Who consumes ultra-processed food? A systematic review of sociodemographic determinants of ultra-processed food consumption from nationally representative samples

Abstract

Ultra-processed food (UPF) intake is associated with increased non-communicable disease risks. However, systematic reports on sociodemographic predictors of UPF intake are lacking. This review aimed to understand UPF consumption based on sociodemographic factors, using nationally representative cohorts. The systematic review was pre-registered (PROSPERO:CRD42022360199), following PRISMA guidelines. PubMed/MEDLINE searches (‘ultra-processed/ultraprocessed’ and ‘ultra-processing/ultraprocessing’) until 07/09/2022 retrieved 1,131 results. Inclusion criteria included: observational, nationally representative adult samples, in English, in peer-reviewed journals, assessing the association between sociodemographics and individual-level UPF intake defined by the NOVA classification. Exclusion criteria included: not nationally representative, no assessment of sociodemographics and individual-level UPF intake defined by NOVA. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). 55 papers were included, spanning 32 countries. All 13 sociodemographic variables identified were significantly associated with UPF intake in ≥1 studies. Significant differences in UPF intake were seen across age, race/ethnicity, rural/urbanisation, food insecurity, income and region, with up to 10-20% differences in UPF intake (% total energy). Higher UPF intakes were associated with younger age, urbanisation, and being unmarried, single, separated or divorced. Education, income and socioeconomic status showed varying associations, depending on country. Multivariate analyses indicated that associations were independent of other sociodemographics. Household status and gender were generally not associated with UPF intake. NOS averaged 5.7/10. Several characteristics are independently associated with high UPF intake, indicating large sociodemographic variation in non-communicable disease risk. These findings highlight significant public health inequalities associated with UPF intake, and the urgent need for policy action to minimise social injustice-related health inequalities.

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

“…Ultra-processed foods tend to be cheaper than minimally processed foods (22,54) . In the UK, a lower social class is associated with greater ultra-processed food intake (55) and income with poorer diet quality (56) . Policy makers must therefore consider the financial implications and abilities of the UK public to shift towards a minimally processed diet and away from ultra-processed foods, particularly with the current cost of living crisis (57) , and issues relating to accessibility of minimally processed foods.…”

The Influence of Ultra-Processed Food on Colorectal Cancer: A Systematic Review

“…Possible explanations for such different sex patterns may involve the effect of sex hormones or genetics [59] or higher calcium intake (protective effect) by women [14]. However, one must go beyond biological assessments and evaluate these differences from a biological and social perspective [60,61].…”

Ultra-processed foods consumption and health-related outcomes: a systematic review of randomized controlled trials

“…In the study conducted by Sartorelli et al, participants were from areas of high social vulnerability, which, according to the authors, could have limited their access to a healthy diet ( 25 ). There is evidence that the consumption of UPFs is usually higher in disadvantaged populations due to greater availability, access, and lower cost ( 5 , 32 ). In fact, according to the study by Hall ( 28 ), the weekly cost to prepare a diet of 2000 Kcal/day consisting of ultra-processed foods was US$ 106, compared to US$ 151 for an unprocessed diet.…”

“…Ultra-processed foods (UPFs) are industrial formulations made from modified and unmodified substances extracted from foods, which include few or no whole foods (1). These products result from intensive industrial processing and contain food additives such as preservatives, emulsifiers, flavorings, bulking agents, among others, which are used to extend the product's shelf life and improve its sensory qualities (2)(3)(4)(5)(6)(7). Most UPFs are characterized by high energy density, being rich in saturated fats, refined starches, free sugars, and salt, and low in dietary fiber, proteins, and micronutrients (4,6).…”