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Trends in Consumption of Ultraprocessed Foods Among US Youths Aged 2-19 Years, 1999-2018

Educational Objective
To understand US trends in the consumption of ultraprocessed foods.
1 Credit CME
Key Points

Question  What were the trends in consumption of ultraprocessed foods among US youths from 1999 to 2018?

Findings  In this serial cross-sectional study of nationally representative data from 33 795 US youths aged 2-19 years, the estimated percentage of total energy consumed from ultraprocessed foods increased from 61.4% to 67.0%, whereas the percentage of total energy consumed from unprocessed or minimally processed foods decreased from 28.8% to 23.5%.

Meaning  From 1999 to 2018, the estimated proportion of energy intake from consumption of ultraprocessed foods increased in the US among youths and comprised the majority of their total energy intake.

Abstract

Importance  The childhood obesity rate has been steadily rising among US youths during the past 2 decades. Increasing evidence links consumption of ultraprocessed foods to excessive calorie consumption and weight gain, but trends in the consumption of ultraprocessed foods among US youths have not been well characterized.

Objective  To characterize trends in the consumption of ultraprocessed foods among US youths.

Design, Setting, and Participants  Serial cross-sectional analysis using 24-hour dietary recall data from a nationally representative sample of US youths aged 2-19 years (n = 33 795) from 10 cycles of the National Health and Nutrition Examination Survey (NHANES) from 1999-2000 to 2017-2018.

Exposures  Secular time.

Main Outcomes and Measures  Percentage of total energy consumed from ultraprocessed foods as defined by NOVA, an established food classification system that categorizes food according to the degree of food processing.

Results  Dietary intake from youths were analyzed (weighted mean age, 10.7 years; 49.1% were girls). From 1999 to 2018, the estimated percentage of total energy from consumption of ultraprocessed foods increased from 61.4% to 67.0% (difference, 5.6% [95% CI, 3.5% to 7.7%]; P < .001 for trend), whereas the percentage of total energy from consumption of unprocessed or minimally processed foods decreased from 28.8% to 23.5% (difference, −5.3% [95% CI, −7.5% to −3.2%]; P < .001 for trend). Among the subgroups of ultraprocessed foods, the estimated percentage of energy from consumption of ready-to-heat and -eat mixed dishes increased from 2.2% to 11.2% (difference, 8.9% [95% CI, 7.7% to 10.2%]) and from consumption of sweet snacks and sweets increased from 10.7% to 12.9% (difference, 2.3% [95% CI, 1.0% to 3.6%]), but the estimated percentage of energy decreased for sugar-sweetened beverages from 10.8% to 5.3% (difference, −5.5% [95% CI, −6.5% to −4.5%]) and for processed fats and oils, condiments, and sauces from 7.1% to 4.0% (difference, −3.1% [95% CI, −3.7% to −2.6%]) (all P < .05 for trend). There was a significantly larger increase in the estimated percentage of energy from consumption of ultraprocessed foods among non-Hispanic Black youths (from 62.2% to 72.5%; difference, 10.3% [95% CI, 6.8% to 13.8%]) and Mexican American youths (from 55.8% to 63.5%; difference, 7.6% [95% CI, 4.4% to 10.9%]) than the increase among non-Hispanic White youths (from 63.4% to 68.6%; difference, 5.2% [95% CI, 2.1% to 8.3%]) (P = .04 for trends).

Conclusions and Relevance  Based on the NHANES cycles from 1999 to 2018, the estimated proportion of energy intake from consumption of ultraprocessed foods has increased among youths in the US and has consistently comprised the majority of their total energy intake.

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Article Information

Corresponding Author: Fang Fang Zhang, MD, PhD, Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111 (fang_fang.zhang@tufts.edu).

Accepted for Publication: June 6, 2021.

Author Contributions: Drs Wang and F. F. Zhang had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Wang, Herrick, Mozaffarian, F. F. Zhang.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Wang, Du, Pomeranz.

Critical revision of the manuscript for important intellectual content: Wang, Martínez Steele, Pomeranz, O’Connor, Herrick, Luo, X. Zhang, Mozaffarian, F. F. Zhang.

Statistical analysis: Wang, Du, O’Connor, Luo, X. Zhang.

Obtained funding: Mozaffarian, F. F. Zhang.

Administrative, technical, or material support: X. Zhang, F. F. Zhang.

Supervision: Herrick, Mozaffarian, F. F. Zhang.

Conflict of Interest Disclosures: Dr Mozaffarian reported receiving research funding from the Bill & Melinda Gates Foundation, the National Institutes of Health, and the Rockefeller Foundation; receiving personal fees from Acasti Pharma, Amarin, America’s Test Kitchen, Barilla, Cleveland Clinic Foundation, Danone, GOED, and Motif FoodWorks; serving on scientific advisory boards for Beren Therapeutics, Brightseed, Calibrate, DayTwo (ended in June 2020), Elysium Health, Filtricine, Foodome, HumanCo, January Inc, Perfect Day, Season, and Tiny Organics; and receiving chapter royalties from UpToDate; all outside the submitted work. No other disclosures were reported.

Funding/Support: This study was supported by grant R01MD011501 from the National Institutes of Health (awarded to Dr F. F. Zhang) and Processo grant 2018/17972-9 from the São Paulo Research Foundation (awarded to Dr Martínez Steele).

Role of the Funder/Sponsor: The National Institutes of Health and the São Paulo Research Foundation had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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