para la Población Uruguaya". Montevideo: Ministerio de Salud del Uruguay. 2016.
  38. ↑ Guías Alimentarias para la Población Peruana (Report). Lima: Ministerio de Salud del Perú. 2018.
  39. ↑ Documento Técnico de las Guías Alimentarias Basadas en Alimentos (GABA) del Ecuador. GABA-ECU (Report). Quito: Ministerio de Salud Pública del Ecuador y Organización de las Naciones Unidas para la Alimentación y la Agricultura. 2018.
  40. ↑ Colchero, M. Arantxa; Paraje, Guillermo; Popkin, Barry M. (2021-12-02). Vadiveloo, Maya K. (ed.). "The impacts on food purchases and tax revenues of a tax based on Chile's nutrient profiling model". PLOS ONE. 16 (12): e0260693. Bibcode:2021PLoSO..1660693C. doi:10.1371/journal.pone.0260693. ISSN 1932-6203. PMC 8638973. PMID 34855853.
  41. ↑ Shekar, Meera; Popkin, Barry, eds. (2020-02-13). Obesity: Health and economic consequences of an impending global challenge. The World Bank. doi:10.1596/978-1-4648-1491-4. hdl:10986/32383. ISBN 978-1-4648-1491-4. S2CID 219141840.
  42. ↑ Scientific Advisory Committee on Nutrition (2023-07-11). "SACN statement on processed foods and health". GOV.UK.
  43. ↑ Gibney, Michael J.; Forde, Ciarán G.; Mullally, Deirdre; Gibney, Eileen R. (2017-03-01). "Ultra-processed foods in human health: a critical appraisal". The American Journal of Clinical Nutrition. 106 (3): 717–724. doi:10.3945/ajcn.117.160440. ISSN 0002-9165. PMID 28793996.
  44. ↑ Tobias, Deirdre K.; Hall, Kevin D. (2021). "Eliminate or reformulate ultra-processed foods? Biological mechanisms matter". Cell Metabolism. 33 (12): 2314–2315. doi:10.1016/j.cmet.2021.10.005. PMID 34699743. S2CID 239986991.
  45. ↑ Monteiro, Carlos A.; Astrup, Arne (2022-12-01). "Does the concept of "ultra-processed foods" help inform dietary guidelines, beyond conventional classification systems? YES" (PDF). The American Journal of Clinical Nutrition. 116 (6): 1476–1481. doi:10.1093/ajcn/nqac122. PMID 35670127. Archived from the original on 2022-06-12. Retrieved 2023-10-11.{{cite journal}}: CS1 maint: bot: original URL status unknown (link)
  46. ↑ Astrup, Arne; Monteiro, Carlos A. (2022-12-01). "Does the concept of "ultra-processed foods" help inform dietary guidelines, beyond conventional classification systems? NO" (PDF). The American Journal of Clinical Nutrition. 116 (6): 1482–1488. doi:10.1093/ajcn/nqac123. ISSN 0002-9165. PMID 35670128. Archived from the original on 2022-06-12. Retrieved 2023-10-11.{{cite journal}}: CS1 maint: bot: original URL status unknown (link)
  47. ↑ Astrup, Arne; Monteiro, Carlos A. (2022-12-01). "Does the concept of "ultra-processed foods" help inform dietary guidelines, beyond conventional classification systems? Debate consensus" (PDF). The American Journal of Clinical Nutrition. 116 (6): 1489–1491. doi:10.1093/ajcn/nqac230. ISSN 0002-9165. PMID 36253965. Archived from the original on 2022-10-22. Retrieved 2023-10-11.{{cite journal}}: CS1 maint: bot: original URL status unknown (link)
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