The ultra-processed foods hypothesis: a product processed well beyond the basic ingredients in the package

Abstract

The NOVA classification of food items has become increasingly popular and is being used in several observational studies as well as in nutritional guidelines and recommendations. We propose that there is a need for this classification and its use in the formulation of public health policies to be critically discussed and re-appraised. The terms “processing” and “ultra-processing,” which are crucial to the NOVA classification, are ill-defined, as no scientific, measurable, or precise reference parameters exist for them. Likewise, the theoretical grounds of the NOVA classification are unclear and inaccurate. Overall, the NOVA classification conflicts with the classic, evidence-based evaluation of foods based on composition and portion size because NOVA postulates that the food itself (or how much of it is eaten) are unimportant, but rather that dietary effects are due to how the food is produced. We contend that the NOVA system suffers from a lack of biological plausibility so the assertion that ultra-processed foods are intrinsically unhealthful is largely unproven, and needs further examination and elaboration.

Novel plant-based meat alternatives: future opportunities and health considerations

“…For example, the authors (154) highlighted fifty 'ultra-processed' food products (charactersised according to the NOVA classification system) that were identified as 'healthy' food products according to the 2011 and 2018 Nutritional Profiling tool. This and similar findings have led to criticism of NOVA as an ambiguous classification system (155)(156)(157)(158)(159) . Additional concern relates to the use of one umbrella term of "ultraprocessed" to describe a diverse range of processing techniques which have distinct functions (156) .…”

Unhealthy Food and Beverage Consumption during Childhood and Risk of Cardiometabolic Disease: A Systematic Review of Prospective Cohort Studies

“…For example, heat-related ultra-processing of foods produces neo-formed contaminants, including acrylamide and acrolein, which could also be implicated in the development of CVD [42]. However, some contend that the health effects of excessive intake of UPF, including discretionary foods, may be because of their energy-dense, nutrient-poor composition, rather than the nature and degree of processing [50]. Indeed, further investigation is warranted to understand if the concept of UPF can inform dietary guidelines beyond traditional approaches to the study of diet and NCD risk [51,52].…”

“…Although we aimed to minimize typical bias in grading by using standardized methods and transparent reporting, we acknowledge that assessment of risk of bias and certainty of evidence is subjective. Finally, NOVA classification of foods presents challenges; it may be affected by insufficient detail collected about food items in conventional dietary assessment methods and is influenced by subjective coding of foods [50][51][52]. Therefore, misclassification of foods and potential under-or over-estimation of UPF exposure in the observational studies included in our review cannot be excluded.…”

Consumer Awareness of the Degree of Industrial Food Processing and the Association with Healthiness—A Pilot Study

“…Besides the risk of misclassifications, there is a scientific debate about whether the degree of industrial processing as such is a valid tool to judge the healthiness of foods [ 6 , 7 , 11 , 48 ]. If the degree of processing has negative health consequences, then underlying biological mechanisms should explain this relationship.…”