‘Concerning’: 67% of calories kids and teens consume come from ultra-processed foods

The proportion of total energy that children and adolescents consumed from ultra-processed foods rose nearly 6 percentage points during a recent 20-year period, according to data from the National Health and Nutrition Examination Survey.

“To our best knowledge, this is the first study that looked at how American children’s consumption of ultra-processed foods changed in the past 2 decades,” Fang Fang Zhang, MD, PhD, an associate professor at the Friedman School of Nutrition Science and Policy at Tufts University, told Healio Primary Care.

The study was also novel in that it evaluated trends among different types of ultra-processed foods, according to Zhang.

The researchers assessed 24-hour dietary recall data on 33,795 children and adolescents aged 2 to 19 years (weighted mean age, 10.7 years; 49.1% female) from 10 cycles of the National Health and Nutrition Examination Survey from 1999 to 2018.

Zhang and colleagues reported in JAMA that total energy from consumption of ultra-processed foods increased from 61.4% to 67% (difference = 5.6%; 95% CI, 3.5-7.7), and the percentage of total energy from consumption of unprocessed or minimally processed foods dropped from 28.8% to 23.5% (difference = -5.3%; 95% CI, 7.5 to 3.2).

The remaining percentage of energy came from moderately processed foods, including cheese and canned fruits and vegetables, and consumer-added flavor enhancers such as sugar, honey, maple syrup and butter, according to a press release.

Among subgroups of ultra-processed foods, the estimated percentage of energy from eating ready-to-heat and ready-to-eat mixed dishes like takeout, frozen pizza and burgers rose from 2.2% to 11.2% (difference = 8.9%; 95% CI, 7.7-10.2). In addition, the percentage of energy from consumption of sweet snacks and sweets increased from 10.7% to 12.9% (difference = 2.3%; 95% CI, 1-3.6).

The researchers observed a decrease in the estimated percentage of energy from sugar-sweetened beverages, which declined from 10.8% to 5.3% (difference, 5.5%; 95% CI, 6.5 to 4.5), and from processed fats and oils, condiments and sauces, which declined from 7.1% to 4% (difference = 3.1%; 95% CI, 3.7 to 2.6).

The increase in the estimated percentage of energy from ultra-processed foods was significantly larger among underrepresented populations, which rose from 62.2% to 72.5% (difference = 10.3%; 95% CI, 6.8-13.8) in non-Hispanic Black youths and 55.8% to 63.5% (difference = 7.6%; 95% CI, 4.4-10.9) in Mexican American youths compared with the increase among non-Hispanic white youths, which rose from 63.4% to 68.6% (difference = 5.2%; 95% CI, 2.1- 8.3).

A previously published study revealed multiple factors that influence children’s eating habits, including parents’ attitudes toward type and amount of food consumed, how often families eat together, family income level, whether a child was breastfed and frequency of exposure to television commercials for unhealthy foods.

Because not all these factors are easily modifiable, Zhang said more population-based strategies, like sugar-sweetened beverage taxes, may “achieve a broader and more sustainable impact.”

Fang Fang Zhang

“For ultra-processed foods, addressing processing level as a food dimension in food policies and dietary recommendations may encourage the consumption and manufacture of less processed nutrient-dense food products,” she said in the interview.

Zhang also recommended that health care providers “play a larger role” in encouraging healthy eating behaviors among their pediatric patients, such as replacing a sweet bakery product with a whole grain one.

In a related editorial, Katie A. Meyer, ScD and Lindsey Smith Taillie, PhD, both assistant professors in the department of nutrition at the University of North Carolina Gillings School of Global Public Health, said the findings “are concerning and potentially have major public health significance.”

They called for “better dietary assessment methods” that record trends and improve the understanding of ultra-processed foods “to inform future evidence-based policy and dietary recommendations.”

Meyer and Smith Taillie identified several successful nutrition policies, including Mexico’s 8% tax on energy-dense non-basic foods, which has thus far led to a 6% drop in such purchases, and Chile’s policies on product labeling, marketing and sales that spurred “product reformulation, reduced availability of unhealthy foods in schools [and] improved ability by children and parents to identify unhealthy foods.”

References:

Meyer KA, Smith Tallie L. JAMA. 2021;doi:10.1001/jama.2021.9845.

Scaglioni S, et al. Nutrients; 2018;doi:10.3390/nu1006060706.

Wang L, et al. JAMA. 2021;doi:10.1001/jama.2021.10238.