No, all UPFs are not full of salt, sugar, saturated fat and calories. That's why UPFs matter.

‍Introduction

There is some level of confusion in the general population, and to some extent amongst health professionals around what ultra-processed foods (UPFs) areis and why it matters. 

Some claim the issue is that UPFs typically have a poor nutritional profile (high in sugar, salt, saturated fat or calories). Others claim that actually, not all UPFs are bad, which has also been backed by science. Some claim that UPFs have adverse effects aside from their nutritional profile, see a blatant example here. So which is it?

To find out, we ran through the food products database of the USDA, to identify which were UPFs and which had a poor nutritional profile. 

Methods

Criteria

The criteria we used to test both features are: 

1. Ultra-processed foods: NOVA classification. 

We apply the calculation of the NOVA classification system, the world reference UPF classification method. This method classifies foods into 4 groups based on their processing:

• NOVA 1: corresponds to unprocessed or minimally processed foods.
• NOVA 2: Applies to processed culinary ingredients. Items classified in this group are products that come from Group 1 by crushing, pressing, or grinding, etc. and are typically used for cooking and seasoning. NOVA 2 products are rarely consumed alone (for example sugar, vegetable oils, salt, vinegar, flour, etc.).
• NOVA 3: Refers to processed foods. they are normally NOVA 1 products that have been combined with NOVA 2 products (salts, sugar, oil, etc.). It is common for these products to contain between two, but no more than five ingredients.
• NOVA 4: Corresponds to ultra-processed products. They are usually industrial preparations with more than five ingredients, many of which are impossible to find in a domestic kitchen. They can and usually are subject to unnatural processes such as hydrogenation, extrusion, milling, etc., and are usually foods that are the subject of intense marketing and advertising campaigns (well above the products in the rest of the NOVA categories).

2. Nutrient profile: Chilean warning labels. 

The Chilean regulations are widely recognised as a pioneering nutritional profile front-of-pack (FOP) labeling system. It mandates labeling for products exceeding specified thresholds for sugar, sodium, saturated fats, and calories. The limits stipulated by law are detailed in the table below. 

‍Exemptions. Some food categories are exempt from the Chilean labeling regulation, some of the relevant exemptions are:

• Food without added sugar, honey, syrups, sodium and saturated fat. 
• Bulk food
• Baby formula
• Supplements and sports food
• Non-sugar non-calorie sweeteners

Datasets

We obtained the publicly available data from the USDA collected in 2023.
From 429.651 packaged food products identified, we eliminated those that did not have the necessary information to be rated for Chilean warnings (nutritional table, serving size, etc). This left us with 364,372 products which we evaluated against Chilean FOP labeling regulations to determine which items would require black stop signs. In order to dig into further detail per food category, we used the packaged products designated category, and merged those categories to narrow down to 19 food groups. 

Results

General overview

The analysis of the dataset demonstrated that: 

• 68% of the products are ultra-processed (UPFs)
• 71% of the products would require at least one Chilean warning

By crossing the data, we determined that there is significant overlap:

• 82% of the ultra-processed foods would also require a Chilean warning, for excessive sugar, sodium, saturated fat or calories
• 79% of the products with Chilean warnings are UPFs
• 56% of products are both ultra-processed and would require a warning, ie would be considered poor according to both criteria
• 17% of products are neither ultra-processed, nor would they require a warning, ie would be considered healthy according to both criteria.

 But there are also areas of discrepancy:

• 18% of the ultra-processed foods would not require a Chilean warning, so they could be considered nutritionally appropriate. 
• 21% of the products with Chilean warnings are not UPFs: not only ultra-processed foods have poor nutritional value !

In total, 73% of products would be rated in the same way according to both UPF and “high in criteria. This means that more than 1 out of 4 products (27%), UPF and “high in” criteria would not be aligned: products that are either only UPF or only nutritionally poor. These products would therefore be scored widely differently according to one or the other standard. 

_{Figure 1: general breakdown  of packaged products according to UPF and Chilean warnings criteria.} 

Rating of products per criteria per food category

The chart below details the prevalence of products that either qualify:

• as UPF as well as Chilean warnings (red, ie assessed as poor by both standards),
• qualify for only one of those (pink and yellow),
• for neither (green, ie assessed as healthy by both standards).

This chart shows that the discrepancies differ greatly between categories: 

• For Snacks; Fats & Oils and Spices & Herbs categories, there is higher prevalence of “high in” warnings, rather than UPF
• For Meals, Entrees & Sides Dishes and for Beverages, there is much higher prevalence of UPF products than “high in” products.  

‍

_{Figure 2: Distribution of products that are UPF and/or qualify for Chilean warning labels, per food category.} 

‍

Overlap and discrepancies between “ultra-processed” (NOVA) and “high-in” (Chilean warnings) criteria

The chart below shows the level of agreement between UPF and warnings per food category, to determine whether either criteria could be interchangeable. The level of agreement is measured by % of products that either comply with both or neither of the UPF and Chilean “high in” warnings criteria. The food categories for which both criteria best coincide are shown on the left, while those with higher discrepancy are shown on the right. 

