The Ultra-Processed Food Health Controversy

Among the most controversial and contentious topics in contemporary foods and their impact on nutrition quality and health status is the concept of “ultra-processed foods,” a concept that was actually discussed during deliberations by the 2010 Dietary Guidelines Advisory Committee. Thankfully, common sense prevailed as the committee deferred the topic to U.S. statutory definitions of processed food and minimally processed food. Even in this space, there are multiple definitions and descriptors established by the World Health Organization, USDA, and European Food Safety Authority, just to name a few.

Fundamentally, all foods that humans consume are processed in some manner from post-harvest activities to preparation in the typical home kitchen. Within the U.S., processed foods are those, other than raw agricultural commodities, that are subjected to washing, cleaning, milling, cutting, chopping, heating, and many other interventions that transform food from its innate state. With respect to minimally-processed food, most of the inherent physical, chemical, sensory, and nutritional properties are retained.

The NOVA Food Classification

Since 2010, numerous organizations, health authorities, and scientists, in search of a “cause” of obesity and poor health, have grouped foods into four categories termed NOVA (not an acronym). NOVA is the classification that categorizes foods according to the extent and purpose of food processing, rather than in terms of nutrients. Those NOVA categories are:

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

Examples of processed ingredients include vegetable oils, margarine, butter, cream, lard, milk and soy proteins, sugar, sweeteners of all types, starches, flours, “raw” pastas and noodles, salt, gums, preservatives, and cosmetic additives. Transitioning to ultra-processed foods, there are sugared beverages, juices, milks, “no-calorie” cola, infant formulas, follow-on milks, baby food, cheeses, sauces, and salted, pickled, smoked, or cured meat and fish. Also included are breads, breakfast cereals with added sugar, bars, savory and sweet snack products, chips, and crisps.

Upon close examination of NOVA categories and nutrient bioavailability, there appears to be a spectrum of evidence from the National Health and Nutrition Examination Survey analysis that indicates fortified ready-to-eat cereals provide positive nutrition, especially among those at-risk populations that typically fail to achieve nutrient adequacy, such as children, pregnant and lactating women, and seniors. In addition, as many investigators advocate potential health benefits of bioactives from plants, processing enhances bioavailability of many of these bioactives while improving the safety of these foods. For example, toxins that are innate to most of agricultural commodities, such as carrots (falcarinol), cassava (cyanogenic glycosides), radishes (isothiocyanate), parsley and celery (psoralens), cruciferous vegetables (goitrin), and even citrus fruit (limonene), are actually reduced, removed, and/or destroyed during many conditions of thermal processing.

It is imperative to remember that the processing of fruits and vegetables actually contribute to their increased consumption. Of course, these foods provide an array of shortfall nutrients, such as potassium and dietary fiber. With respect to dietary fiber, the NOVA categorization contends that grains are transformed from minimally processed (whole grains), to processed ingredient (flour), to processed food (bread ≤ 5 ingredients) to ultra-processed foods (cereals and breads > 5 ingredients). Importantly, NOVA does not address whole grains, high fiber, or nutritionally enhanced foods in the categories and how processing actually enhances nutritional value consistent with dietary recommendations.

A Number of Studies…

Using a 24-hour dietary records approach, the 2018 French self-reporting, web-based NutriNet-Santé study published in The BMJ indicated that ultra-processed foods were considered of lower nutritional quality, primarily due to the presence of food additives and food-contact substances in packaging materials, and that these foods were associated with an increased risk of cancer (prostate, colorectal, breast) based on a Cox proportional hazard model. On the other hand, an earlier 2014 report published in Nutrition Today indicated food processing improves retention and bioavailability of bioactive food components, minimizes the formation of some carcinogens, and improves the overall quality and acceptability of foods.