Ultra-processed foods (UPFs) have become a frequent topic of conversation recently. What are ultra-processed foods, and how do they affect health?

Food processing emerged in response to World War II, when there was a need for foods that were shelf stable, easy to transport, calorically dense,
and palatable. Food technology and product development has continued to evolve and expand in the decades that have followed.
Between 2018 and 2023, 81,693 new food and beverage products entered the US food market; 81% of these new products are considered ultra-processed.

Processed foods are defined using the Nova food classification system, which categorizes foods based on the extent and purpose of processing.
The categories are:

    1. Unprocessed/Minimally processed: Naturally occurring foods with no added salt, sugar, or fats. Examples: fresh vegetable, fruits, grains, legumes, meat, pasteurized cow’s milk.
    2. Processed Culinary Ingredients: Food products that have been processed by pressing, refining, grinding and/or milling, used to prepare
      or season foods in group 1. Examples: fats, oils, sugars, starches, salt.
    3. Processed Foods: Food products made by adding sugar, oil and/or salt to create food products with increased shelf life or enhanced taste. Examples: canned vegetables in brine, fruit in syrup, cheese, pre-seasoned meats.
    4. Ultra-Processed Foods: Food products created with the addition of multiple ingredients that may include additives to enhance the taste
      and/or convenience of the product, such as stabilizers, flavor enhancers, non-sugar sweeteners, and processing aids such as stabilizers
      and bulking and anti-bulking agents. Examples: sweet and savory snacks, reconstituted meat, candy, tofu, nutrition supplements, fortified breads and grain products, fortified alternative milks and dairy products, pre-marinated or dye-injected meats.

Intake of UPFs has increased, accounting for 50%-60% of the usual diet of the average person in the United States. High UPF intake based on
the Nova classification is associated with increased risk of overweight/obesity, high waist circumference, low HDL cholesterol, and metabolic syndrome. UPFs may also pose a risk for people with kidney disease, as additives may contain sodium, potassium, and phosphorus.

It’s important to note that “ultra-processed” is not necessarily synonymous with “unhealthy”. A number of foods that fall into the category of UPF are nutrient dense and can be part of a high-quality diet. Examples include whole-grain fortified breads and cereals, canned fish, and fortified milk/milk alternatives. Similarly, not all unprocessed foods are healthy to consume. Foods like raw milk, unwashed produce, and dried beans pose health risks
if consumed unmodified.

In addition to the convenience and palatability of UPFs, intake of UPFs is influenced by social and demographic factors including age, race and ethnicity, income, food insecurity and geographical location. UPFs may provide convenience, accessibility, and value.

For people living with CKD or those at risk for kidney disease, reducing intake of UPFs may be a helpful strategy for supporting kidney health.
Nutrition counseling should prioritize equity and a holistic approach to improving overall diet quality in a sustainable way, rather than promoting a blanket avoidance of ultra-processed foods. Choosing whole or minimally processed foods more often, such as fresh vegetables, fruits, whole grains, beans, nuts,
and lean proteins, can help improve diet quality.

Practical strategies for improving overall diet quality include reading nutrition labels, paying attention to sodium levels, limiting packaged snacks
and sugary beverages, and preparing more meals at home when possible. Including nutrient-dense UPFs like fortified whole-grain products or high-quality nutrition supplements can help to improve overall diet quality to meet nutrition needs. For patients who struggle with poor appetite
or are at risk for malnutrition, these options may play an important role in helping meet protein and calorie needs while supporting overall health.

For additional resources on nutrition support and patient education, including clinical presentations and handouts, please visit our Clinician Portal.

References

  • Academy of Nutrition and Dietetics Nutrition Fact Check https://www.eatrightpro.org/news-center/practice-trends/nutrition-fact-check-ultra-processed-foods.

We thank our guest blogger Rory C. Pace, MPH, RD, CSR for sharing her knowledge and writing this blog post!