_{Figure 3: Level of alignment /discrepancy in assessment according to UPF (NOVA) and nutritional content (Chilean warnings) criteria.} 

This analysis shows:

• For categories Cereals, Grains & Pasta; Baked Products; Legumes and Sweets, the using either criteria will provide the same result (healthy or poor) in over 85% of products. So for this side of the spectrum, both criteria could be used almost interchangeably. Interestingly, those are also the “best” and “worst” categories: some text
  • Cereals, Grains & Pasta; Legumes: categories which most prevalence of products that are neither ultra-processed nor would require a “high in” warning
  • Baked Products; Sweets: categories which most prevalence of products that are both ultra-processed and would require a “high in” warning
• For categories Beverages, Fats & Oils, Finfish & Shellfish, at least 40% of the products are rated differently: either ultra-processed with no warnings, or warnings but not ultra-processed. It is therefore for this end of the spectrum that diving into more detail by considering both criteria is most relevant to better analyze the worth of a product. 

Analysis of Chilean warnings specifically on UPFs

The prevalence of Chilean warnings on all products was compared to that for UPFs only. This demonstrates that: 

• The total number of Chilean warnings are 21% higher on UPFs, compared to the general average. 
• The prevalence of Chilean warnings increases for UPF products, for all warning signs, by 22% on average. 
• The highest increase is for High in Sugar warning, 31% more prevalent on UPFs compared to the overall average of products.  
• The relative prevalence of each warning sign remains unchanged, with “high in calories” as the most common. However for UPFs, “high in sugar” are almost as common, as they would  

The detailed analysis per food category showed that the general profile is relatively similar to the full database (UPFs + non UPFs), but with increased prevalence of warnings in all food categories. 

_{Figure 4: Prevalence foods qualifying for Chilean warning labels amongst the UPF food segment}

Discussion

The consideration of which criteria to consider to measure the worth / risk of a food product (ultra-processed and/or nutrient profile) will be the cornerstone of any activities aiming at fomenting better diets and lifestyle. 

The results of this analysis have shown that to fully address the value of a product, “ultra-processing” and “high-in” should both be considered in conjunction. Otherwise, for more than 1 out of 4 products, we would be missing half the picture.  

The level of agreement of these criteria greatly varies from one to another food category. In those cases, the consideration of both criteria is key to detect unhealthy products. For example, this can us enable to identify : 

• Beverages that qualify as UPF, despite bearing a healthy nutrient profile because sugar was replaced by non-sugary sweeteners
• Savory snacks that are free from ultra-processing markers, but are heavily loaded with salt

If only 1 of those criteria is considered, this provides loopholes for food & beverage manufacturers to get a tick in the box highlighted, while disregarding the other. This would generate even more confusion amongst consumers, as a product could be considered healthy by 1 criteria and boast a health claim… while not complying with the other, without consumers knowing nor understanding.

This discrepancy could be deemed irrelevant if health concerns for UPFs were limited to a root cause from their nutritional profile, but several studies suggest otherwise (eg. K. Hall’s controlled diet study). This therefore demonstrates that qualifying a food product as UPF has value in terms of public health in its own right.

This new information comes at a key time for US regulations: the Food and Drug Association (FDA) is currently working on a redesign of food labeling regulations, with an outcome due for 2024. Irrespective of format, those are likely to focus on nutritional profile alone, similarly to most areas around the globe. In the meantime, the US Department of Agriculture (USDA) is reviewing the Dietary Guidelines for Americans, due to be issued in 2025. At this stage it is unclear whether either of those will include the UPF criteria, which we have demonstrated could hinder proper assessment of food products and diets guidelines.   

Conclusion

There is significant overlap between standards of ultra-processed (NOVA) and “high in” nutrients of concern (Chilean warnings): 

• 82% of the ultra-processed foods would also require a Chilean warning, for excessive sugar, sodium, saturated fat or calories
• 79% of the products with Chilean warnings are UPFs
• 56% of products are both ultra-processed and would require a warning, ie would be considered poor according to both criteria

But there are also areas of discrepancy: for more than 1 out of 4 products (27%), UPF and “high in” criteria would not be aligned, ie those products are either only UPF or only nutritionally poor. These products would therefore be scored widely differently according to one or the other standard.

The “UPF” consideration can therefore not be dismissed, because:
- it cannot be fully represented by other criteria such as “high in”
- science suggests it may cause harm to health irrespective of the nutritional profile

‍

Article written by Laura Guinovart Martín, certified Dietitian and Nutritionist; Specialized in TCA, Obesity and Food Development and Design; Nº Col:CAT002123, Julie Ruelle, Registered Dietitian (US) and Lynne Bouchy, Dietitian student.

‍